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Free samples of prescription drugs are costly to patients, study says

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Free samples of prescription drugs may seem like a great deal for patients. But even when doctors think they’re doing patients a favor by handing out the freebies, the real beneficiaries are the drug manufacturers, according to new research in the journal JAMA Dermatology.

Medical groups have grown increasingly wary about free drug samples, and they've already been banned by Kaiser Permanente, many academic medical centers, the Veterans Health Administration, the U.S. military and plenty of private medical clinics. Critics of the practice say it encourages doctors to prescribe drugs that are more expensive and potentially less safe  than the work-horse generics that are just as effective. If the goal is to make costly medications available to low-income and uninsured patients, there are better ways, they say.

Yet $6.3 billion worth of free samples were handed out to doctors in 2011, according to the market research firm Cegedim Strategic Data (as quoted by American Medical News). Among physicians, dermatologists are particularly likely to give free samples to their patients.

A group of researchers from Stanford University took a close look at how those free samples might be influencing the prescriptions written by dermatologists. They focused on prescriptions for patients with a new diagnosis of adult acne (either acne vulgaris or rosacea).

Based on survey data from the National Disease and Therapeutic Index, the researchers found that dermatologists were still enamored with free samples. In 2010, 18% of all prescriptions they wrote came with a free sample, up from 12% in 2001. That was in marked contrast to doctors from other specialties: Only 4% of their combined prescriptions were accompanied by a free sample in 2010, down from 7% in 2001.

Dermatologists were especially likely to give free samples to their adult acne patients – 25% of their prescriptions came with a free sample in 2010, up from 10% in 2001. Very often, the drugs that were most frequently prescribed with a free sample were also the most frequently prescribed overall. In 2005, for instance, the four acne medications most often prescribed with a free sample – Differin, Duac, Benzaclin and Retin-A Micro – were the four most-prescribed acne drugs as well, the researchers found.

It’s not just that these four drugs were perennial favorites. The list of top five acne drugs changed considerably between 2001 and 2010, according to the study. But the favorites were usually closely aligned with the drugs that doctors had available for free in their offices.

In 2010, nine of the 10 most popular acne drugs nationwide were either brand-name drugs or branded generics (which companies sell at a premium), and free samples for them are typically available. To get a sense of whether things would be different in the absence of free samples, the researchers examined the prescribing behavior of dermatologists at an academic medical center that had a policy against freebies. In this group, nine of the 10 most popular acne drugs were low-cost generics (which don’t come with free samples).

Similarly, in 2010, 79% of acne prescriptions in private practices were for name-brand or branded generic drugs, compared with 17% of prescriptions written by the academic dermatologists.

“Prescribing preferences are at least in part related to what is contemporaneously available as free samples,” the Stanford researchers wrote.

It doesn’t seem that the free samples wound up saving patients much money. Those who were seen in private practices walked away with prescriptions for $465 worth of medications, on average, while the patients treated at the academic medical center got prescriptions that cost about $200 to fill. “In other words, the national mean retail cost of the prescriptions received at an office visit for acne is conservatively two imes higher compared with the AMC (academic medical center), where samples were unavailable,” the researchers concluded.

In an editorial that accompanied the study, three dermatologists noted that this pattern had been documented before. A 2008 study in the journal Medical Care found that patients seeking treatment for a variety of ailments paid more out of their own pockets when they got free samples compared with patients who didn’t. But everyone pays, since “samples increase the cost of medicines for all patients by encouraging doctors to prescribe more expensive drugs,” they wrote.

The trio called on their fellow dermatologists and other physicians to steer clear of free samples: “Alongside those other inappropriate tools of drug marketing – sports tickets, Caribbean junkets, and free pens – samples belong not in dermatologists’ closets, but in our dustbins.” 

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