Free Drug Samples Not Going to the Poor. Does this mean we should abandon them?

A recent story from the Amercian Journal of Public Health has gained some attention ( see US News, MSNBC, and NPR). The study shows that wealthier and insured patients were more likely to get free drug samples (which the pharmaceutical industry spends billions on) then the poor and uninsured. This certainly does put a damper on the drug industry's claim that samples help the poor and insured. Combined with data showing that samples increase the likelihood that physicians will use more expensive drugs and therefore drive up health care costs, this suggest maybe we should abandon samples altogether. Consumer groups and others have called this practice into question, and some major medical institutions have stopped the practice altogether.

However, as a physician that uses and would like to continue using samples, here's my take on the study and the issue.

1. It should be no suprise that physicians don't give samples to the poor and uninsured. Drug samples are usually for the newest and most expensive drugs, and usually only come in a 7 day supply. You could certainly give poor patients these medicines, but what happens after the first week or two when the samples run out? Even if poor patients have good insurance, they are often not able to pay the generally high co-pays associated with the newest medications. One smaller finding of the study was that patients who were uninsured at least part of the year were more likely to receive samples than patients who always had insurance. In other words, physicians were more likely to give samples to patients until they were able to get coverage. I have a patient who I gave samples for 6 months until he was able to get insurance. He would have surely suffered without these samples. Sounds like a good use to me.

2. Prescription drugs are a major investment for patients. Even if patients have insurance, co-pays on non-generics can reach hundreds of dollars a year, and that's just for one drug. Medicines are generally dispensed in 30 and 90 day supplies. The ability for a patient to try out a drug before they fully commit to taking it long term is a welcome opportunity. If the patient experiences a side effect (particularly important for drugs that are new to the market) then an entire co-pay an pricey medication bottle need not go to waste.

3. Samples are one way for physicians to get comfortable utilizing newer medications. Even if a patient has insurance, and even if there are no side effects from the medication, if the drug doesn't work the patient has wasted time and money (and possibly health). For a very new medication, the drug companies will often give doctors a few samples with a full one month's supply. These "starter packs" allow physicians to see how effective the medication is (which often takes more than a week) without the patient paying anything.

4. Certain non-pill samples are invaluable. I do a tremendous amount of asthma care. Using an inhaler takes some getting used to, and takes some time to explain to patients. With samples, I can not only demonstrate proper technique, but allow the patient to show me that they can use the device properly. This is true for different kinds of injectable medicines (like insulin) as well.

Bottom line: The study does shed light on the industry's claim that samples benefit the poor and needy. However, samples may actually be more beneficial to the insured and non-poor who can ultimately afford these newer medications, and can be important in filling a gap for those who are between jobs and in the process of getting insurance. The real issue is how to get affordable medications to all people who need them.