From: Reuters
Published January 2, 2008 05:03 PM

Free drug samples go to wealthy, insured: U.S. study

By Kim Dixon

WASHINGTON (Reuters) - Insured and wealthy Americans are more likely than needy patients to get the billions of dollars in free drug samples distributed by pharmaceutical companies to win patient and doctor loyalty, a study released on Wednesday said.

Free prescription samples are popular with doctors who want to try new drugs, and the pharmaceutical industry contends that such samples also help the low income and the uninsured.

But the study of prescription use of nearly 33,000 U.S. residents during 2003 found the neediest are least likely to get free samples.

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"Our findings suggest the free samples serve as a marketing tool, not a safety net," said Dr. Sarah Cutrona, co-author of the report to be published in the February issue of the American Journal of Public Health.

The Pharmaceutical Research and Manufacturers of America (Phrma), a trade group representing most major drugmakers, in a statement called the study out of date. It said samples were one way to tackle the problem of getting prescription drugs to the estimated 47 million Americans without health insurance.

About $16.4 billion in free drug samples were distributed in the United States in 2004, up from $4.9 billion in 1996, the study said. Samples are nearly always the newest and most expensive prescriptions, according to the report.

Distributed by thousands of sales representatives, the samples distribution has been controversial.

Critics said the samples and representatives steer doctors and patients to the priciest drugs, and spur use of prescriptions for ailments not originally intended or tested.

The now-recalled painkiller Vioxx, made by Merck & Co <MRK.N>, was the most frequently distributed free drug sample in 2002, the study found.

Use of Vioxx beyond the intended patient population was cited as a factor contributing to findings that it increased rates of heart attack and stroke in some patients, which eventually led to the drug's withdrawal.

Phrma said many drug representatives are healthcare professionals.

WHO DO THEY HELP?

The study, which analyzed U.S. government data in a 2003 nationally representative survey, found that about 12 percent of all Americans have received at least one free sample.

About 13 percent of those with insurance were given a sample, while about 10 percent of those uninsured for all or part of the year got one, a statistically significant finding.

Similarly, of all sample recipients, 72 percent had income above 200 percent of the federal poverty line, while 28 percent had incomes below that level.

William Shrank, a physician who studies pharmaceutical use in large populations at Boston's Brigham and Women's Hospital, said the study "helps debunk the assertion" that drug samples help the needy.

Brigham now bans sales reps, but Shrank described how early in his career he worked at academic centers where reps roamed the halls freely. For doctors short of time and unable to keep up with medical literature, "You are getting biased data. It's not objective," he said.

Nearly 47 million people in the United States lack health insurance, making it an issue looming large among voters in the 2008 presidential election.

Lack of access to regular medical care by the uninsured and underinsured is a major factor contributing to the discrepancies in who gets free drug samples, the report said.

The uninsured are more likely to get care from emergency rooms or clinics.

(Editing by Braden Reddall/Leslie Gevirtz)

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