The Sampling Subsidy

Pharma can't afford to kill it or continue it. Alternatives are needed now.
Feb 01, 2005

With a retail value exceeding $10 billion dollars, sampling is a tempting target for industry's cost cutting efforts. The retail value of samples distributed each year to physicians is pharmaceutical companies' second largest promotional expenditure—topped only by the $16.5 billion dollars spent on detailing—yet the effect of this investment on physician prescribing behavior and the market in general is poorly understood.

Sampling with Coupons
The relationship between putting samples in a physician's office closet (often shared by several others in a group practice) and changes in patient treatment behavior has been an elusive metric. Because the return on this promotional investment has defied quantification, some pharma management sees reducing samples as a way to improve the bottom line. But those executives are toying with a billion-dollar decision with little or no understanding of the actual role samples currently play in the complicated web of healthcare in the United States.

ImpactRx has examined this issue since 2001 and has learned some valuable insights. From networks of more than 3,000 high-volume prescribing (HVP) primary care physicians and specialists, the company has collected extensive, longitudinal sample usage data that offers a different look (than has traditionally been available) at the use of samples in our healthcare system.

Treatment by Sample
How Much Subsidy? With regard to samples, the research has uncovered an intricate relationship between the pharma industry, physicians, and patients. Physicians increasingly view samples as an important subsidy provided by the industry to their patients and thus the healthcare system of the United States. Almost universally, physicians in focus groups emphasize the important role samples play in providing drug therapy to their patients who do not have prescription coverage.

A subset of physicians even refuses to give samples to patients with prescription drug coverage, preferring to save those samples for patients without it. Physicians also express a high degree of gratitude to the industry for providing their patients with samples and feel a need to support the companies that provide this subsidy.

Pharmaceutical Executive
Thus, the United States currently has in place a promotional mechanism in which a substantial portion of the samples distributed by the pharma industry is actually used to subsidize an underground network of support that provides prescriptions to a segment of the population that otherwise would not receive treatment. How extensive is this level of support?

That depends on the therapeutic category. For erectile dysfunction, 34.7 percent of patients receive sample-only therapy. In other words, these patients see a physician and are given samples but not a prescription. In other classes, such as statins for cholesterol and oral anti-diabetics, the percentage is much lower, 5.8 and 5.5, percent respectively. (See "Treatment by Sample.")

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