The influence of pharmaceutical companies
Unfortunately, the process of obtaining these free medications can be time consuming (and therefore costly), and there can be delays of up to 8 weeks until the medications are delivered. Drug samples play an essential role in bridging the gap until the free medications arrive. Although it may be argued that delays in starting medications for chronic diseases are of little clinical consequence, this can make clinic visits inefficient in terms of following up the effectiveness of new medications. Also, in certain symptomatic chronic diseases such as asthma delays in initiating therapy may lead to detrimental outcomes.
When patient assistance programs are unavailable to indigent patients, samples are often useful to test the effectiveness of a medication before it is purchased. If the medication is found to not be beneficial, then the patient can often save a considerable amount of money by not buying it.
Finally, the cost of a “reasonably priced” antibiotic such as sulfamethoxazole-trimethoprim (approximately $10) may still be unaffordable to many indigent patients, and a prescription would therefore not be filled. In those situations, clinical outcomes may be improved by providing a full course of antibiotics as a drug sample.
Although the use of drug samples have the potential to be detrimental to patient care, for medically indigent patients it can be an essential part of the care. I hope that most providers who care for indigent patients are aware of the pitfalls of samples and are able to use them responsibly for the benefit of this group of patients.
Bennett Parnes, MD
Denver, Colorado
- Strickland, WF, Hanson, CM. Coping with the cost of prescription drugs. J Health Care Poor Underserved 1996; 7:50-62.
The preceding letters were referred to Dr Westfall who responded as follows:
Dr Parnes suggests that samples are very helpful in caring for medically indigent patients. He gives several examples, including bridging the gap between prescribing medication and receiving medications from pharmaceutical patient assistance programs and testing the efficacy of medications before paying for them. Providing medication to medically indigent patients is a valuable and important step in meeting their health care needs. It is unclear whether samples are truly the best method for this. Samples are often newer and more expensive medications that might be no more effective than older more established medications. Another method for providing medications to medically indigent patients might be to have a formulary of basic medications that are purchased by the office and dispensed as needed. I am familiar with many community health centers that provide basic medications to their patients with this method.
Dr Messmer suggests that we train our physicians to be more discerning in what they believe, rather than limit advertising to physicians through drug samples and pharmaceutical representatives. This is a great idea and one that we model in our residency. However, the impact is difficult to assess. If this method is successful we will likely find out from the pharmaceutical companies when they stop providing direct visits, meals, and entertainment. Dr Messmer also poses the question whether advertising speech for pharmaceuticals is different than advertising for other products, such as beer. The answer is an emphatic yes! Medical providers are afforded an incredible amount of trust by our patients. Patients understand that beer companies make money for selling beer; they understand that drug companies make money for selling drugs. Patients do not expect physicians to profit from the pharmaceutical industry.
John M. Westfall, MD, MPH
University of Colorado Health Science Center
Denver
