There have been many arguments against physicians giving out free "samples" of pharmaceuticals. I understand what the experts say. They argue that in the end, the free medicine costs patients more because we have a tendency to hand out the free, more expensive branded product before we consider cheaper alternatives. They argue that visiting with cute (or handsome) drug reps will change the way we prescribe, specifically, that we will prescribe more of that sales reps product. They argue that Big Pharma has built in so much profit into their branded medicines that the free samples are a drop in the bucket, and that even one new script will bring in profit enough to support the "hard sell" we doctors get from the reps. I completely understand these arguments. There is some validity to them. However, I feel the need to offer some retort.
With so many excellent generic medicines available, a physician would have to be really disconnected from their patient to not reach for a generic first. We may not like this, but with deductibles continuing to rise, we are stewards of our patients health care dollars. It is in our best interests, outside of being incentivized to do so, to be as cost-effective as we can. This is true for all aspects of our job, whether it's medicines, test ordering, frequency of medical visits, et cetera.
My biggest concern about turning off the samples is that there are some excellent new medicines that have come on the market that physicians will be less likely to try if they don't take samples or see reps. It's not easy for us to learn about new classes of medicines. If I didn't visit with reps, I suppose I could go to a symposium, corner a colleague at the hospital, or ask a local pharmacist. Don't you think it is a little easier to have a brief conversation with a sales rep who can give you a 2 minute spiel, and leave some science behind?
Having samples allows me to test-drive some of these new therapies. I can give 2, 3, or 4 weeks of samples to a patient to see how they respond to the therapy. During this time, they can call their insurance to check on their out of pocket costs. I always let the patient decide if the medicine is worth their cost. In particular, with certain diabetes medicines like the new DPP-4 inhibitors, I will make a hard sell, because I truly believe that the cost is worth it. These new therapies don't have the dangerous side effects some of their older generic counterparts have.
I have a well organized sample closet in my practice. Honestly, we dispose of expired samples in at least a 6:1 ratio of samples we give to patients. If a patient fails generic therapy, or, if your professional opinion is that a branded medicine is a better choice, let the patient take the new medicine for a spin, before they drop $35 on a branded co-pay.
We just need to put our patients first. Period. Be the smartest guy on the block. Use your training and expertise to decide if you think a new therapy has merit, not the gleaming smile across the front desk or the Moo Goo Gai Pan they bring for lunch. Explain your decisions about the medicine you are prescribing to the patient. They'll understand. Remember, we are supposed to be our patients advocates. Let's behave like it.
