Healthy Skepticism Library item: 13655

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Publication type: news

Garloch K.
No more free Rx samples
The Charlotte Observer (Charlotte, North Carolina) 2008 May 12
http://www.charlotte.com/112/story/620097.html

Full text:

Carolinas HealthCare System tells 600 doctors to stop giving away drugs

It’s been a tradition in most doctors’ offices.

You get a new prescription, and to test out the drug or save a little money, the doctor hands over some samples.

But if your doctor works for Carolinas HealthCare System, that’s no longer the deal.

Since Jan. 1, the system’s 600 physicians have been told to stop giving out free drug samples.

Some patients and doctors “are violently opposed” to the change, said Dr. William Sugg, medical director for the CHS physician network.

But he said it was made for good reasons — to protect patients, limit liability and decrease the influence of drug companies on prescribing practices.

CHS doctors’ offices hadn’t done a good enough job of tracking to make sure the samples were discarded when they expired and to know which patients got them, in case of a recall, Sugg said.

“There’s a safety issue about the management of samples in the doctors’ office,” he said. “We’ve got to be held to the standard of a dispensing pharmacy.”

He added that prestigious teaching hospitals, such as the Cleveland Clinic, have already banned free drug samples.

Charlotte’s other hospital system, Presbyterian Healthcare, still permits samples. An electronic system helps track lot numbers and expiration dates, said Michael Gum, senior director of pharmacy.

But Gum said he understands that teaching hospitals, such as Carolinas Medical Center, would want to prevent drug companies from influencing medical students and residents. “Who do you want them to learn from — their (faculty doctors) or the drug company representatives?”

Studies have shown that doctors’ prescribing habits are affected by the availability of free samples from drug company representatives who also bring lunch, ink pens and even more expensive gifts.

“If it wasn’t influencing prescribing habits, why would they be doing it?” Sugg said.

Not the `preferred drug’

Several CHS doctor groups had already banned samples, as well as endless visits by drug reps.“Knowingly or not, it was affecting our practice to have the samples there, and it probably wasn’t good for our patients,” said Dr. Michael Richardson, who made the change at Charlotte Medical Clinic’s Arboretum office three years ago.

Samples are usually newer, expensive drugs without long-term safety data, he said. For many conditions, such as high blood pressure or bacterial infections, there are good, safe generic drugs but “they don’t give you those for free.”

Studies show doctors may give out samples that are convenient but aren’t the “preferred drug.” Then, if the drug works without side effects, the tendency is to stick with it even though a generic might have been as good and cheaper in the long run.

Help paying for medicines

Pharmaceutical companies defend free samples, saying they give doctors experience with new medicines.

“Samples can help patients begin treatment sooner and find the medicines that are best for them,” said Ken Johnson of the Pharmaceutical Research and Manufacturers of America, the industry’s trade group.

“Those who question the motives of companies providing free pharmaceutical samples would better serve patients and the general public by closely examining health outcomes,” Johnson said in a statement.

Free samples also help those who can’t afford to buy medicines, he said.

But Sugg said patients who need help paying for drugs can get it from MedAssist of Mecklenburg, a community pharmacy for low-income and uninsured patients. Other counties have similar programs.

MedAssist, which gets most of its medicines free from drug company donations, was a beneficiary of the CHS policy change, said executive director Lori Giang. In January, when CHS doctors cleared their drug closets of free samples, they donated about $1 million worth of medicines to MedAssist.

Instead of samples, CHS doctors are encouraged to give out vouchers, provided by the drug companies, that can be taken to pharmacies for free or discount drugs, Sugg said.

Also, CHS doctors are still allowed to give free samples of drugs that require special instructions, such as injectable medicines and inhalers.

Stuck with drugs they can’t use

Many patients are surprised and disappointed with the policy.Mary Ann Kirkman, 60, an office administrator for a Charlotte home builder, said she and her husband have spent at least $500 on medicines they can’t use because of side effects.

For example, she said she developed hives 36 hours after taking an antibiotic for a sinus infection. “If I had gotten a week’s sample, I could have tried it for free and known that I couldn’t take it because I got a rash.”

For osteoporosis, she tried different drugs, each for $100 a month. Both Fosamax and Boniva gave her acid reflux. A nasal spray called Miacalcin gave her nosebleeds.

She ended up in the hospital. “Everything they gave me literally gave me an ulcer,” Kirkman said. “Now I’m on stomach medicine. This is stupid. I’m not going to go buy stuff I can’t take and then end up throwing it away.

“And I don’t think it’s fair,” she added. “Why is it some doctors give them out, and others don’t?”

Shannon Carney, 43, a breast cancer survivor from Tryon, appreciated the free samples of anti-nausea medicine she got during chemotherapy at Carolinas Medical Center in 2003.

But she can see the benefit of the hospital’s anti-sample policy.

“As a former patient, I want my nurses to be focused on what’s important, which is me, and not one more administrative duty.”

MedAssist of Mecklenburg

• Serves about 2,100 uninsured and low-income patients a month and dispenses about 2,200 prescriptions, valued at $340,000, per month.

• To qualify, Mecklenburg residents must be uninsured and earn no more than 200 percent of the federal poverty level (no more than $20,800 a year for a single person; $42,400 for a family of four).