Free drug samples may end up costing uninsured more

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Free drug samples may end up costing uninsured more

http://www.eurekalert.org/pub_releases/2008-09/wfub-fds090108.php

Free drug samples provided to physicians by pharmaceutical companies

could actually be costing uninsured patients more in the long run,

according to a study done by researchers at Wake Forest University

Baptist Medical Center and colleagues.

The retrospective study looked at the prescribing habits of more than

70 physicians in a university-affiliated internal medicine practice

in the months immediately before and after the closing of their drug

sample closet. The results indicate that the availability of free

samples from pharmaceutical companies greatly impacts whether an

uninsured patient is given a prescription for a generic or a brand-

name drug. The complete findings can be found in the September issue

of Southern Medical Journal.

" It's true that samples can save patients money in the short-run, "

said P. , M.D., lead researcher and internal medicine

physician at Wake Forest Baptist. " But our study shows that they may

end up paying more in the long run when they are given prescriptions

for brand-name only drugs. "

For the study, researchers used a pharmacy database to track all of

the prescriptions in four classes of chronic medications given to

uninsured and Medicaid patients. Nearly 2,000 prescriptions

categorized as antihypertensives (blood pressure medications), oral

diabetic agents, peptic ulcer and gastroesophageal reflux

medications, and non-narcotic pain medications, were tracked for the

nine months leading up to and following the relocation of the

practice, at which time the drug sample closet was permanently closed

due to a lack of suitable storage space in the new building.

Researchers found that, for uninsured patients, the percentage of

medications prescribed as generics rose from 12 percent to 30 percent

after the clinic closed its drug sample closet. For Medicaid

patients, however, there was no significant change in generic

prescribing.

Drug samples are available only for brand name drugs, which are often

newer, more heavily advertised and almost always much more expensive

than generic drugs in the same class.

" The theory is that drug companies hand out samples because it gets

physicians in the habit of using a drug and physicians, therefore,

are more likely to prescribe that drug later, " said.

Many times, initially, a patient will be given a sample of a drug to

test tolerability and effectiveness. Often times, when a physician

gives a patient a sample, it is accompanied with a prescription to

fill after the sample is gone. Sometimes free samples are used by

physicians to help patients who cannot afford medications. But the

availability of drug samples is not always predictable and, when

patients return for refills and the samples they need are missing

from a practice, either because the drug representative didn't leave

enough or stopped distributing them altogether, patients who were

started on brand name drugs in sample form are left paying the price

when they have to fill a prescription.

Researchers were surprised to find that, throughout the study,

Medicaid patients were generally prescribed generic drugs, even with

the availability of branded samples. Surprising, said, because

at the time of the study, Medicaid didn't have a formulary, so all

drugs for Medicaid patients, branded or generic, were only $1.

One possible explanation, said, is that because Medicaid

patients rarely receive samples, doctors' prescribing decisions for

these patients were based purely on what drug they thought was best

and not on what samples happened to be available in the closet.

" In terms of safety and effectiveness, doctors have the most

information about older drugs because they have been used for years

and are often more studied, " said. " Sometimes, doctors don't

discover that a new drug has serious side-effects until it has been

used in a large number of people or for a long time. " In recent

years, added, the Food and Drug Administration has issued

warnings about some new drugs and a few have been pulled from the

market, showing how a promising new drug can later be discovered

harmful.

" Physicians and medical organizations need to ask themselves if

samples are doing more harm than good, " added. " While doctors

might intend to help someone by handing them a free sample, in the

long run, it could cost them more. And removing samples from a

practice can help doctors focus on which medication is best for a

patient, rather than which medication happens to be available for

free. Patients who want to save money should ask their doctor if an

effective generic medication is available for their condition instead

of taking a sample. In the long run, the generic prescription will

probably save them more. "

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Co-researchers for this study were B. Woods, M.D., and

L. Wofford, M.D., M.S., both of Wake Forest Baptist;

Mansfield, M.D., M.S., of the Veterans Affairs Medical Center; and

P. Moran, M.D., M.S., of the Medical University of South

Carolina.