Among private practitioners, the question of whether to accept free pharmaceutical samples is highly contested. The arguments on either side can be narrowed down to three main areas of concern: patient health, logistics, and ethics.
Patient health. Perhaps the most persuasive argument in favor of dispensing free drug samples relates to patient benefits. According to most studies, patients are more likely to begin and continue treatment when they are provided with an initial dose at no cost, even among those who are not financially disadvantaged.
Samples are particularly valuable to primary care physicians, who treat a variety of acute and chronic conditions, says Ly-Le Tran, MD, JD, an associate professor in the Program in Bioethics, Law, and Medical Professionalism at the University of Florida College of Medicine who has written about bioethics. “Not everyone responds to one particular class of drugs,” says Tran. “Samples allow us to more easily switch to another drug when one doesn’t work.”
Logistics. Although the drug samples themselves are free, methods for storing, labeling, tracking, and prescribing these drugs may not be. There is widespread agreement that simply tossing samples into an unorganized cabinet and handing them out as needed is a recipe for disaster. There is also the matter of state law. Although the federal government continues to permit samples, state laws vary, and practices must not only comply with existing statutes but also monitor updates.
Not all practices have the bandwidth for this. And even those that do will forego the extra safeguards offered by pharmacists whose fulltime job is to preclude adverse effects, allergic reactions, contraindications, and administration of duplicate therapies and expired medications.
Ethics. In a world of rapidly increasing drug prices, many argue that free samples encourage overprescription of brand-name drugs even though less expensive generics would be equally effective. However, a study of a large cohort of Medicare patients found that “policies restricting or prohibiting drug sample distribution may adversely impact access to medications among patients in high-risk groups.” But other studies have found that limiting samples reduces branded prescribing.
It is ultimately a challenging but attainable judgment call, concludes Tran. “I’ve seen the benefits that samples provide to patients,” she says, “and they outweigh the potential problems.”