Thursday, August 19, 2010

The Free Sample Debate

A blog post on KevinMD about how free drug samples raise health care costs garnered lots of responses. What we found interesting was the diversity in the responses – some extremely anti-pharma, some very pro-pharma, some were in the middle and saying let’s be practical about this.

The author’s essential argument, often opined before: Once the patient is finished taking the free samples, he will get a script for the drug, instead of a generic version, thus raising the cost of health care. But is it really?

One of the practical responders used Lipitor as an example. A patient’s LDL is 160, and the physician wants it under 100. While the generic simvastatin is effective, the patient would need the highest dose of 80mg to reach the goal – but the higher the dose, the higher the odds that side effects will occur. Simvastatin has no samples, and costs $10 per month at the local pharmacy. The physician prescribes Lipitor. Why? He can reach the goal at the 20mg dose. Even though it costs $25 per month, the physician has a free 4-week drug supply to ensure there are no side effects, plus coupons that can stretch for a year. By then, Lipitor should be generic. “Using the branded product with samples and coupons [I] just saved you $120 for the year, allowed you to try the med first, and gave you a drug that worked better with fewer side effects,” he wrote.

This scenario shows how important free samples can be. What have we learned from this? That some doctors don’t know their drugs, even the well known ones. That drug samples have a place in the world, because a physician could show what Lipitor at 20mg v simvastatin 80mg could do. What concerns us is that not one of the dissenters in the "ban the sample debate" chooses to share their stories like this one.

No one denies that free samples are a successful marketing tool. But denying that free samples can often help the right person, at the right time is short-sighted. Industry critics need to keep in mind the unintended consquences of their intentions.

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