Product samples are a key marketing tool for drugmakers, opening physicians' doors and capturing market share. Many doctors, in turn, view samples as a helpful handout and a route to patient goodwill.
But a growing number of critics, including both doctors and pharmacists, say important controls are lost when doctors dispense drug samples, meant to start patients on new prescriptions.
For example, samples aren't run through pharmacy computer programs that watch for dangerous drug interactions and produce patient-specific labeling. Expiration dates and product recalls also can go unnoticed.
At least two projects give pharmacists a role in dispensing such freebies. The key will be to persuade doctors and drug companies that the alternatives are easy and still engender good feelings.
"This is a great opportunity to improve patient outcomes," said Robert Holt, a Minnesota pharmacist. "People go home with samples and do totally the wrong thing because they don't have instructions."
Drug samples are a significant output of the drug industry. Doctors often amass large quantities of samples from sales representatives. The retail value of samples in the field in 1993 was $6.7 billion, according to a study by the accounting firm Coopers & Lybrand.
Many staff-model HMOs and hospitals already limit drug sampling because the practice is intended to influence physicians' drug choice. As an alternative, however, pharmacies could match requested samples to formularies of preferred drugs, Holt said.
Holt is director of clinical support services at Austin (Minn.) Medical Center, which includes 25-physician Austin Clinic and a 108-bed hospital. Austin, a town of 22,000 people, is located in eastern Minnesota, just north of the Iowa border.
In 1993, articles about the pitfalls of drug sampling started Holt thinking. Why not send patients to pharmacies for samples?
Austin Clinic adopted special "sample" prescription pads in April 1995 after three drugmakers agreed to electronically reimburse area pharmacies for the products. The project is small, involving just 12 products, but has shown such a system is workable, Holt said. More products might be available in February.
A subsidiary of McKesson Corp., a drug wholesaler, recently launched a similar program, called Trial Script, as a marketing service for drugmakers. Instead of samples, drug company salespeople give doctors stickers or certificates with which to mark trial prescriptions. The subsidiary, Healthcare Delivery Systems, tracks product use and reimburses pharmacies.
Many complaints about the current practice of drug sampling come from pharmacists, who feel their role in good healthcare isn't properly appreciated. Some doctors, however, don't like the practice either.
Safety tops the list of critics' concerns. But they also charge that samples are wasteful, consuming office space and requiring individual packaging. And samples can be diverted for resale or use by clinic staff. According to one estimate, just over half the samples actually reach patients.
The Coopers & Lybrand study, commissioned by Healthcare Delivery Systems, predicted that pharmacy-based sampling would cost the drug industry about $900 million a year, compared with the $1.6 billion cost of making and distributing samples to doctors.
Eli Lilly and Co., a drug company participating in both the Austin and HDS programs, said pharmacy-based sampling actually can be more costly, depending on how costs are evaluated. But it has definite advantages, such as helping drugmakers track the use of samples, said Ben Rogge, manager of marketing services at Lilly.
More importantly, alternatives to traditional sampling are drawing more interest from providers. "As customers change, we need to adapt," Rogge said.
Tim Johnson, a primary-care physician at Austin Clinic, rarely gave his patients samples. "I found it to be an unsatisfactory practice," Johnson said. "Now the only samples I give are through the prescription pad, unless it is after hours or there are other needs. The things that sold me are the benefits to the patient because they do get pharmaceutical care."
But many doctors might find traditional samples hard to give up, Johnson said. "Physicians like to have the drugs at their fingertips. It gives them a sense of control and immediate positive feedback from the patient," he said.
"The other issue is that some physicians use samples to provide medication for indigent patients. Drug supplies for indigent patients, however, probably could be better managed out of the pharmacy," Johnson added.