How often do oncologists receive industry payments from competing companies?

BACKGROUND: Payments from pharmaceutical companies to oncologists can influence prescribing practices. However, some physicians believe that receiving payments from multiple competing manufacturers might balance these biasing effects, effectively "canceling out" any conflict of interest. This study examines how often physicians receive industry payments for multiple, competing drugs. METHODS: Using the CMS Part D Prescribers file 2017-2019, we included medical oncologists who prescribed a class of cancer drugs wherein there are multiple, competing drugs. We then matched these oncologists to their industry payments records (Open Payments). We assessed the proportion of oncologists who received any industry payments related to 0, 1, 2, or 3 of the competing drugs, and whether oncologists prescribed differently with respect to the number of drugs for which they received payment. RESULTS: Among 2460 eligible oncologists, a minority received payments related to all 3 competing drugs within the drug class they prescribed: 1.6% of oncologists prescribing epidermal growth factor receptor inhibitors, 25.3% for BCR-ABL tyrosine kinase inhibitors, and 34.3% for CDK4/6 inhibitors. Oncologists who received payments for all 3 drugs were more likely to prescribe ribociclib versus palbociclib, and less likely to prescribe dasatinib, compared to unpaid oncologists. Those who received payments for 2 drugs were more likely to prescribe afatinib versus osimertinib. CONCLUSIONS: Receipt of payments from all competing companies occurs among a minority of oncologists, but a substantial minority for some drug classes. Oncologists who receive payments from multiple companies have different prescribing patterns than unpaid oncologists, suggesting that competing payments may not result in "balanced" influence.