Free Dermatological Drug Samples Increase Prescription Costs

Laird Harrison

April 18, 2014

Free drug samples given to dermatologists can increase overall prescribing costs, a new study shows.

"The benefits of free samples in dermatology must be weighed against potential negative effects on prescribing behavior and prescription costs," conclude Michael P. Hurley, MS, from the Department of Health Research and Policy, Stanford University School of Medicine, California, and coauthors.

The authors report their findings in an article published online April 16 in JAMA Dermatology.

Free drug samples have stirred controversy for years. Advocates say they can help provide uninsured and poor patients with drugs they could not otherwise afford. In addition, the free drugs might give patients an opportunity to try various drugs until they find the one that works best, and they could give physicians a chance to see whether new drugs work better than old ones.

However, the free samples do not necessarily go to the patients who cannot afford their own prescriptions, the samples may not include all the information patients need to take them safely, and they may add indirectly to healthcare costs.

To get a better idea of the effects of free samples, Hurley and colleagues looked into prescription patterns for acne vulgaris and rosacea.

They focused on acne because it is common, lots of dermatologists get free samples for acne medications, the medications have not changed much in the past decade, and there are multiple bioequivalent drugs sold under different brands.

To measure the effects of free samples, the researchers compared data from Stanford University, which does not give out sample drugs, with data from the National Disease and Therapeutic Index, a nationally representative survey of primarily office-based US physicians conducted by IMS Health.

The authors compared branded drugs with generics, as well as branded generics, which they defined as "products that have novel dosage forms of off-patent products or...use a trade name for a molecule that is off patent."

From 2001 to 2010, the proportion of prescriptions written with a sample by dermatologists has increased from 12% to 18%, whereas the aggregate proportion for all other specialties decreased from 7% to 4%. For acne vulgaris and rosacea, for example, the proportion of prescriptions written from a sample has increased from 10% to 25% during that time. The proportion of branded generic drugs increased in tandem, whereas the proportion of generics remained flat.

The top 5 drugs prescribed for acne vulgaris and rosacea change from year to year, but most years this list is similar to the list of the medications most often prescribed with a sample. Only 1 of the 10 most commonly prescribed acne drugs at Stanford was among the top 10 drugs prescribed nationally.

Among the commonly prescribed medications, 17% of those at Stanford were branded or branded generics compared with 79% nationwide. Among the top 20 most prescribed acne medications, the mean estimated costs of medications per patient visit nationally was $465 compared with $200 at Stanford.

"With rising retail costs of prescription drugs, it will be ever more important for physicians to be cognizant of how pharmaceutical marketing practices can affect their habits and potentially inflate the cost of prescribed drugs," the authors conclude.

The study was supported by the National Institutes of Health and the Stanford Translational Research Integrated Database Environment. One of the authors reported past expert testimony for Mylan Pharmaceuticals, a manufacturer of generic medications, regarding patterns of doxycycline use in rosacea.

JAMA Dermatol. Published online April 16, 2014. Abstract

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