More Hospitals, Clinics Banning Drug Sample Use
In response to concerns about prescription drug costs and the safety of medication samples, "a small but growing number" of hospitals and clinics are banning or limiting the brand name medication samples that their doctors can accept from drug companies, the New York Times reports. Even some hospitals that care for many uninsured patients and "could benefit from the free pills" are limiting use of samples, the Times reports. Last year, drug companies handed out $7.2 billion in free medications, almost a 10% increase over the previous year, according to the prescription drug tracking firm IMS Health. Doctors have used free medication samples to either allow patients to try new treatments or to start patients on medications quickly while waiting for prescriptions to be filled. But some hospital administrators "worry" that they are unable to control the "increasing amount" of medication samples given to patients and that the samples are contributing to inflated drug costs "because drug companies tend to give out samples of the newest brand name drugs, which are often the most expensive." For example, if the sample brand name medication works well for a patient, a doctor will prescribe the higher-cost medication, "even though a generic drug may work just as well." Dr. John Chessare, Boston Medical Center's CMO, said that drug company representatives "are not bringing us samples of things we need. They're bringing us samples of things they want us to know about."
Clinics and hospitals that have banned medication samples have done so either in response to safety or cost concerns. Since banning samples and barring drug representatives from visiting its physicians in 1998, the Everett, Wash.-based Everett Clinic has experienced a 10% decrease in drug costs. Besides banning samples, the clinic hired a clinical pharmacist to "provide more balanced information about new drugs" than pharmaceutical representatives provided. Other clinics have decided to address medication samples in response to the Joint Commission on Accreditation of Health Care Organizations' "new focus on samples," according to Chessare. Dr. Paul Schyve, JCAHCO senior vice president, said that the commission "had increased its emphasis on medication safety in the last two years," and as part of that, has "been making sure that hospitals properly control drug samples." Some doctors and pharmacists point out that there is an "increased risk" that a doctor could give a patient a medication sample that might later be recalled by the manufacturer and then the doctor would have no way of notifying the patient. In addition, prescription medications use both the doctor and pharmacist as "safety checks," unlike the sample system, where medications pass directly from doctor to patient.
But as hospitals and clinics ban samples, some doctors have "complained bitterly," stating that they "often depend on the samples to help patients who lack insurance coverage and cannot afford the expensive new drugs," the Times reports. Some doctors have said that hospital administrators "are too focused on the bottom line," the Times reports. For example, Dean Health Systems in Wisconsin decided in July to bar drug company sales representatives from directly visiting its doctors. But Dr. Don Bukstein, a Dean Health pediatric allergist and pulmonologist, said, "I've had a lot of patient complaints. The difficulty of not having samples in my area is a major problem." Dean Health now gives doctors vouchers to give patients for a free prescription of a variety of mostly generic medicines.
As for drug companies, they maintain that free samples "play an essential role in the health care system," the Times reports. Dr. Bert Spilker, senior vice president for scientific and regulatory affairs at the Pharmaceutical Research and Manufacturers of America, said that free samples "allow doctors to learn about the benefits of new drugs recently introduced to the market," but added that "it is entirely up to doctors to determine whether it's appropriate to use drug samples" (Petersen, New York Times, 11/15).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.