Most drug freebies go to well-off: study

A new study showing low-income, uninsured patients receive few of the $16 billion worth of free drug samples given away yearly by pharmaceutical companies may do little to change the way healthcare providers distribute drug samples, according to some healthcare policy experts.

The study—which found that the vast majority of drug-sample recipients are well-insured, middle- and upper-income patients—concluded that “drug samples serve as a marketing tool, not a safety net” and suggested the practice may actually put patients’ health at risk.

“I think this study helps demonstrate that free samples aren’t about altruism; they’re about promotion,” said William Shrank, a drug-policy researcher for 746-bed Brigham and Women’s Hospital in Boston. “How (the research) will affect policy is unclear, but it sort of weakens manufacturers’ argument that samples are created for patients who can’t afford their drugs.”

Conducted by physicians at Boston’s Cambridge Health Alliance and Harvard Medical School, the study found that 82% of patients receiving free drug samples had no break in their insurance coverage during 2003, while just 18% of free-sample recipients were uninsured for all or part of that year. “We found that free-sample receipt was consistently higher among well-insured patients and among those who received care in an office setting,” said Sarah Cutrona, a Cambridge Health Alliance physician and lead researcher on the study.

Educational and income levels as well as race and gender also determined whether patients were likely to have access to free samples, according to the study, which is set for publication in the February issue of the American Journal of Public Health. Patients with doctorate degrees accounted for 17%—or the largest group based on educational category—of drug-sample recipients. Seventy-two percent of sample recipients had incomes of 200% or more of the federal poverty level, while 81% of recipients were white and 51% were women.

But in a statement that called the study “flawed,” Ken Johnson, senior vice president of communications and public affairs at the Pharmaceutical Research and Manufacturers of America, noted researchers also found that uninsured patients treated in office settings were more likely than insured ones to receive free drug samples from doctors.

“Instead of second-guessing motives, Harvard researchers would better serve patients by examining health outcomes,” Johnson said. “Clearly, free samples often lead to improved quality of life for million of Americans regardless of their incomes.”

Cambridge Alliance’s Cutrona argued, however, that the study actually found current sampling practices put patients at greater risk for negative drug interactions and safety problems. “With sampling, we know doctors are less likely to do patient counseling (on drug side effects), and since the pharmacist is bypassed (in the process), there may be less awareness of what drugs a patient is on that could cause a bad reaction,” Cutrona said.

Sean Hennessy, an assistant professor of epidemiology and pharmacology at Philadelphia’s University of Pennsylvania School of Medicine, said the Cambridge Alliance-Harvard study may be the first to provide data that supports the long-held belief that sampling is strictly a marketing practice. He doubts, however, that it alone will influence or change healthcare providers’ policies on drug-sample distribution.

“I think (this study) can provide some information to organizations making decisions on drug-sampling procedure, but not a lot” of guidance, Hennessy said.

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