HMN 2026: How do financial conflicts of interest influence medical prescribing practices?

Financial relationships between physicians and the pharmaceutical industry have long raised important questions about how these interactions may influence clinical decision-making, prescribing behavior and health care spending.

In a new study published in Pulmonary Circulation, Yale researchers examined associations between industry payments and prescribing patterns among physicians treating pulmonary arterial hypertension, a rare but serious condition characterized by progressive damage to the arteries that supply blood to the lungs.

Elizabeth Tarras, MD, a clinical fellow in the Section of Pulmonary, Critical Care and Sleep Medicine at Yale School of Medicine (Yale-PCCSM) and first author of the study, notes that therapies for pulmonary arterial hypertension have evolved significantly in recent years, resulting in major improvements in patients’ quality of life and overall outcomes, but they are often expensive.

“Pulmonary hypertension is a uniquely important disease space in which to study industry relationships because therapies are very costly, and prescribing is concentrated among a relatively small group of specialists,” she says. “That makes it an important setting to start asking questions about how external influences may shape clinical decision-making and the overall cost of care.”

Physician-industry relationships can take many forms, including sponsored meals, speaking engagements, consulting roles or royalties from medical devices.

“We know from prior work that these financial interactions are common across medical and surgical subspecialties,” Tarras says. “Openly examining and discussing these exchanges is important to maintaining transparency, preserving scientific integrity and sustaining public trust in medicine.”

To investigate these relationships further in the context of pulmonary arterial hypertension, Tarras and her team conducted a cross-sectional analysis of U.S. pulmonologists, cardiologists and pediatricians who prescribe pulmonary arterial hypertension therapies. They used national data sets, including the Centers for Medicare & Medicaid Services Open Payments database, to link drug-specific payments from manufacturers to physicians and to examine how these payments were associated with the prescribing of those same therapies.

The study found that physicians who received drug-specific industry payments were significantly more likely to prescribe the corresponding pulmonary arterial hypertension therapies. This relationship demonstrated dose-response patterns, with increasing numbers of payments associated with higher rates of prescribing. Industry payments were also linked to lower use of generic alternatives.

“Physicians were still delivering appropriate, standard-of-care treatment,” Tarras notes. “At the same time, conflicts of interest introduce the potential for influence, which makes it important for us to openly acknowledge and discuss them.”

The researchers also found that even modest industry payments were associated with higher Medicare spending on pulmonary arterial hypertension therapies, underscoring the impact of these relationships on costs in an already expensive treatment landscape.

“Medicare is ultimately bearing many of these costs,” Tarras says. “Our findings suggest that receiving an industry payment is associated with increased prescribing of a more expensive medication, which in turn contributes to higher overall spending.”

Tarras has studied financial conflicts of interest for several years, with earlier work looking at prescribing patterns in cancer care. “I’ve been interested in how even subtle financial interactions can influence physician decision-making, particularly in high-cost areas of care,” she says.

“Recognizing how conflicts of interest impact practice is critically important,” says Naftali Kaminski, MD, Boehringer Ingelheim Pharmaceuticals, Inc. Professor of Medicine (Pulmonary) and section chief of Yale-PCCSM. “In recent years, our medical communities have made great strides forward. Tarras’ work will help us do even better,” he adds.

As a future pulmonary vascular disease specialist, Tarras says the study has important implications for clinical practice. “Pulmonary arterial hypertension is a life-changing diagnosis with high morbidity and mortality, and specialists play a central role in guiding treatment decisions,” she says. “These are high-stakes interactions in a very expensive disease space, where we need to consider both patient care and the sustainability of the health care system.”

She notes that while industry plays a critical role in advancing drug development, particularly in rare diseases, these relationships also require careful oversight to ensure they remain aligned with patient care.

“The next question is how to structure these relationships in a way that supports continued innovation while maintaining transparency, high-value care and public trust in medicine,” she says.

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