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Free
drug samples may end up costing uninsured
more
Newswise — 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 David P. Miller, 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,” Miller
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, Miller 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, Miller 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,” Miller 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, Miller 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,” Miller 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.”
Co-researchers for this study were Jonathan B. Woods, M.D.,
and James L. Wofford, M.D., M.S., both of
Wake Forest Baptist; Richard Mansfield,
M.D., M.S., of the Veterans Affairs Medical
Center; and William P. Moran, M.D., M.S., of
the Medical University of South Carolina.
Wake Forest University Baptist Medical Center (www.wfubmc.edu) is an
academic health system comprised of North
Carolina Baptist Hospital, Brenner
Children’s Hospital, Wake Forest University
Physicians, and Wake Forest University
Health Sciences, which operates the
university’s School of Medicine and Piedmont
Triad Research Park.
The system comprises 1,154 acute care, rehabilitation and long-term
care beds and has been ranked as one of
“America’s Best Hospitals” by U.S. News &
World Report since 1993. Wake Forest Baptist
is ranked 32nd in the nation by America’s
Top Doctors for the number of its doctors
considered best by their peers.
The institution ranks in the top third in funding by the National
Institutes of Health and fourth in the
Southeast in revenues from its licensed
intellectual property.
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