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Lou Sawaya is a physician and president of the Ottowa-based marketing research firm RETICULUM and consults exclusively for the pharmaceutical industry. He is also a lecturer at the University of Ottawa, where he teaches various marketing courses. This article was adapted from his book "Super Reps," which is available through RETICULUM at (888) 335-4465 or at www.super-reps.com.
Deliver exceptional sampling service.
The distribution of free drug samples by pharmaceutical companies has always been a contentious issue in the medical world. Critics claim that samples exert an improper influence on physicians' prescribing behavior and add to the overall cost of healthcare. Samples, they assert, promote the use of newer, less established, more expensive drugs that are not necessarily more effective. They add that physicians handing out drugs circumvent the counseling and safeguarding role of pharmacists. They also fear that freely available drugs could increase the risk of self-medication and drug abuse among physicians, nurses, office staff and pharmaceutical reps.
Because of these concerns, a small but growing number of physicians refrain from accepting and using samples. The reasons (with quoted comments) they give are:
•Â Inconvenience of samples ("Require room for storage. Expired samples are hard to get rid of.").
•Â Legal and security concerns ("Administratively too complex. Require secure storage; my office was burglarized in the past.").
•Â Philosophical, ideological and ethical concerns ("I prefer patients to buy medications. They become dependent on samples and don't fill the prescription because they say they can't afford it." "What I don't like about samples is the subtle manipulation to prescribe what is available in samples, rather than the best choice for a particular patient.").
•Â Fear of harming the pharmacist's business ("Next to my office is a pharmacist whose work I respect; I don't want to affect his business.").
For most physicians, however, drug samples have become an integral part of patient care. A survey of more than 2,200 Canadian physicians in the year 2000 by Montreal-based IMS Health Canada found that, in an average week, physicians hand out samples of prescription drugs to 15 of their patients and samples of non-prescription drugs to nine. Dermatologists are by far the heaviest users of samples; in a week, 43 of their patients receive samples of prescription drugs. They are followed by family physicians, pediatricians and gynecologists (19, 16 and 15 patients per week, respectively). Light users include internists (seven patients) and psychiatrists (four patients). Female physicians in general tend to be heavy users of samples.
The average number of treatment days covered by a drug sample is 19. This figure drops to 15 if samples of oral contraceptives are excluded from the calculation. Twenty-three percent of samples are for a period of six days or less, 16% are for a week, 19% are for two weeks, 19% are for four weeks, and the remaining 23% are for various lengths of time.
Slightly more than 50% of samples are accompanied by a prescription for the same drug. Only 18% of patients receiving a drug sample have been on the drug before.
Doctors' reasons for resorting to samples can vary considerably. In more than 30% of cases, samples are handed out to help uninsured patients defray, in total or in part, the cost of the drug. Samples are particularly useful in helping physicians conduct their own mini-trials and assess the drug's efficacy and tolerability in an individual patient. Doctors also believe that samples can improve patient compliance, protect patient confidentiality and enhance the doctor-patient relationship. The following are the reasons physicians give most frequently for using samples; they reflect the clinical, logistical and social problems facing practitioners on a daily basis. Doctors use samples:
•Â When the drug is not on formulary or a special authorization is needed.
•Â To start therapy immediately.
•Â To convince a patient to start therapy, or to increase patient compliance.
•Â To encourage a patient to come back for a follow-up visit.
•Â To treat a medical problem that is of a limited nature (drug needed for short-term use).
•Â To test efficacy before filling a prescription.
•Â To assess tolerability before filling a prescription.
•Â To help in switching a patient to a new medication.
•Â To gain first-hand experience with a drug.
•Â For dosage titration (increasing dosage temporarily).
•Â On patient request or to increase patient satisfaction.
•Â For patient convenience (e.g., if the drug store is closed).
•Â To preserve patient confidentiality.
•Â Because they are there (e.g., if a doctor just has samples in the office, or has a stock of the drug left by the representative).
•Â If samples are about to expire.
•Â Because "it's common policy."
•Â To teach and to demonstrate.
•Â To taste-test the drug (this is mentioned quite often by pediatricians).
Physicians appreciate a regular, prompt and ample supply of samples, and the compassionate provision of samples to needy or uninsured patients. Physicians will remember the company that supports its products with a superior sampling program. Here are the sampling services physicians said they appreciated from reps the most:
•Â Providing a regular supply of samples.
•Â Providing a generous amount of samples.
•Â Providing samples for needy patients.
•Â Providing samples for physicians' personal use, use by family members or staff use.
•Â Responding promptly to requests for samples.
•Â Responding to special requests for samples.
The most common complaint concerning samples focuses on the mismatch between supply and demand. More than 70% of physicians can identify at least one drug for which they are receiving an insufficient quantity of samples, and 40% can name at least one drug for which they are receiving a greater-than-needed quantity. Close to 32% of practitioners admit that they have stopped or greatly reduced prescribing of certain products because of a lack of samples, and 25% have refrained from prescribing a new product until samples were made available.
The following is an abridged list of physicians' grievances in matters related to sampling:
•Â The drug company had a 'no samples' policy for certain drugs.
•Â Requests for samples were denied.
•Â The response to requests for samples was poor.
•Â The rep displayed inappropriate or questionable behavior (e.g., the doctor signed for samples that were never delivered, the rep mislead the doctor about availability of samples).
•Â The rep provided expired or soon-to-expire samples.
•Â The rep provided too many samples or non-requested samples.
Despite these complaints, it is clear that most doctors appreciate samples. The rep who provides the physician with superior sampling services is most likely the rep doctors will want to see again and again. PR