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Most Free Drug Samples go to the Wealthy and Insured

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Sarah L. Cutrona, MD, MPH
Steffie Woolhandler, MD, MPH
David U. Himmelstein, MD

Harvard Study Says Samples are a Not a Safety Net Despite Drug Company Claims to the Contrary

Click here to read the study.

Most free drug samples go to wealthy and insured patients and are not used to ease the burden of the poorest nor the uninsured, according to a study by physicians from Cambridge Health Alliance and Harvard Medical School. The study, which is the first to look at free drug samples nationally, will appear in the February, 2008 issue of the American Journal of Public Health.

The study found that use of free prescription drug samples is widespread. More than one out of every ten Americans received one or more free drug samples in 2003. Among Americans who take at least one prescription drug, nearly one out of five got free samples.

Few free samples went to the needy. Insured Americans and those with higher incomes were more likely to report receiving at least one free sample. More than four-fifths of sample recipients were insured all year. Conversely, less than one-fifth were uninsured for all or part of 2003, and less than one-third had low incomes (under $37,000 for a family of four.)

Free sample receipt was consistently higher among those with better access to medical care. Non-Hispanics, English-speakers and Whites were all more likely to receive free samples than were members of ethnic, linguistic or racial minorities. Receiving medical care in an office and taking more medications also increased the chances of receiving free drug samples.

Author Sarah Cutrona, a physician at Cambridge Health Alliance and an Instructor of Medicine at Harvard commented: "The distribution of free samples has become controversial. Evidence shows that free samples may influence physicians' prescribing behavior and cause safety problems. For instance, we found that the most widely distributed sample in 2002 was Vioxx, with Celebrex being number 3. These drugs turned out to have lethal side effects. While many doctors still view samples as a safety net for their neediest patients, our study shows that samples are potentially dangerous, and do little for the needy."

Senior co-author David Himmelstein, a primary care physician and an Associate Professor of Medicine at Harvard adds: "Drug companies usually decide which medical office gets which free samples. They distribute samples according to their marketing needs, not our patients' needs"

"Free drug samples are not the solution to the disproportionately low amount of health care resources going to the poor and uninsured; they are part of the problem," said Dr. Steffie Woolhandler, Associate Professor of Medicine at Harvard and study co-author.