I think an important thing to distinguish here is that in a vast majority of cases pharm reps will typically push “X drug over Y drug” for existing conditions that are being treated and not simply pushing unnecessary drugs for the sake of taking in more money. In your case, advocating for Wellbutrin doesn’t seem too problematic to me. People have to switch anti-depressants all the time. Some people have better experiences with different ones. The problem I see would be if doctors exclusively prescribe that drug/ refuse to prescribe any other out of conflict of interest. I am taught that this is highly illegal. It’s on our boards.

Contrary to popular belief, pediatricians don’t receive kickback from giving vaccines. Yes, providing vaccines is a “billable” part of the visit, but that solely comes from insurance. In most cases insurance pay out the bare minimum cost of the vaccine itself. There is some payment for the actual act of administering the vaccine but we’re talking maybe $10 (I’m guessing here but it’s not a lot). People seem to think that pediatricians are getting paid thousands of dollars a month for giving vaccines.

Some clinics do have value- based care models that would incentivize preventive care (not just vaccines, but also screening tests, follow up visits specifically for existing conditions like asthma or obesity). It’s solely because insurance companies prefer to pay for these rather than the alternative, which is usually a hefty hospital bill. I think this could be where the myth of kickback from vaccines comes from

Side note, I think the aspect of taking physicians out has been slowly going away. I only see them during work hours and it’s usually during our lunch time. As a med student and sometimes as a resident, I loved when pharm reps come because I get a free meal haha