Hitting a Nerve

The problem with samples


Ubrelvy and Nurtec are the latest in acute migraine treatment, both with solid data to back them up.

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

As with the triptans 25 years ago, my sample cabinet (and probably everyone else’s) is loaded with them, and friendly sales reps bringing coupon cards are a frequent occurrence.

Unfortunately, samples also bring up the same conundrum I faced with the triptans earlier in my career. It’s one thing to give patients samples to see if they work. It’s quite another to get them covered if they do.

This is an ongoing issue in modern medicine. It’s hard to resist the temptation to just hand something out when it’s conveniently at hand. It saves the patient a trip to the pharmacy and a medication copay up front, which is great.

But if it works, you have a whole new set of issues. The patient wants a real prescription now. So you call it in, then get a denial back saying it isn’t covered. It tells you to call a number, or try CoverMyMeds.

You do that, but the patient has to have failed three triptans, two NSAIDs, and a partridge in a pear tree to get it approved. The “copay assistance cards” don’t help if the medication isn’t covered at all. Each of these new medications is currently listed at roughly $900/month on GoodRx.com. Inevitably, your staff gets an earful when a patient with sticker shock calls your office.

One manufacturer is now eating the cost of the first script, so the patient leaves the pharmacy with a 1-month supply, under the impression that it was covered by insurance. This only kicks the can down the road 4-6 weeks, until they call for a refill.

To the chagrin of my sales reps (who are certainly going to read this), I’ve been burned on this and similar issues many times in my career, so I don’t even bother playing the game.

Certainly, there are cases where handing out a sample of Ubrelvy or Nurtec is indicated – some patients have already failed other agents, or have medical contraindications to them – but most don’t. So I start with triptans, currently going for $15/month. That doesn’t mean I’m not open to a newer agent at some point, but leaping directly to them quickly becomes an exercise in frustration.

Which brings up another issue I’ve encountered. While I try to be aware of this sort of thing, many other docs aren’t. Especially my already overburdened colleagues in primary care, who have enough on their plate with COVID-19, insurance regulations, paperwork, and an insanely busy schedule. In the controlled chaos of a general practice, it’s often easier for the staff to just hand out a sample at the same time they refer to a neurologist. So when the patient comes to me, they’re expecting I’ll be able to get it covered. After all, I’m the specialist. Getting expensive tests and medications covered seem to be something that’s expected for the higher copay to see me.

It doesn’t work that way, either.

I have nothing against new drugs. It’s the breakthroughs that keep medicine moving forward (like the COVID-19 vaccines). Nor do I have anything against samples or sales reps.

Ubrelvy and Nurtec definitely have their benefits and uses, and in appropriate cases they’re worth the battle of getting the expense covered.

But in many cases, the time you save handing out samples isn’t worth the time you have to spend on them down the line.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recommended Reading

About one in five clinicians considers quitting because of pandemic
MDedge Neurology
The waiting room: Then and now
MDedge Neurology
What COVID did to MD income in 2020
MDedge Neurology
The ripple effect
MDedge Neurology
Vaccinating homebound patients is an uphill battle
MDedge Neurology
Percentage of doctors who are Black barely changed in 120 years
MDedge Neurology
Is common courtesy no longer contagious?
MDedge Neurology
Doctors lose jobs after speaking out about unsafe conditions
MDedge Neurology
Death from despair
MDedge Neurology
Who can call themselves ‘doctor’? The debate heats up
MDedge Neurology