Free Samples and the Bottom Line

Sep 10, 2008

A study published last week in the Southern Medical Journal by the Wake Forest University Baptist Medical Center determined that physicians are less likely to prescribe generic medication if they have equivalent branded drug samples in their sample closet.

The study examined the prescribing habits of 70 physicians in a large urban practice that moved to a new location in 2000, losing its sample storage area in the process. According to the study, the number of uninsured patients prescribed a generic treatment spiked from 12 percent to 30 percent after access to samples was eliminated, and in subsequent months rose to 40 percent.

Investigators noted that there was no significant change in generic prescribing patterns for patients on Medicaid (63 percent with samples available, 65 percent without), and explained that fact by assuming that doctors favored the uninsured when handing out samples.

The study has some limitations. It was performed in a university-affiliated facility using databases from the in-house pharmacy. Patients who filled their prescriptions outside of the location were not included in the data. Nor did the study account for patients who chose not to fill their prescriptions.

“Physicians and medical organizations need to ask themselves if samples are doing more harm than good,” said David P. Miller, lead researcher and internal medicine physician at Wake Forest University Baptist Medical Center. “While doctors might intend to help someone by handing them a free sample, in the long run, it could cost them more.” In the study, there was not a significant drop in patient costs when samples were eliminated, but the authors point out that the facility, which serves many low-income patients, was eligible for deep discounts on pharmaceuticals, which may have muted any change.

Consultant Steven Tarnoff disagrees, telling Pharm Exec that although the study is correct, impoverished and uninsured patients can enroll in a number of patient assistance programs offered by the major pharmaceutical companies.

“For the most part, tier-two and tier-one companies have programs that are very generous in giving medication for free, and it is very easy to qualify,” Tarnoff said.

He also noted that with the lack of access to doctors, sales reps are leaving far more samples with each visit. “In many cases—especially in acute cases—doctors will give more than an adequate supply of samples to cover treatment.”