Wednesday, January 21, 2009

Update on Drug Samples: What Part of "Marketing" Don't You Understand?

Since HOOKED was published, the relatively sparse literature on the effects of drug samples on physicians' practice has been expanded somewhat. My apologies for having come across these relatively old articles only just recently.

David Miller and colleagues from Wake Forest University had a sort of natural experiment occur in 2000 when a large, mostly resident-run internal medicine clinic moved to a new building which lacked an appropriate storage space for the former drug sample closet, and the managers decided to end the practice of stocking samples. It also happened that they had a good computeratized tracking system for all prescriptions. They tracked prescriptions written in the 9 months before and after the switch in four major medication categories (antihypertensives, oral diabetic agents, peptic ulcer/reflux drugs, and nonnarcotic analgesics) in relation to the patients' insurance status. (Presumably these four classes of drugs were chosen because they included both brand-name and generic drugs, and there was little evidence if any that the brand-name drugs were superior to the generics.) They found that once the samples were gone, no significant changes occurred in the Medicaid patients' prescriptions, but nearly three times as many prescriptions for generic drugs were written for the uninsured patients. They suggested that by prompting docs to give uninsured patients expensive brand-name drugs rather than generics, samples drive up the costs of care overall for that group.

Sarah Cutrona and colleagues at Cambridge Hospital looked at data on 32,681 Americans from the 2003 Medical Expenditure Panel Survey (MEPS). MEPS offers the advantage of being a population-based community survey, so its contents are not dependent on differential access to medical care. The investigators compared whether a patient had received a drug sample with insurance and income level. They found that people who had higher incomes and who had continuous insurance were more likely to have received samples. This, of course, makes sense if you figure that to get a sample, you have to get into the door of a physician's office, and the physician has to have a stock of samples to give you; and those are more likely to occur if you're higher income and/or insured. Cutrona and colleagues conclude that samples are for marketing and do not provide for any sort of effective "safety net" for getting drugs to the indigent or uninsured. Well, duh, but it's nice to have confirmation from another source.

Nothing earthshattering here but a few more pieces of the puzzle to document what we have long thought about so-called "free" samples.

Miller DP, Mansfield RJ, Woods JB, et al. The impact of drug samples on prescribing to the uninsured. South Med J 101:888-893, 2008.

Cutrona SL, Woolhandler S, Lasser KE, et al. Characteristics of recipients of free prescription drug samples: a nationally representative analysis. Am J Public Health 98:284-289, 2008.


Unknown said...

Of course they're for marketing, but that doesn't mean the doctor has to use them for that purpose. I had a doctor give me a prescription for Prevacid because I could buy it cheaper and samples for Prilosec because he didn't have any samples of Prevacid. I didn't have any insurance and the generic drugs available at the time weren't doing the job. He always filled a grocery sack with as many samples as he had for whatever I needed that didn't come in a generic.

Another doctor not long ago gave me a one month prescription for a Brand name, two ingredient drug and a coupon that would cover my copay for it and a 90 day prescription for generics of two other drugs for the same condition for my mail order pharmacy (to be taken after the Brand name ran out.) If she had given me the Brand name for mail order it would have cost me 4 times as much in copays. The pharmacy sales people are always there when I am. She writes the prescription for the Brand name and allows for generic substitution but I sometimes have to ask for a drug that has a generic alternative.

Anonymous said...

This arguement does not seem to take into account the time samples bridge from the beginning of treatment to time you are accepted on a PAP or other type of assistance program. Also, any doctor or company that admitted they were supplying patient(s) with quantities of drug through their therapy may be then accused of dispensing or implicating Best Price. This is a flawed study. Drug samples may be one form of marketing; they do serve other functions.

Anonymous said...

correct me if i am wrong, but we live in a free enterprise society. i fail to see the problem with a company providing samples to their potential companies. how would it be ethical to put the screws to one industry and let others conduct business as they see fit? i suspect some would play the cost card, suggesting that sampling drives up health care costs thus samples should be gone. great arguement...correct me if i am wrong, but smoking is also a health risk. our government taxes cigs big time, so they make money off a habit which costs the health care system far more than samples. capitalism is a beautiful thing. leave it alone.