Twenty promoted brands are 2 percent of psychiatrists' Medicare prescriptions and half the cost
Medicare Part D 2024: twenty promoted brands were 2.3 percent of psychiatrists' prescriptions and about 54 percent of the drug cost. The sixty best-paid psychiatrists prescribed them at 2.8 times the rate of their peers.
We have not finished checking this source. No judgement either way. how we score evidence
Caveat on this rating: Cross-sectional and ecological to the group: no timing, so it cannot separate payment-then-prescribing from prescribing-then-payment. Part D is one payer; Medicaid and commercial prescribing are not visible. Long-acting injectables and tardive dyskinesia drugs cluster in clinics that treat severe illness, which is also where speakers are recruited. Specialty is as recorded by CMS.
The payment file says who was paid. The prescribing file says what they wrote. Both are federal, both carry the same prescriber number, and nobody had put them side by side for psychiatry's best-paid sixty.
Significant findings
In the 2024 Medicare Part D file, 23,932 psychiatrists wrote 32.5 million prescriptions costing $4.03 billion. The twenty branded products that industry payments to psychiatrists were attached to (Vraylar, Rexulti, Caplyta, Invega, Abilify Maintena, Ingrezza, Austedo and others) were 753,686 of those prescriptions, 2.3 percent, and $2.17 billion of the cost, about 54 percent. More than half of psychiatrists had no countable prescribing of any of them.
Of the sixty psychiatrists paid most by industry in 2024, 52 appear in the prescribing file. For them the same brands were 6.5 percent of prescriptions, 2.8 times the rate for all psychiatrists, and the figure holds when the single largest prescriber is removed (6.4 percent). Twenty five of the 52 were in the top tenth of all psychiatrists on this measure.
Seven of the fourteen best paid are either absent from the file or wrote fewer than 100 Medicare prescriptions, against a median of 494 for all psychiatrists. They are national speakers and authors. They are not being paid for their own prescription pads.
Worth asking
This is an association in one year and one payer. It does not show that a payment caused a prescription: companies choose speakers who already favour the drug, and the HHS Inspector General has said so. Some of these clinicians treat the most treatment-resistant patients, where a newer brand or a long-acting injection is a reasonable choice. The file hides any drug a prescriber wrote fewer than eleven times, so small prescribers look like zero. We name nobody, because a group pattern is not evidence about one person's motives. What it does show is where the money in psychiatric prescribing is: a fiftieth of the prescriptions carry half the cost, and those are the products the speaker fees are attached to.
Source
Medicare Part D Prescribers, by Provider and by Provider and Drug, data year 2024 — Centers for Medicare & Medicaid Services (2026)
How this was scored
- Study design
- not recorded
- Funding
- not recorded
- Published in
- not recorded
- Sample size
- 23,932
- Preregistered
- not recorded
- Conflicts disclosed
- not recorded
- Independent of proponent
- not recorded
- Retracted
- No
We have not finished checking this source, so there is no scoring to show yet. “We have not checked this yet” and “this is disputed” are different statements, so no scored band is shown rather than a low one.
Read the full scoring rubric, including what it can't tell you.
Published September 21, 2026.
Questions
How strong is the evidence behind this?
veisund rates this source "not yet assessed". We have not finished checking this source. No judgement either way. One caveat travels with that badge: Cross-sectional and ecological to the group: no timing, so it cannot separate payment-then-prescribing from prescribing-then-payment. Part D is one payer; Medicaid and commercial prescribing are not visible. Long-acting injectables and tardive dyskinesia drugs cluster in clinics that treat severe illness, which is also where speakers are recruited. Specialty is as recorded by CMS. The score is calculated from recorded facts about the source — study design, funding, publication venue, sample size, preregistration — not typed in by an editor.
What is the source for this?
Medicare Part D Prescribers, by Provider and by Provider and Drug, data year 2024 — Centers for Medicare & Medicaid Services (2026). The full source is linked on this page so you can read it yourself.
Is this medical advice?
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.
This is information to bring to your prescriber, not medical advice and not a reason to change anything on your own. Nothing here is an instruction to stop or reduce a medication. If you are in crisis, call or text 988.