A group out of the Cambridge Health Alliance at Harvard have published what appears to be the first population-based survey of the use of free prescription drug samples in the February, 2008 American Journal of Public Health (subscription needed to access on-line). To satisfy conspiracy theorists, I should admit up front that the notorious duo of Steffie Woolhandler and David Himmelstein, single-payer advocates and big honchos in Physicians for a National Health Program, are co-authors.
The authors took advantage of the fact that a large, detailed national survey, the Medical Expenditure Panel Survey (MEPS), asks several questions about receiving free samples, and allows those answers to be correlated with information about demographics, income, and insurance status.
The results: more insured than uninsured people received free samples in 2003, the year for which data were available. The poorest patients were less likely to receive samples. The authors note the likely dynamic--being given free samples by a physician usually requires that you were able to get inside the door of a certain type of office. Once you get inside that door, if you lack insurance, you may be more likely to be given a sample than your neighbor who has insurance. Within the confines of the office, that is, the docs may make decisions about distributing samples that are in keeping with an intention to serve the neediest. But whatever shift that produces toward the poor and uninsured getting more samples, is outweighed by the fact that the poor and uninsured usually cannot get inside that door to begin with.
The finding that most samples do not go to the medically indigent is no surprise; previous studies have shown similar findings, without the benefit of a national database. (This study could not detect an effect reported in previous studies, that as many as 1/3 of the samples may walk home with the physicians and office staff.)
The bottom line here seems to be that yet again, when we try to get straight on the various issues at the interface between medicine and the pharmaceutical industyry, we encounter layers and layers of rationalization before we ever get to enlightenment. Studies show that the majority of samples do not go to the indigent. It is not in the interests of the companies to give samples to the indigent. (Samples come out of the marketing budgets. The companies have separate programs to give away drugs for free as charity; how well those programs work is a matter for another post; but there is no benefit to the company in robbing its marketing budget to enhance charitable giveaways. As marketing, samples given to the poor are mostly a flop; you want to focus your marketing efforts on folks who can afford to buy your product.) Yet, as soon as a critic of the industry talks about samples, the industry apologists immediately trot out the canard about all the samples going to the needy.
Cutrona SL, Woolhandler S, Lasser KE, et al. Characteristics of recipients of free prescription drug samples: a nationally representative analysis. Am J Publ Health 98:284-89, 2008.