Free Drug Samples Not Really Free

A new study by University of Chicago researchers reveals free <"">drug samples can cost patients in the long run.  Apparently, patients given free samples tend to spend nearly 40 percent more on medications in the first six months and 20 percent more the six months, running significantly higher out-of-pocket expenses versus those not receiving free samples.  “The notion that people have is that if you receive samples, it helps with out-of-pocket costs because you don’t have to go out and buy the drugs,” said Anirban Basu, a study author and assistant professor of medicine at the University of Chicago.  “What we found, actually, was that their out-of-pocket expenditures increased.  Most surprising was that those out-of-pocket expenditures continued even after the samples stopped.”

The study, published in this week’s journal Medical Care, renews the question of the role of over $18 billion in free pharmaceutical samples distributed annually, which drug industry representatives describe as a cost-saving alternative for the poor.  “This builds on a growing body of literature that shows that samples are not aimed to help the uninsured and the poor, but to increase the sales of the branded drugs,” said Dr. William Shrank, an instructor at Harvard Medical School, who has studied the issue.

The study follows an earlier report revealing samples are more likely to go to insured and the wealthy than to the needy and despite pharmaceutical industry’s claims that samples are meant to assist uninsured and low income people, a study of prescription use by nearly 33,000 U.S. residents in 2003 found the neediest were the least likely to receive samples; the billions of dollars in free drug samples distributed by pharmaceutical companies is meant to win patient and doctor loyalty.  “Our findings suggest the free samples serve as a marketing tool, not a safety net,” said Dr. Sarah Cutrona, co-author of that report.

The Chicago study is the first to examine the link between drug samples and patient expenses and reviewed over 5,700 patients for two years in which patients received over 2,300 free drug samples.  The results were “counter-intuitive,” said lead author Dr. G. Caleb Alexander, an assistant professor of medicine at the University of Chicago Medical Center. “We expected that free sample receipt would be associated with lower, not higher, cost,” he said.  Reason for higher costs isn’t clear, said Alexander, who added that the study wasn’t designed to answer that question.  Perhaps those receiving samples were sicker than those who didn’t, which would explain the higher costs, a point emphasized by PhRMA representatives; however, review indicated illness played a small part, Alexander said.  Patients may have received higher-priced brand-name drugs—those most often given as samples—and continued with the same costly prescriptions, Alexander said.  This would be in line with what other studies indicated, said Dr. Andrew F. Leuchter, professor of psychiatry who heads a committee on drug industry relations at the David Geffen School of Medicine at the University of California, Los Angeles.

Doctors and patients should discuss using more generic drugs, offering three-month instead of one-month supplies and discontinuing unnecessary medications, Alexander said.

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