Free drug samples spur higher costs

Dermatologists are less likely to prescribe generic drugs when they are provided with samples of brand name drugs to give to their patients, a new study suggests.

Researchers from Stanford University School of Medicine found that even though physicians believe access to samples doesn’t bias their decisions or recommendations, dermatologists with access to free samples tend to write prescriptions for the samples more often than for generics. The study also found that the average prescription price for dermatologists with samples was roughly double the average price of dermatologists without samples.

The study was initiated after Stanford Medicine instituted a policy in 2006 preventing its physicians from accepting free samples and other industry gifts. Alfred Lane, M.D., an emeritus professor of dermatology and pediatrics at Stanford and the study’s senior author, noticed cost discrepancies between the prescriptions he prescribed and those written by other area physicians.

“I think the most important finding of this study is the fact that patients’ expenses for prescriptions are much higher than what I or, probably, most doctors expected,” Dr. Lane tells Dermatology Times. “Patients are grateful for the gift when they get these samples, but they don’t realize the potential future cost to them or their insurance companies.”

Dr. Lane and colleagues focused their study on medications prescribed to treat adult acne. They examined the prescribing patterns of dermatologists in the National Disease and Therapeutic Index database, which contains survey self-reported results of primarily office-based physicians. Participating doctors regularly self-report aspects of their clinical encounters, including whether they wrote a prescription for a particular drug (without also giving a sample), gave a sample of a medication (without writing a prescription) or gave both a sample of and a prescription for the same drug.

The researchers then compared the prescribing patterns of physicians at the academic medical center with those of doctors in the database and calculated the retail price of prescribed medications for a single visit in 2010 for adult acne. The results showed that nearly 80 percent of prescriptions issued are either branded generic drugs - new dosages or trade names for off-patent drugs, such as OxyContin or Concerta - or name-brand drugs. In contrast, among dermatologists without access to free samples, fewer than 20 percent of prescriptions issued are for either branded generic or name-brand drugs.

The study found that the average retail cost of prescriptions written by physicians with access to free samples was $465, more than double the $200 retail price of prescriptions written by physicians without access to the free samples.

“The benefits of free samples in dermatology,” the researchers wrote, “must be weighed against potential negative effects on prescribing behavior and prescription costs.”

The study was published online April 16 in JAMA Dermatology.