A distortion of sample size?

Abstract

The costs and needs of health care continue to increase in a down-trending economy. Pharmaceutical companies have pared down their sales forces; it is hypothesized that fewer field representatives are leaving fewer sample medications. We have surveyed sample medications (and their average wholesale price costs) given to our allergy practice during the last 12 years and first 4 months of 2009 (Table 1).1,2 This calendar year, we estimate that the pharmaceutical industry is extrapolated to give our practice $340,000 worth of samples and an additional $65,000 in free vouchers. Comparisons to past years must take into account not only escalating drug costs but also that our practice has oscillated between 1 and 2 physicians and 1 and 2 nurse practitioners straddling 2 to 3 offices.3 Taking all factors (eg, inflation, type of health care professional, practice locations) into account, we estimate that the number of donated samples has decreased 25%. The provision of 1 drug, fluticasone propionate (Advair) decreased substantially in sample volume from $125,000 to $88,000 when comparing 2005 with 2009. This difference was made up for by other drugs in its class entering the marketplace. In addition, vouchers for free medication, noticeably on the rise, made the total amount of medicine given relatively stable. The corporate strategy of sampling seems healthy, albeit changing. Sample medications, often maligned,4,5 remain a key marketing vehicle for pharmaceutical companies and an important adjunct to help patients experience a drug before incurring its cost. Sample medications may also help indigent patients with acute care needs and help bridge them to patient assistance programs that supply medications for chronic disease states. One nonprofit organization, TheDispensary ofHope (www. dispensaryofhope.org), has provided a conduit for interested physicians of all types to contribute a portion of their samples to less fortunate individuals. To date, samples worth upwards of $20,000,000 have been given and, in turn, forwarded to both uninsured and underinsured patients in 7 states who earn less than 200% of the federal poverty guidelines. Pharmaceutical companies’ contributions remain significant over time and, although somewhat less relative to the past, may be more meaningful than ever to patients at this time.