Last week, the Wall Street Journal reported on documents submitted to Congress (though it is unclear who in congress requested this information or released it) from pharmaceutical companies giving a first glimpse of how widely companies use free samples. Specifically, the documents showed that:
– Pfizer Inc. 101 million drug samples worth $2.7 billion in 2007
– Merck & Co. dispensed 39 million samples worth about $356 million
– Eli Lilly & Co. 33 million worth $67 million
– Wyeth, which was acquired by Pfizer last year, 52 million worth $64 million
– Abbott Laboratories 16 million worth $32 million
– Baxter International Inc. 33,000 worth $7 million.
The revelation of these numbers will likely have critics claiming that such “samples induce prescriptions for more costly brand-name medicines when cheaper generics might be available.” This claim clearly ignores the obvious benefit a free prescription has for a patient: it allows the individual, through the advice of their physician, to try something before making a decision. This gives the patient a number of options: stay with the free sample, move to the generic, get the brand name, or try something else completely. What is unsafe about a doctor giving his or her patient a free choice?
If a patient is concerned about a free sample, they can simply ask: "Am I being prescribed this medication because the drug rep just came by and dropped all these drug samples, or is it really the best medicine for me?"
The reporting of such samples is part of the health care legislation, which “requires companies to tell Congress how many samples they distribute.” This kind of transparency stems from the Sunshine Act. Information wasn't available on individual drugs.
Companies reported to Congress the value of the drugs based on either market price or wholesale cost for the drugs. “The companies noted that the medicines were not to be resold. Some companies counted samples by dose while others counted by unit. Multiple samples may be contained in one unit.”
In response to the publication of such numbers, a spokesman for Pfizer said samples "enable patients and physicians to try a medicine and evaluate tolerance, assess effectiveness, and adjust dosage before committing to a full prescription regimen." In addition, samples help some patients get on a drug quickly without having to wait for a prescription to be filled, and save patients money.
Some concerns about the use of samples rest on the fact that “doctors often don't keep a good tally of when samples expire and could inadvertently hand out old medicines.” Another risk of free samples is that “bypassing pharmacists is risky because a pharmacist may view a database on a patient's other prescriptions and notice potentially dangerous interactions.” Despite these worries, “few specific examples of patient harm resulting from such adverse interactions have been reported.”
Still, critics are worried that "free drug samples may lead to higher costs for uninsured patients by encouraging physicians to write prescriptions for brand-name drugs only." In fact, last year the Institute of Medicine “recommended that companies shouldn't give out samples except in cases when patients can't otherwise afford the medicines.”
These kinds of recommendations concern lawmakers because the “disclosure of drug-sample distribution might dissuade doctors from providing free samples to people who can't afford their medicines.”
Accordingly, the concerns regarding free-samples are misguided because such services are akin to projects that companies use to help patients who cannot afford their prescriptions. For example, Pfizer said in the last five years it has helped six million patients receive more than 48 million Pfizer prescriptions, the equivalent of $5.7 billion worth of free medicines and savings.
Ultimately, free samples "enable patients and physicians to try a medicine and evaluate tolerance, assess effectiveness, and adjust dosage before committing to a full prescription regimen," while saving money.
What will patients do if pharmaceutical companies take away the free samples and under the healthcare reform have to pay their full co-pay for their prescriptions even if they cannot tolerate the medicine?