Estimates and Predictors of Prescription Medication Sample Use in the US
Estimates and Predictors of Prescription Medication Sample Use in the US
Objectives: To determine the prevalence of free medication sample use in the United States and analyze the effects of socioeconomic status and drug safety actions.
Design: Cross-sectional study.
Setting: United States from 1999 to 2005.
Participants: Survey respondents representative of the civilian noninstitutionalized population.
Intervention: Analysis of data from the Medical Expenditure Panel Survey, a nationally representative longitudinal household survey.
Main outcome measures: Identification of a medication as being provided as a sample at least once during a study year.
Results: An annual average of 5.1% (range 4.4% in 2005 to 5.8% in 2002) of all prescription medications were provided as a sample at least once during a year, with 18.3% of all Americans who received at least one prescription drug receiving at least one drug as a sample. On multivariate analysis, sample use was greater among young (18–30 years) non-Hispanic whites and the uninsured but had minimal independent association with income. The proportion of sample use among users of hormone replacement therapy and cyclooxygenase-2 inhibitors remained relatively constant even as total use of these drugs declined after Food and Drug Administration regulatory action.
Conclusion: Use of medication samples is common in the U.S. population. After adjusting for health insurance, sample use was not associated with income and samples were less frequently provided to racial/ethnic minorities and to the elderly. The putative economic benefits of free samples do not appear to go to patients with the greatest financial need. Drug regulatory actions did not have a disproportionate effect on provision of drugs as samples.
Providing free medication samples to prescribers (physicians, nurse practitioners, dentists, and other clinicians) for distribution to patients is a popular marketing approach used by pharmaceutical companies to promote use of their medications. Physicians and patients have generally favorable views of the availability of medication samples; perceived benefits include avoidance of cost to the patient, ability to initiate therapy immediately, and ability to evaluate medication effectiveness and tolerability. Compared with other pharmaceutical marketing techniques (e.g., free meals or paraphernalia), acceptance of samples is viewed as more ethical and appropriate. Despite the popularity of the practice, a number of concerns exist regarding sample use. Sample use bypasses the role of the pharmacist in screening for drug interactions, optimal dosage, and allergies. Adherence to requirements for proper storage and record keeping of medications samples is poor, which may complicate the tracking of patients using particular samples in the event that a recall is required. The availability of samples may have a substantial impact on prescribing behavior, leading to the use of costly brand-name medications in place of generic alternatives. Studies performed on the effect of sample use on quality of care or patient outcomes have examined the role of samples in the management of hypertension and found that compliance with national guidelines for treatment was less common and blood pressure was slightly higher among patients treated with samples. Groves at al. reviewed 23 studies of prescription drug sampling and found a lack of well-designed studies addressing these issues. Nevertheless, these concerns have led a number of university medical centers to ban or severely restrict sample use.
Because provision of medication samples bypasses the systems most commonly used to estimate aggregate medication use (pharmacy dispensing records and insurance billing records), studying sample use on a national level is challenging. Data obtained from a medical information company survey of office practices suggested that the total retail value of free medication samples tripled from $6 billion in 1996 to $18 billion in 2005. Several recent studies have attempted to characterize medication sample use in nationally representative surveys in single years. Cutrona et al. used the Medical Expenditure Panel Survey (MEPS) to estimate the use of medication samples in the United States in 2003 and found that 12% of the civilian population reported receiving at least one medication sample during that year. Socioeconomic characteristics of respondents were studied, and likelihood of sample receipt was found to be similar regardless of income or medical insurance status. Analysis of data from the 2004 Medicare Current Beneficiary Survey revealed that 48.3% of Medicare beneficiaries reported sample access. Sample use was higher among those who reported problems adhering with their regimens as a result of cost concerns and those lacking prescription drug benefits. Alexander et al. used data from the 2002–03 MEPS survey to examine out-of-pocket prescription costs associated with sample use. Among the 14% of individuals receiving at least one sample, out-of-pocket medication expenditures were higher during the periods they were receiving samples.
Abstract and Introduction
Abstract
Objectives: To determine the prevalence of free medication sample use in the United States and analyze the effects of socioeconomic status and drug safety actions.
Design: Cross-sectional study.
Setting: United States from 1999 to 2005.
Participants: Survey respondents representative of the civilian noninstitutionalized population.
Intervention: Analysis of data from the Medical Expenditure Panel Survey, a nationally representative longitudinal household survey.
Main outcome measures: Identification of a medication as being provided as a sample at least once during a study year.
Results: An annual average of 5.1% (range 4.4% in 2005 to 5.8% in 2002) of all prescription medications were provided as a sample at least once during a year, with 18.3% of all Americans who received at least one prescription drug receiving at least one drug as a sample. On multivariate analysis, sample use was greater among young (18–30 years) non-Hispanic whites and the uninsured but had minimal independent association with income. The proportion of sample use among users of hormone replacement therapy and cyclooxygenase-2 inhibitors remained relatively constant even as total use of these drugs declined after Food and Drug Administration regulatory action.
Conclusion: Use of medication samples is common in the U.S. population. After adjusting for health insurance, sample use was not associated with income and samples were less frequently provided to racial/ethnic minorities and to the elderly. The putative economic benefits of free samples do not appear to go to patients with the greatest financial need. Drug regulatory actions did not have a disproportionate effect on provision of drugs as samples.
Introduction
Providing free medication samples to prescribers (physicians, nurse practitioners, dentists, and other clinicians) for distribution to patients is a popular marketing approach used by pharmaceutical companies to promote use of their medications. Physicians and patients have generally favorable views of the availability of medication samples; perceived benefits include avoidance of cost to the patient, ability to initiate therapy immediately, and ability to evaluate medication effectiveness and tolerability. Compared with other pharmaceutical marketing techniques (e.g., free meals or paraphernalia), acceptance of samples is viewed as more ethical and appropriate. Despite the popularity of the practice, a number of concerns exist regarding sample use. Sample use bypasses the role of the pharmacist in screening for drug interactions, optimal dosage, and allergies. Adherence to requirements for proper storage and record keeping of medications samples is poor, which may complicate the tracking of patients using particular samples in the event that a recall is required. The availability of samples may have a substantial impact on prescribing behavior, leading to the use of costly brand-name medications in place of generic alternatives. Studies performed on the effect of sample use on quality of care or patient outcomes have examined the role of samples in the management of hypertension and found that compliance with national guidelines for treatment was less common and blood pressure was slightly higher among patients treated with samples. Groves at al. reviewed 23 studies of prescription drug sampling and found a lack of well-designed studies addressing these issues. Nevertheless, these concerns have led a number of university medical centers to ban or severely restrict sample use.
Because provision of medication samples bypasses the systems most commonly used to estimate aggregate medication use (pharmacy dispensing records and insurance billing records), studying sample use on a national level is challenging. Data obtained from a medical information company survey of office practices suggested that the total retail value of free medication samples tripled from $6 billion in 1996 to $18 billion in 2005. Several recent studies have attempted to characterize medication sample use in nationally representative surveys in single years. Cutrona et al. used the Medical Expenditure Panel Survey (MEPS) to estimate the use of medication samples in the United States in 2003 and found that 12% of the civilian population reported receiving at least one medication sample during that year. Socioeconomic characteristics of respondents were studied, and likelihood of sample receipt was found to be similar regardless of income or medical insurance status. Analysis of data from the 2004 Medicare Current Beneficiary Survey revealed that 48.3% of Medicare beneficiaries reported sample access. Sample use was higher among those who reported problems adhering with their regimens as a result of cost concerns and those lacking prescription drug benefits. Alexander et al. used data from the 2002–03 MEPS survey to examine out-of-pocket prescription costs associated with sample use. Among the 14% of individuals receiving at least one sample, out-of-pocket medication expenditures were higher during the periods they were receiving samples.
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