Saturday, January 5, 2008

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.


ernie said...

dude, fess up. the samples benefit you, not your patients. you get to strut in with the freebies, thinking that the patients will genuflect to your having an "in" with the drug companies. actually, you are in bed with the drug companies. you get to feel powerful. they think you are a fool. you do us all a disservice and cheapen the profession. take a stand.

Dr. Matthew Mintz said...

There is certainly truth to your point that samples are usually appreciated by patients, and so this does benefit me directly by increasing my patient's satisfaction with their care. On the other hand, patients certainly do not appreciate the high cost of drugs, even if it is just a higher co-payment or the hasstle of having to get a newer, expensive prescription approved by their insurance company. In other words, inappropriate dispensing of samples or giving out "freebies" to patients just because I have them is more likely to cause patients disatisfaction.
One possible solution might be for insurers to allow for a 14 day "free trial" of all prescriptions. Not only would this provide all the benefits of samples, but would likely lower use of non-generic drugs for which samples do not exist. This could not only lower the insurers bottom line, but cut the overall costs of drugs entirely. As soon as insurers to this, I will immediately get rid of all industry supplied samples. However, I highly doubt this will happen under our current health care system.

Anonymous said...

Kudos doc -- just because free drug samples don't benefit everybody equally doesn't mean we should toss 'em out.

In addition to providing samples, which by design are meant to help patient and doctors try out new drugs the companies want them to buy, these same companies offer patient assistance programs for people who cannot afford them. Through these programs millions of free drugs are provided to people in need.

If you end all access to the marketplace for these companies to promote their products then they'll stop making them -- I don't think any of us want fewer treatment options or less investments in new drug research.

The real losers when doctors and patients decide to use a specific treatment they think best but that may cost a little more is the insurance company -- not the patient who is ostensibly getting the best care they and their doctor determine. Blue Cross or their HMO may not be happy about it but their profits are just a big (some bigger) thanthe drug companies, and not suprisingly, these insurance and health care providers are among the biggest funders and proponents of banning free samples...

Anonymous said...

So how do they deliver the drugs?

Unknown said...

What are the various types of health insurance programmes that are available to me, and which is best suited to suit the needs of my family and myself? How do I choose the ideal health care plan? What are the major points that one needs to bear in mind while buying Health Care Insurance Policy?

Anonymous said...

I disagree in part with this blog.

Samples in our case (Wife & I) keeps us from being poor.

We both have a huge list of meds we take (all generic but one).

We have insurance for generic meds and its good...

But one drug we both take is $500/mth each for 30day supply.

And we are rich via IRA.
Though income wise currently makeing 1/4 of what I used to make.
I used to make $100k a year and now make $25k per year.

Getting the samples keeps us from being poor...

And we never even considered buying them outright (only other choice) because its too expensive.

And we already know that not taking the drug we would likly die quicker... (ACTOS MET PLUS).

We would rather die than pay so much for meds that we become poor.

Hopefully we can reduce our need for a BRAND (insurance only does generic)... that we can go to the generic portion metformin.

AcTOS MET PLUS is not generic and may not become that for a while.

Besides the doctors who are 'in bed' with salesreps on samples are usually going to prescibe samples even when there is generic or more usual alternatives.

MY previous doctor refused to treat my wifes diabets and was constantly doing just bp basics and telling her to lose weight.

New doctor immediatley put her on diabetes related per her numbers were almost deadly.

If I could prove it I would sue that previous doctor for malpractice per samples & related usage.

Current doctors use of samples is to help us save $1000/mth in wasted costs...

Also the poor I know actually get prescriptions free via the clinics they go to..

I dont go the free clinic route per the quality of the doctors other treatments are suspect (though acceptable to most) in quality.

Dr. Matthew Mintz said...

As per my post, what seems true about the study I commented on was that samples don't go to the poor. You state you are rich via your IRA, which means that your samples are not going to the poor.
There is no question, that samples can help patients save money. Patients who are not poor but by no means rich, often have high co-pays for many drugs. I often give samples to these patients to help defray costs, especially in lean times.
Also, Actos plus met costs about $100 a month (go to to see prices). Not that this is cheap.