And that's not the only place drugmakers spend money. The pharmaceutical industry spent more than $24 billion on marketing directly to physicians in 2012 compared with $3 billion a year to consumers, according to a study published by the Pew Charitable Trusts. About $15 billion of that was face-to-face selling and around $6 billion was in free samples. As of 2012, the U.S. had about 72,000 pharmaceutical sales representatives; there were 916,000 licensed physicians.
Providing free samples to healthcare professionals led to significant increases in new prescriptions for the sampled drugs, per the Pew study. While drug companies argue that the samples are especially important to patients who couldn't afford them otherwise, research shows that most are given to insured patients.
The decline in promoted drug prescriptions was more drastic following the implementation of stricter policies, including bans on salespeople in patient care areas; requirements for salesperson registration and training; and penalties for salespeople and physicians for violating the policies.
Researchers studied 19 centers that implemented the new policies, including 2,126 physicians who practiced in California, Illinois, Massachusetts, New York and Pennsylvania, compared with a control group of 24,593 physicians. They analyzed more than 16 million prescriptions of eight major drug classes: lipid-lowering drugs, gastroesophageal reflux disease drugs, anti-diabetic agents, anti-hypertensive drugs, sleep aids, attention deficit hyperactivity disorder drugs, antidepressant drugs and antipsychotic drugs.
"Important next steps include assessing the economic impact of these policies and whether they affect patients' clinical outcomes," Schoenbaum said.
Soaring drug prices have taken a significant chunk out of hospitals' bottom lines. Annual inpatient drug spending rose an average of 23.4% from 2013 to 2015, and 38.7% on a per admission basis, according to a 2016 study from America's biggest hospital lobbies.