By JoNel Aleccia Health writer
msnbc.com
updated 3/25/2008 8:17:02 AM ET 2008-03-25T12:17:02

Leaving the doctor’s office with a bagful of free drug samples may seem like a good way to save money, not to mention an inconvenient trip to the pharmacy.

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But people banking on the freebies need to think again, according to a new study that shows patients who get samples end up with significantly higher out-of-pocket costs than those who don’t.

On average, patients who got free prescription samples spent nearly 40 percent more for medication during the six months they received samples, and nearly 20 percent more in the six months afterward, than those who didn’t, according to University of Chicago researchers.

“The notion that people have is that if you receive samples, it helps with out-of-pocket costs because you don’t have to go out and buy the drugs,” said Anirban Basu, one of the study authors and an assistant professor of medicine at the University of Chicago.

“What we found, actually, was that their out-of-pocket expenditures increased. Most surprising was that those out-of-pocket expenditures continued even after the samples stopped.”

The study, published this week in the journal Medical Care, renews debate about the role of more than $18 billion in free pharmaceutical samples distributed each year, which drug industry representatives have described as a cost-saving safety net for the poor.

“This builds on a growing body of literature that shows that samples are not aimed to help the uninsured and the poor, but to increase the sales of the branded drugs,” said Dr. William Shrank, an instructor at Harvard Medical School, who has studied the issue.

The study comes on the heels of a January report that showed free samples are more likely to go to insured and wealthy patients than to the needy.

Drugmakers dispute critics
But the Pharmaceutical  Research and Manufacturers of America, a trade group representing most drugmakers, disputed those views.  Free samples allow doctors to try new medicines and to implement them immediately in people of all income levels — including patients who lack prescription drug coverage, Ken Johnson, a PhRMA senior vice president, said in a statement.

Looking at samples in isolation “misses the point,” Johnson said. “Contrary to statements made by critics, American’s physicians prescribe medicines based on a wide range of factors, not simply receipt of free prescription drug samples,” he wrote.

Two out of every three drugs prescribed is generic, not branded, and drugmakers have offered struggling patients a range of options besides samples for receiving medication, Johnson added.

In the Chicago study, patients who never received free samples spent an estimated $178 out-of-pocket on prescription drugs over six months. By comparison, patients given free samples spent about $166 of their own money during the six months before they got the samples — but then $244 during the six months they received the samples and $212 in the six months after that, researchers found.

The study, billed as the first to examine the relationship between drug samples and patient expenses, followed more than 5,700 patients for two years using data from the 2002-2003 Medical Expenditure Panel Survey, a national poll conducted by the Agency for Healthcare Research and Quality. During that time, the patients received more than 2,300 free drug samples.

The results were “counter-intuitive,” said lead author Dr. G. Caleb Alexander, an assistant professor of medicine at the University of Chicago Medical Center. “We expected that free sample receipt would be associated with lower, not higher, cost,” he said.

Reason for higher costs isn't clear
Exactly why the costs rose wasn’t clear, said Alexander, who added that the study wasn’t designed to answer that question.

Patients who received samples may have been sicker than those who didn’t, which would explain the higher costs, a point emphasized by PhRMA representatives.  But analysis showed that illness played a small part, at most, in the higher expenses, Alexander said.

Or, patients may have received higher-priced brand-name drugs — those ones most often given as samples — and then continued with the same pricey prescriptions, Alexander said.

That would be in line with what other studies have shown, said Dr. Andrew F. Leuchter, a professor of psychiatry who heads a committee on drug industry relations at the David Geffen School of Medicine at the University of California, Los Angeles.

“We have known for a while that sample use increases health care costs,” said Leuchter.

But the new study provides first details of out-of-pocket costs, including the fact that the medication expenses remained high even after the samples were finished.

That makes sense to patient J.W. Wright of Goodrich, Texas, who has lived with high blood pressure for 18 years. The 72-year-old retired aerospace engineer has received three different samples of medication in the past year alone. He didn't continue with any of them because they didn't work, but he said he understands how some patients could wind up paying more.

“When you get a sample and a prescription, first you find it works, then you get that brand without thinking the cost, UNLESS the pharmacist tells you the insurance company will only pay for the generic,” Wright wrote in an e-mail. "There's a trade-off. Do I buy the brand at $100 or do I take the generic at $5? I think I try the generic."

If the generic drug works, fine. But if it doesn't, or if no alternative is suggested, the patient — — or the insurer — has to foot the higher bill.

Doctors, patients need to consider larger costs
The solution is for doctors and consumers to be vigilant about the use of drug samples, said Shrank, of Harvard.

"Consumers just need to know that getting a free sample will not reduce their costs over time," he said.

Doctors and patients should discuss using more generic drugs, offering three-month instead of one-month supplies and discontinuing unnecessary medications, Alexander said.

At UCLA, the medical school has adopted guidelines that prohibit shipping drug samples to individual doctors and allow their use only in cases where a patient is indigent or where there’s another significant barrier to care, Leuchter said.

In cases where patients simply wants to avoid an insurance co-payment or a trip to the pharmacy, samples are discouraged.

Sample drugs do have the potential to help needy patients, and to expose doctors to innovative new treatments, Leuchter said. But there's no question indiscriminate use can drive up consumer health care costs, he said.

“We’re trying to do everything we can to encourage people to do the right thing,” he said.

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