American College of Physicians: Internal Medicine — Doctors for Adults ®

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Samples: cost-driver or safety net?

By Phyllis Maguire

When it comes to the cause of rising drug costs, the media increasingly point to physicians' bulging sample closets. Yet most physicians say that samples are a key component of treating uninsured or underinsured patients.

Critics often argue that when doctors introduce patients to samples—typically for the newest and most expensive drugs—they tend to write more prescriptions for those medications and drive up health care costs. According to IMS Health, drug companies in 1999 gave physicians more than $7.2 billion worth (in retail dollars) of sample drugs, making samples by far the biggest line item in the industry's more than $12 billion professional promotional budget.

Yet even physicians who won't meet with drug detailers because they want to avoid any marketing pressure depend on samples.

Bowdoin Medical Group in Brunswick, Maine, is one such practice. According to Bowdoin general internist John D. Halporn, ACP-ASIM Member, the group has a formulary of sample drugs that it stocks for patients who can't afford prescriptions. Physicians sign a card requesting particular samples, then leave the card at the front desk for drug representatives.

"It's ironic that most of the time I prescribe generic drugs that aren't sampled to patients with health insurance," Dr. Halporn said. "The people who get the fancier drugs are the ones who have no money."

One alternative to samples is free drugs from pharmaceuticals. Drug companies allow physicians to petition for free drugs for individual patients. (For application criteria and forms, see www.rxassist.org.) Yet drug companies don't make the programs easy, said R. Scott Hanson, ACP-ASIM Member, a general internist in Narragansett, R.I.

Each manufacturer has its own form, and several demand proof of patient income. And because most drug companies provide only three months' worth of a medication, physicians must continually submit paperwork—and rely on samples to tide patients over until the refill is approved. "There's a lag time of six weeks" to get refill requests processed, Dr. Hanson said.

At least one company, however, is trying to make the process less onerous. Dr. Hanson said that SmithKline Beecham is implementing an toll free number that physicians can use to order refills and speed the process along.

And one newly launched effort will challenge the argument that samples can't be cost effective. Last November, pharmacy benefit management company Merck-Medco, in partnership with generic drug companies, announced its Generics First program, a project to offer physicians samples of generic drugs. The promotion intends to make an undisclosed dollar amount of generic samples available to 15,000 physicians over the next two years.

Related resources:

For an article on groups and hospitals that are banning the use of samples, see an article in the Nov. 15, 2000 New York Times (http://www.nytimes.com/2000/11/15/business/15SAMP.html).

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