NEWS2U Health & Wellness
Living Healthy in an Unhealthy World

Friday, September 05, 2008

Free Drug Samples May End Up Costing More

Uninsured patients tend to stay on these more expensive brand name drugs, study found

By Alan Mozes

Doctors who hand out drug companies' free samples to uninsured patients may actually be costing those patients more money over the long term, a new study finds.
That's because doctors tend to continue patients on the more expensive brand name drug in the sample, rather than switch them over to a cheaper generic later on, researchers say.

"When physicians had access to brand name drug samples, they were much more likely to give uninsured patients prescriptions for that drug," said lead author Dr. David P. Miller, an internal medicine physician at the Wake Forest University Baptist Medical Center in Winston-Salem, N.C. "But when giving out drug samples is not an option, the same physicians are almost three times more likely to prescribe generic drugs to the uninsured. And generic drugs are often much cheaper than their brand-name counterparts."

"So, given that for many conditions there are very effective generic options, I think any patient who wants to save money on their medications is better off asking for an effective generic prescription rather than asking their physician for a free drug sample," Miller advised. "Because while the sample might be free in the short term, they might end up paying a lot more money in the long term."

The research team outlined its conclusions in the September issue of the Southern Medical Journal.

The current finding follows on the heels of a University of Chicago Medical Center study released this past spring that indicated that patients who receive free drug samples go on to incur significantly higher out-of-pocket expenses when filling their prescriptions than those who never get such freebies. In that instance, three-quarters of the patients had private insurance coverage.

In the new study, the researchers spent 18 months tracking prescriptions written for uninsured and/or Medicaid patients cared for by more than 70 physicians. All of the doctors worked at a large university-affiliated internal medicine practice.

Midway through the study period, the institution's so-called "drug sample closet" was closed due to a physical relocation of the facility -- meaning that for the next nine months, doctors were unable to distribute the free brand name drug samples that had been previously available.

Using a pharmacy database, Miller and his colleagues characterized the nearly 2,000 chronic prescriptions for blood pressure, diabetes, ulcers, and gastrointestinal problems that were issued during the first nine months, while drug samples were still available. They then compared those patterns with prescriptions issued by the same doctors over the next nine months.

According to the researchers, the overall percentage of money-saving generic drugs prescribed to uninsured patients more than doubled once samples became unavailable -- from 12 percent while supplies lasted to 30 percent when the flow of free samples dried up.

This dynamic, however, did not appear to be in play for Medicaid patients, who were typically prescribed generic drugs regardless of sample availability. According to the researchers, that might stem from the fact that doctors know that Medicaid patients typically incur the same minimal out-of-pocket expense for generic or brand name drugs, so there was less incentive to try and save the patient money with a free sample.

But for the uninsured, it's a different story. "Physicians assume they are helping out by giving a free sample to patients who have no insurance," Miller said. "But there are, nevertheless, unintended consequences to that action that physicians need to weigh when doing so."
A representative of the pharmaceutical industry took issue with the findings.

In a statement, Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America (PhRMA), said the study, "overlooks the fact that Americas physicians prescribe medicines based on a wide range of factors, not simply receipt of samples."

He added that, "free samples provide physicians valuable first-hand experience with new medicines. In many cases, samples help patients begin treatment sooner by quickly discovering the medicines that are best for them. And they can be an important option for patients in need of help."

But Reginald Frye, an associate professor in the department of pharmacy practice at the University of Florida College of Pharmacy in Gainesville, agreed that while free samples can benefit patients, they must be used carefully.

"For example, sometimes you have a question as to if a drug is going to work well for your patient, so you give him or her the free sample as a trial," he said. "And there's, of course, the initial intent to spare some expense. But I'm not too surprised that it would influence a patient's choice later on and perhaps not to that patient's benefit."

"So it's important," he added, "for a physician to discuss with patients all the options, such as the availability of generics at a cheaper cost. And for their part, patients should ask their pharmacists as well if a brand name drug is available as a generic."