Background The pharmaceutical industry spends over 16 billion dollars per year on promotional activities. Providing free pharmaceutical samples is one of the industry’s methods to influence physician-prescribing behavior. This tactic capitalizes on physicians’ desire to decrease cost, and reluctance to stop medications once they have started. Many sample medications do not meet first-line recommendations for the hypertension treatment. We hypothesized that patients started on free samples remained on these medications after the samples had been exhausted, resulting in increased long-term cost to the patient.
Methods All samples dispensed at the Medical Center of Louisiana at New Orleans clinics are entered into a logbook. We reviewed the medical record of each patient that had received free antihypertensive samples from 2000 to 2003. The charts were evaluated for two parameters: whether the patient could have received an alternative, less expensive, first-line medication (i.e., beta-blockers of HCTZ for hypertension; ACE inhibitor for hypertension and diabetes), and the duration the patient remained on the sample medication. Patients with a contraindication to recommended first-line therapies were excluded from the analysis. Costs for sample and alternative drugs was calculated using the Red Book. Total opportunity cost to the patient was calculated by subtracting the cost of the first-line medication from the total cost of the sample medication over the time that the patient remained on the medication.
Results Five classes of antihypertensive medications alone and in combination were dispensed. Fifty-two charts containing complete data have been reviewed thus far. Of the charts reviewed, patients spent on aggregate 2,507 days on free samples. These same patients remained on these medications for a total of 25,019 days. The mean cost per patient for sample medications was $336; the aggregate cost was $22,469.
Conclusion Dispensing pharmaceutical samples in lieu of prescribing less expensive alternatives that meet first-line recommendations results in higher expenses to the patient, even after adjustment for the free sample period.
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