Those least needy most likely to get free drug samples

Most free drug  samples are  not used to ease  the burden of the poor or the uninsured, but rather go to those most able to pay for their prescriptions, according to a  study by  physicians from Cambridge Health Alliance and Harvard Medical   School. The study, which is the first to look at the free drug samples pharmaceutical companies provide to physicians, will appear in the February 2008 issue of the American  Journal  of Public Health.

The study found that use of free  prescription drug  samples is widespread, with more than one-in-ten Americans receiving one  or more free drug samples in 2003. Almost 20 percent of those surveyed who take at least one  prescription drug were given free samples.

Few free  samples went to the needy, the study found: insured Americans and those with higher incomes  were more likely to  report receiving at least one free sample; more than  four-fifths of  sample recipients were insured all year. Conversely, less  than  one-fifth were uninsured for all or part of 2003, and less than   one-third had low family incomes (under $37,000 for a family of  four.) 

The study also found that those with better access to medical care were consistently more likely to receive three samples. Non-Hispanics,  English-speakers and Whites were all  more likely to receive free  samples than were members of ethnic, linguistic  or racial  minorities. Receiving medical care in an office and taking more   medications also increased an individual’s chances of receiving free  drug  samples.

Author Sarah Cutrona, a physician at Cambridge  Health  Alliance and an Instructor of Medicine at Harvard commented:  “The  distribution of free samples has become very controversial.  Evidence shows  that free samples may influence physicians’  prescribing behavior and cause  safety problems. For instance, we  found that the most widely distributed  sample in 2002 was Vioxx,  with Celebrex being number 3. These drugs turned  out to have lethal  side effects. While many doctors still view samples as a  safety net  for their neediest patients, our study shows that samples are   potentially dangerous, and do little for the needy.”

David  Himmelstein, senior author of the study, a physician at  Cambridge Health  Alliance and an Associate Professor of Medicine at  Harvard adds: “We know  that many doctors try to get free samples to  needy patients when those  patients come into the office. We found  that such efforts do not counter  society-wide factors that determine  access to care and selectively direct  free samples to the affluent.  Our findings strongly suggest that free drug  samples serve as a  marketing tool, not as a safety net.”

“Free drug  samples are  not the solution to the disproportionately low amount of health  care  resources going to the poor and uninsured; they are part of the   problem,” said Steffie Woolhandler, a physician at Cambridge  Health  Alliance, Associate Professor of Medicine at Harvard, and  study co-author. 

The study used data on 32,681 US  residents from the Medical  Expenditure Panel Survey (MEPS), an  annual federal survey. Dr. Cutrona’s  work on the study was supported  under a National Research Service   Award.