Most Samples Don’t Go To The Needy: Study
9 CommentsBy Ed Silverman // January 2nd, 2008 // 5:32 pm
Insured and wealthy Americans are more likely than needy patients to get the billions of dollars in free samples distributed by reps to win patient and doctor loyalty, according to a new study.
In fact, the research found that nearly 33,000 US residents during 2003 found the neediest are least likely to get free samples. “Our findings suggest the free samples serve as a marketing tool, not a safety net,” Sarah Cutrona, co-author of the report to be published in the February issue of the American Journal of Public Health, tells Reuters.
About $16.4 billion in free samples were distributed in the US in 2004, up from $4.9 billion in 1996, the study said, adding that samples are nearly always the newest and most expensive meds. Merck’s Vioxx, Reuters notes, was the most frequently distributed free sample in 2002.
The study, which analyzed US government data in a 2003 nationally representative survey, found that about 12 percent of all Americans have received at least one free sample. About 13 percent of those with insurance were given a sample, while about 10 percent of those uninsured for all or part of the year got one, a statistically significant finding. Similarly, of all sample recipients, 72 percent had income above 200 percent of the federal poverty line, while 28 percent had incomes below that level, Reuters writes.
In a statement, PhRMA called the study out of date and…
…maintained that samples were one way to tackle the problem of getting prescription drugs to the estimated 47 million Americans without health insurance. But William Shrank, a physician who studies pharmaceutical use in large populations at Boston’s Brigham and Women’s Hospital, told Reuters that the study “helps debunk the assertion” that samples help the needy.
Nearly 47 million people in the United States don’t have health insurance, and lack of access to regular medical care by the uninsured and underinsured is a major factor contributing to the discrepancies in who gets free drug samples, the report said. The uninsured are more likely to get care from emergency rooms or clinics.
Dan
I’d like to add a possibility to the statements in this post:
Believe it or not, and fortunately, there are pharma reps that exist that intentionally sample doctors and offices that primarily see and treat those with limited income for this reason. And I applaude such pharma reps. for discovering such doctors and offices and deviating away from the objectives of thier employers with intent.
Kinda cool.
Atlex
It is interesting to note how the authors define needy vs. wealthy. One part of their analysis suggests that 200% of poverty level defines needy. It can be argued that a large percentage (maybe half) of those who fall below 200% of the FPL are in Medicaid programs (~40M million people) and receive drugs at little or no co-pay. While these people may be impoverished, they don’t necessarily have the need for free drugs via samples. In addition, many states have programs to provide drug access to children, women and the elderly (prior to Medicare Part D). Also, every large pharmaceutical company has a program to provide free drugs for people under 200% of the FPL. On the other hand , one could argue that someone who is at 300% of poverty level may be extremely needy in repsect to paying for medications. Perhaps, physicians understand this and use samples on this middle income group.
Bottom line…this studies has a number of flaws in its design and analysis. Because of these flaws, it really doesn’t contribute much to the debate.
Dan
To the previous post, what you said was said very well. What was most notable about your comment is that there is a debate and there needs to continue to be a debate regarding such issues. Yes, I too question the conclusions of this study, yet I can assure you that there is a direct correlation between the amount of samples a health care provider receives and the volume of prescriptions that they write in thier practice, which virtually every pharmaceutical company is aware of with the data that they acquire and distribute to thier representatives.
Mike L
Why is it that because samples are PRIMARILY a marketing tool, they can’t ALSO help those in need. This seems like a false dichotomy to me. I think that PhRMA is doing a disservice to the industry by trying to deflect criticism of drug sampling by saying, “But samples help the poor!” They should instead say, “Hey . . . what’s better than to get a sample of the drug you’re being prescribed so that you can see how well it works . . . or so that, at least, you don’t have to pay for the entire prescription?” Samples help everyone to some extent. There’s an argument out there that equates pharmaceutical companies to drug pushers, but, frankly, it’s juvenile. To equate prescription (non-narcotic) drugs to illegal substances of abuse demeans those suffering from true addiction and stigmatizes those who truly need medicine. But I digress . . .
As stated above, poverty doesn’t adequately define need. The physicians who need samples the least are those who see patients that are strictly Medicaid. Those patients can, for the most part, get their drugs for free. The patients most in need of samples are the underinsured. These are patients that have to choose between food and drugs. These are, most likely, the people physicians give their samples to.
Ed Silverman
Just a quick note to say Lilly ended its Patient Assistance Program earlier this year and then replaced it with another, but smaller program. You can read that here…
http://www.pharmalot.com/2007/04/at_lilly_pap_is_profit_assista/
We’re not aware of any change, but if one has been made, please let us know.
ed at Pharmalot
Joana Ramos
Based on the above comments, there seem to be some misunderstandings about how the Medicaid program really works, about the patient assistance programs (PAPs),and about the kinds of drugs that are usually sampled.
To be brief, while there are a basic minimum set of federal mandates for Medicaid (both the child and adult programs), each state sets its own eligibility rules and scope of coverage. It is not true that patients on Medicaid ” get their medicines for free.” Presently many states limit the number of scripts per month that a patient can receive, with a total of 4 allowed not uncommon. In some states, the Medicaid program charges co-pays per script. Many patients on Medicaid also are unable to receive the specialty care they need, including for monitoring of chronic conditions , because many physicians will not accept patients on Medicaid due to the very low reimbursement they receive from the state. In general,insurance via Medicaid is lean and mean, and in some states, things are quite dreadful. For details, see the monthly Medicaid Watch report on the website of the National Health Law Program.
Regarding the PAPs, patients are forced to play a sort of cat-and-mouse game with the pharmas to be able to get through the hoops to possibly be able to get a limited quantity of a needed drug. These programs usually have complex, lengthy documentation and application procedures, a separate application is needed for each individual drug even from the same manufacturer, and the entire process must be repeated at least several times per year. The programs also frequently have the same citizenship/immigration status rules as does Medicaid, making them off-limits to many who might qualify by the income guidelines. Like their newer cousins, the co-pay assistance programs, the PAPs too may have monthly quotas of how much assistance they will offer.
The rationale for PAPs appears to be yet another ploy to try to convince the public and policymakers that that there is no need for regulation of drug prices, as “something” is being done to promote access to medicines.
Sampling, in the same vein, is usually publicized as a “community service” measure, while in reality the samples are for some of the newest , most expensive drugs,in order to accustom both prescribers and patients to their use. Readers of this blog, and of sites like Healthy Skepticism, should be aware that the newest drug may not necessarily be the best, and in some cases may be dangerous.
While those of us in the trenches of healthcare help our current patients to access and navigate all of the above programs, many of us also take the knowledge gained to also work at the policy level. Advocates see over & over again that these programs are not the answers to the real problem of the need for universal access to quality, affordable care.
Joana Ramos, MSW
Cancer Resources & Advocacy
http://ramoslink.info/
http://www.bmtbasics.org
Atlex
Ed, please take a look at this link (http://www.lilly.com/products/access/direct_patient.html). As you will read, Lilly has clearly not ended its patient assistance programs. It specifically ended one program that was targeted at seniors and replaced it with a program designed to work as a complement to Medicare Part D. There are a number of additional programs targeted at various patient segments.
Atlex
James
I love when Atlex and others like him (her?) post responses. Rather than jumping to conclusions, or accepting the conclusions drawn by researchers and others, Atlex actually looks at the data and methodology and points out the flaws. Thanks for doing so.
Very valuable critical reasoning skill, and very important to such discussions. If only Atlex were moderating the Presidential debates.
Anna
WSJ Health Blog has a good piece on the subject as well
http://blogs.wsj.com/health/2008/01/02/poor-get-short-shrift-on-drug-samples/