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Free drugs are a prescription for higher health care costs

A free sample sounds like a good deal. But when it comes to samples of pricey brand-name prescription drugs, good things come to an end quickly and can result in tough-to-swallow medical bills.

"After the sample runs out the consumer may face higher co-pays if they have insurance, or if they don't have insurance, they're going to be scrambling to pay," says Wells Wilkinson, director of the Prescription Access Litigation Project for Community Catalyst in Boston, a nonprofit consumer advocacy group for affordable health care.

That’s because free samples are typically offered for the newest and most expensive drugs. Once your free sample runs out and you go to the pharmacy, you may get sticker shock.

free prescription drugs"Samples are the No. 1 most important marketing tool drug companies have," says Dr. Adriane Fugh-Berman, director of PharmedOut, a Georgetown University-based research and education project that addresses industry influence on prescribing medications. "They affect what drugs are prescribed and what drugs are used, and are bad for patient care."

Sales representatives visit doctors' offices to tout the newest products, answer questions and provide free samples. Then drug companies use pharmacy data to hone their marketing tactics according to which drugs doctors prescribe and how frequently they prescribe them. Concerned about rising health care costs, Vermont passed a law in 2007 that forbade drug companies from using doctors' prescription data for marketing, but the U.S. Supreme Court struck down the law in June, ruling it violated drug companies' First Amendment rights.

The good life of free drug samples

Many doctors like free samples. The Pharmaceutical Research and Manufacturers Association says free drug samples have helped improve quality of life for millions of patients. In a 2010 media statement, PhRMA Senior Vice President Ken Johnson pointed to a study by KRC Research that found more than 90 percent of doctors say free drug samples help them determine whether a medicine works for a patient before filling a full prescription. Most doctors (75 percent) report they give out free drug samples to help patients with out-of-pocket costs, according to the Kaiser Family Foundation.

However, Wilkinson says, "Many doctors do not have any idea of how much a particular drug costs."

The difference in prices between brand-name drugs and generics is startling.

Take Lipitor and Nexium, the No. 1 and No. 2 selling drugs in the last four years. The generic alternatives, which, although not identical, have scientifically been shown to be as effective, cost one-tenth the price of the brand-name drugs, Wilkinson says.

After a patient accepts a free sample, a doctor typically will write a prescription for that drug and will tend not to switch to another alternative if the drug works. Critics of free samples say they interfere with doctors' prescribing decisions. A 2000 study published in the Journal of General Internal Medicine found samples may influence physicians to prescribe drugs that were not their first choice.

You’ll pay, one way or another

Even if your health insurance covers most of the cost of an expensive drug, you and other people on your group health insurance plan will ultimately pay for it through higher premiums, Wilkinson says. The higher the costs for the insurance company, the higher the premiums the next year.

Safety is another concern. The newest drugs on the market generally have been tested on groups of 3,000 to 5,000 people in clinical trials, Wilkinson says.

"But we really don't understand the safety profile until a drug has been taken by tens and hundreds of thousands of people," he says.

Vioxx, for example, was widely promoted through samples about 10 years ago. Within two years it was withdrawn from the market because of safety concerns.

There has been some movement away from brand-name drug samples in recent years as a growing number of health systems prohibited physicians from accepting gifts from pharmaceutical companies, including drug samples. In 2009, 64 percent of doctors still accepted free drug samples, compared to 78 percent of doctors in 2004, according to a survey by Boston researchers published in the New England Journal of Medicine in 2010.

Meanwhile, some health insurance companies are experimenting with providing doctors with free generic drug samples. Eighteen health plans in eight states have partnered with MedVantx in San Diego, which provides sample cabinets stocked with generic drugs and preferred brand-name and over-the-counter medications aligned with insurers' drug formularies. Each cabinet includes an electronic interface that tracks the samples provided. Doctors can give only one full course supply of a drug per patient, such as a 30-day supply for a drug taken daily for a chronic condition. MedVantx also operates a mail-order pharmacy service available to patients who receive samples.

Susan Hogue, director of managed care networks and clinical services, says studies done by health plans have shown a 7-to-1 return on investment in their partnerships with the company.

Don't be afraid to talk about costs when your doctor prescribes a drug. If you're given a free sample of a new brand-name drug, Wilkinson says, ask if there's a generic or a lower-cost brand-name medication that can treat your condition.

Says Fugh-Berman: "Give it back and say, ‘Actually, I'd like a time-tested drug.’”

More from Barbara Marquand here

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