Drug Samples

A new study conducted by Harvard University researchers at Cambridge Health Alliance bucks an important piece of conventional wisdom about prescription drug samples: They don’t primarily go to low-income and uninsured people — in fact the study found the opposite: “Most free drug samples go to wealthy and insured patients and are not used to ease the burden of the poorest nor the uninsured,” said the press release on the study (below).

Most doctors and even most patients think of drug samples as benign, and even beneficial. After all, what’s wrong with getting your prescription drug, even the first few days’ or a month’s supply, for free? But this ignores several key facts:

  • Drug samples are almost always for the newest, most expensive brand-name drugs. They are a way to introduce doctors to these newer, costlier drugs, even if they don’t offer any advantage over older, less expensive drugs, especially generics. Newer drugs have less of an established record of safety than older drugs – One of the authors of the study says in the press release below “we found that the most widely distributed sample in 2002 was Vioxx, with Celebrex being number 3. These drugs turned out to have lethal side effects. While many doctors still view samples as a safety net for their neediest patients, our study shows that samples are potentially dangerous, and do little for the needy.”

  • Drug samples are primarily a marketing tool. They are part and parcel of the overall sales pitch aimed at doctors — a pitch delivered by the same drug salespeople who drop off the samples, provide free lunches for the staff, invite the doctor to a “continuing medical education seminar” at a fancy restaurant, and ply the doctor with reprints of medical journal articles casting the company’s drug in the most positive light possible.
  • Drug samples affect prescribing. Doctors tend to continue patients on drugs that are working for them. If the patient starts on Expensive Brand Name Drug X because that’s the sample that was in the Doctor’s cabinet, and it works for them, then they’re likely to continue on that drug, even if Inexpensive Generic Drug Y would have worked just as well. Brand-name drug companies know this, and that’s why they spend billions a year providing samples to doctor’s offices. It’s not feasible for generic drug companies to provide samples, because they can’t guarantee that the patient would get their particular version of the generic when they later fill a prescription at a pharmacy. So drug samples lead to overuse of expensive brand-name drugs and millions in unnecessary spending.

Doctors often justify allow drug salespeople into their offices because of drug samples, and justify accepting drug samples on the notion that they help their needy or uninsured patients. Today’s study undermines that justification, at least on an aggregate basis.

Interestingly, the study pointed to differences in health access and insurance coverage to explain why wealthier and insured patients get more drug samples:

“Free sample receipt was consistently higher among those with better access to medical care. Non-Hispanics, English-speakers and Whites were all more likely to receive free samples than were members of ethnic, linguistic or racial minorities. Receiving medical care in an office and taking more medications also increased an individual’s chances of receiving free drug samples.”

NPR did a story on the study today, and interviewed a representative from PhRMA, the brand-name drug industry’s trade association. That PhRMA rep was quick to point out that drug companies don’t consider samples to be a way to help low-income or uninsured patients — and instead pointed to drug company patient assistance programs as serving that purpose.

There are some moves afoot to put generics on a more equal footing with brand-name drugs at the doctor’s office. More and more health plans are charging their members zero copayments for generics. In our 2006 Bitter Pill Awards, we gave a “Real Deal Award” to MedVantx, a company that places “generic sample cabinets” in doctors’ offices. Doctors are able to give a patient an initial supply of a generic drug, and thus have an alternative to the marketing-oriented brand-name samples that drug companies ply.

Here’s the press release from the researchers who performed the study:

Most Free Drug Samples go to the Wealthy and Insured

-First of its Kind Study from Harvard Medical School Researchers at Cambridge Health Alliance Finds Few Samples Distributed to Poor and Uninsured-

Cambridge, MA……Most free drug samples go to wealthy and insured patients and are not used to ease the burden of the poorest nor the uninsured, according to a study by physicians from Cambridge Health Alliance and Harvard Medical School. The study, which is the first to look at free drug samples nationally, will appear in the February 2008 issue of the American Journal of Public Health.

The study found that use of free prescription drug samples is widespread. More than one out of every ten Americans received one or more free drug samples in 2003. Among Americans who take at least one prescription drug, nearly one out of five got free samples.

Few free samples went to the needy. Insured Americans and those with higher incomes were more likely to report receiving at least one free sample. More than four-fifths of sample recipients were insured all year. Conversely, less than one-fifth were uninsured for all or part of 2003, and less than one-third had low family incomes (under $37,000 for a family of four).

Free sample receipt was consistently higher among those with better access to medical care. Non-Hispanics, English-speakers and Whites were all more likely to receive free samples than were members of ethnic, linguistic or racial minorities. Receiving medical care in an office and taking more medications also increased an individual’s chances of receiving free drug samples.

Author Sarah Cutrona, a physician at Cambridge Health Alliance and an Instructor of Medicine at Harvard commented: “The distribution of free samples has become very controversial. Evidence shows that free samples may influence physicians’ prescribing behavior and cause safety problems. For instance, we found that the most widely distributed sample in 2002 was Vioxx, with Celebrex being number 3. These drugs turned out to have lethal side effects. While many doctors still view samples as a safety net for their neediest patients, our study shows that samples are potentially dangerous, and do little for the needy.”

Dr. David Himmelstein, senior author of the study, a physician at Cambridge Health Alliance and an Associate Professor of Medicine at Harvard adds: “We know that many doctors try to get free samples to needy patients when those patients come into the office. We found that such efforts do not counter society-wide factors that determine access to care and selectively direct free samples to the affluent. Our findings strongly suggest that free drug samples serve as a marketing tool, not as a safety net.”

“Free drug samples are not the solution to the disproportionately low amount of health care resources going to the poor and uninsured; they are part of the problem,” said Dr. Steffie Woolhandler, a physician at Cambridge Health Alliance, Associate Professor of Medicine at Harvard, and study co-author.

The study used data on 32,681 US residents from the Medical Expenditure Panel Survey (MEPS), an annual federal survey. Dr. Cutrona’s work on the study was supported under a National Research Service Award.

Recipients of Free Prescription Drug Samples: A Nationally Representative Analysis published in American Journal of Public Health http://www.ajph.org/ February 2008, Vol 98, No. 2. Authors: Sarah L. Cutrona, MD, MPH, Steffie Woolhandler, MD, MPH, Karen E. Lasser, MD, MPH, David H. Bor, MD, Danny McCormick, MD, MPH, and David U. Himmelstein, MD.