Free drug samples may burden patients' pockets

Following free drug sample receipt, patients who receive these samples have significantly higher out-of-pocket prescription costs than those who don't, according to the first study to look at the out-of-pocket cost associated with free-sample use, published in the March 24, 2008, issue of Medical Care.

Patients who never received samples had estimated out-of-pocket prescription costs of $178 over six months. Patients who received samples spent an estimated $166 for a six-month period prior to getting free samples, $244 for the six months in which they received samples and $212 for the six-month period following sample receipt.

"Our findings suggest that physicians should use caution in assuming that the use of free samples ultimately reduces patients' out-of-pocket prescription cost," said study author G. Caleb Alexander, MD, assistant professor of medicine at the University of Chicago Medical Center.

There has been widespread debate about the advantages and disadvantages of free samples. In 2006, the New York Times published a letter to the editor from Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America. He argued that "many uninsured and low-income patients benefit from these free samples, which often serve as a safety net."

"Samples may be particularly valuable in providing patients economic relief when they are used short-term and not followed-up with long-term prescription for the same medicine," says Alexander. "However, all too often, physicians and patients end up continuing the medicines initially begun as samples, even though older, less expensive alternatives may exist."

Previous surveys have found that free samples can lead to overuse of newer drugs over their older counterparts, but these prior studies have usually examined just one clinical setting and have not examined the costs associated with sample receipt.

"We believe our study is one of the first to look at the economic consequences of sample receipt," Alexander said.

His team used the Medical Expenditure Panel Survey, conducted by the Agency for Healthcare Research and Quality, to examine the characteristics of those receiving samples, as well the relationship between sample receipt and out-of-pocket prescription costs.