Free drug samples might be costly 'gifts' in the long run
Free drug samples might be costly 'gifts' in the long run
Samples often newer, more expensive drugs
Before you hand patients free samples of prescription drugs, consider that the sample that saves them money now may end up costing them in the long run, according to research that indicates patients who receive free drug samples from their doctors have significantly higher out-of-pocket prescription costs than those who don't.
"Our findings suggest that physicians should use caution in assuming that the use of free samples ultimately reduces patients' out-of-pocket prescription cost," according to G. Caleb Alexander, MD, assistant professor of medicine at the University of Chicago Medical Center and author of the research findings.1
According to Alexander, patients who never received free samples had estimated out-of-pocket prescription costs of $178 over six months, while patients who did receive samples spent an estimated $166 for a six-month period prior to getting free samples, $244 for the six months in which they received samples, and $212 for the six-month period after they received samples.
Previous surveys have found that free samples can lead to overuse of newer drugs over their older counterparts, but the earlier studies did not examine the costs associated with sample receipt.
"We believe our study is one of the first to look at the economic consequences of sample receipt," Alexander said. "Samples may be particularly valuable in providing patients economic relief when they are used short-term and not followed up with long-term prescription for the same medicine. However, all too often, physicians and patients end up continuing the medicines initially begun as samples, even though older, less expensive alternatives may exist."
Samples are often newest, most expensive
Alexander and his colleagues followed 5,709 patients for up to two years. The mean age of patients was 48 years, 84% were white, and 76% had private insurance.
The authors found that there were important differences in the characteristics of patients who received samples and those who did not. The odds of sample receipt were lower among those who were older and also among those who had Medicaid as their source of insurance coverage.
The study was not designed to identify the exact reason that sample users have higher prescription costs after sample receipt. However, the authors hypothesize two main possibilities for this surprising finding.
First, those who received samples may have been more seriously ill than those who did not. But underlying health status, say the authors, explains only a part of the difference in out-of-pocket costs.
Equally important, they suggest, is that patients who receive free samples may end up paying for a prescription for the medicine initially begun as a free samples. The medicines that are given as free samples are often the newest and the most expensive.
"Regardless of the degree to which these different mechanisms account for our findings," Alexander said, "patients and physicians should consider complementary ways to reduce patients' burden from out-of-pocket prescription costs, such as using more generic medicines, stopping non-essential treatments, and using three-month rather than one-month supplies."
For policy makers and researchers, their findings provide an opportunity to consider the complexity of issues raised by sample use.
"Further research is needed to examine patient-physician communication about samples," suggests Alexander, "as well as how physicians decide who needs samples and how samples are distributed across different types of physician practices."
Reference
- Alexander GC, Zhang J, Basu A. Characteristics of patients receiving pharmaceutical samples and association between sample receipt and out-of-pocket prescription costs. Med Care 2008;46:394-402.
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