Free drug samples may mean higher drug costs

Out-of-pocket prescription costs are increased when patients are given free drug samples, according to findings from a study conducted in the United States.

“Physicians should not assume that just because a patient is given samples, that they are no longer burdened by their prescription costs,” Dr. G. Caleb Alexander of the University of Chicago told Reuters Health. “In fact, in some cases, sample use may be penny-wise and pound-foolish, while in others it may provide patients with valuable economic relief without leading to greater long-term prescription costs.”

To examine how free samples affect patients’ expenditures, Alexander and colleagues analyzed the 2002-2004 household component of the Medical Expenditure Panel Survey, conducted by the Agency for Healthcare Research and Quality. The study cohort included 5709 adults who were taking prescribed medication but who were not given free samples during the 6-month baseline period.

One hundred thirty-six patients, or 14 percent, received at least one free sample during the analysis period, the investigators note in the journal Medical Care. The odds of receiving a drug sample decreased with age and income. Chronic disease prevalence was higher in those who received free samples.

After controlling for demographics and use of health care services, the average out-of-pocket prescription expense per 6-month period was $178.

Before the free samples were given, expenditures did not differ significantly for either group. However, the average out-of-pocket cost jumped significantly to $244 when one group received free drug samples and remained higher at $212 after the samples were given.

“We were surprised by our findings—we expected that patients receiving free samples would have lower, not higher, prescription costs compared with their counterparts,” Alexander said.

Among 75 matched pairs of subjects—one given free samples and the other given a prescription for the same medication—the odds of continuing the medication was lower among those given free samples.

“There are many strategies patients and physicians can use to reduce patients’ prescription costs,” Alexander noted, “and the use of free samples is probably less effective, in the long-term, than many other methods, such as using 3-month rather than 1-month supplies, using more generic medicines, and discontinuing non-essential medicines.”

“The challenge for physicians and patients is to navigate these questions together.”

SOURCE: Medical Care, April 2008.