Free drugs: Just say no?

“Everybody likes something free.” I don’t think anyone is going to disagree with Chimonas and Kassirer there.

Drugs are expensive. And even if in a country like Australia, universal insurance may mean that vital medicines are cheap for the end-consumer, somewhere someone has pay the full price (i.e. the government).

Because drugs are so expensive, many drug companies – particularly when releasing a new product, will offer “free samples”. Now these aren’t quite like a give-away taste-test counter like at the local deli – the drugs still need to be prescribed by the doctor to a sick patient – but the principle is the same. You try it, and if it works, hopefully you’ll buy the real deal.

Sounds great! Hospitals get free medicines. Doctors learn about new treatments. Patient receives expensive treatment cheaply. And Pharma makes a friend. Everyone is a winner! What’s not to love?

Well… turns out it’s not quite the rosy picture we’d pictured. PLoS Medicine carries an investigative essay on the ramifications of free drug samples on the health care system.

Summarised points below:

1. Samples do not go to those who need them most. Samples are more likely to end up prescribed to high-income insured patients. This has to do with which hospitals and doctors drug reps target.
2. Samples are almost always new drugs. Well-established, popular and reliable drugs are not given as samples. One doctor: “They are not bringing us samples of things we need…They are bringing us things they want us to know about.”
3. Samples end up costing health care services more in the long run – by getting doctors in the habit of prescribing an expensive treatment, when a cheaper alternative may be available.
4. Similarly, any low-income patients who are prescribed an expensive sample drug may feel “locked in” to their regime, when a low cost alternative may have been available all the long.
5. As “freebs” documentation and regulation of samples can often be more lax – expiry dates may be ignored, patients may not be notified of recalls, and some samples just go missing at “unknown destinations”.

You might think that in at least one way Pharma would be happy to hear this. They now have socially responsible excuse to stop giving things away for free. They can save money, and clean up their image. But this is probably where we step into Big Pharma Conspiracy territory.

Free samples represent a solid investment for Pharma. The authors estimate that “between 1996 and 2000, [free drug samples] accounted for slightly more than half of the total promotional dollars spent by industry.” That kind of money does not get invested into programs that do not have significant return on investment.

Maybe Pharma can be convinced the money is better spent elsewhere? Maybe on a whole bunch of independent medical education activities – I’m sure there are agencies out there which help with that sort of thing…

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References
Chimonas, S., & Kassirer, J. (2009). No More Free Drug Samples? PLoS Medicine, 6 (5) DOI: 10.1371/journal.pmed.1000074

Image Credit: FREE DRUGS! by Miss Cuppy ©All rights reserved