An Unexpected Cost of Using Free Drug Samples

Doctors may automatically follow up with a prescription, skipping a cheap generic.

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"Ask your doctor for drug samples" is one of those predictable bromides offered anytime the subject arises of how to save money on prescription drug costs. But now a study says those freebies might actually end up costing uninsured patients more in the long run.

Why? Drug company sales reps distribute samples of the latest brand-name drugs to doctors' offices in the hope that physicians will start prescribing them. Often enough, they do, even when the choices include older but effective generic drugs that are much cheaper. This isn't the first study to find that dishing out drugs from the sample closet can cost patients more out of pocket in the long run. But this particular study focused on people without health insurance, who are likely to feel the sticker shock of a brand-name drug more acutely than patients who only have to consider a copayment.

The study examined what happened after a 70-physician practice in Illinois relocated and no longer had room for a drug sample closet. The study found that, lacking easy access to brand-name samples, doctors switched gears. The percentage of generics prescribed to uninsured patients in four drug classes rose from 12 percent to 30 percent of the total. At the new office, it turned out, physicians were three times more likely to prescribe generic drugs to their uninsured patients. "I was surprised at the magnitude of the impact on prescribing," says David Miller, an associate professor of internal medicine at Wake Forest University Baptist Medical Center and the study's lead author.

When drug samples are available, doctors often send patients home with a prescription for the drug, too. Or a patient may come back to the doctor's office and ask for another free sample; if the office has run out, the doctor may prescribe it. The take-away here is not to turn down drug samples: By all means, take them. But also ask about cheaper alternatives if it turns out you need more. This is obviously most critical for uninsured patients, but it also can make a significant difference to people whose tiered drug benefit requires higher copayments for certain drugs.

Here are some other ways to save on prescription drugs.

While you're asserting yourself about drug prices, you might want to head over to the U.S. Pharmacopeia website and check out the group's new "drug error finder" Web tool. The searchable database of nearly 1,500 drugs reported in medication mix-ups since 2003 lists those that look or sound like another drug. So, for example, if you type in the popular gastric reflux drug "Prilosec," you learn that it has been confused with the steroid prednisone and the antidepressant Prozac, among others.

The idea, of course, is to help you avoid medication errors that kill thousands of people every year. Bad handwriting, fuzzy fax transmissions, and computer glitches all contribute to the problem, says Diane Cousins, vice president for healthcare quality and safety at USP. Armed with a list of drug names similar to that of the one you're supposed to take, you'll be better equipped to pick up on mistakes before you pop that pill. Recently, I wrote about another website that compares drug names used in the United States with drug names overseas that are similar or even identical to one another even though the drugs are entirely different.