Free drug samples may alter prescription habits of dermatologists

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1. For treatment of acne vulgaris, 79% of nationwide prescriptions were written for brand-name generic and brand-name drugs, whereas a large academic medical center (LAMC) that banned samples only had 17%. 

2. In the case of an office-visit for acne, the utilization of branded and branded-generic drugs nationwide translated to an increased retail cost of $465 vs. $200 at a LAMC. 

Evidence Rating Level: 2 (Good)

Study Rundown: Theoretically, free drug samples offer patients the opportunity to try an expensive drug without shouldering the expense. However, studies have documented that samples often aren’t provided to patients who would financially benefit from their usage, and furthermore that free samples may influence the prescribing patterns of physicians. This study sought to investigate whether the provision of free medication samples affects the prescribing behavior of dermatologists associated with acne vulgaris and rosacea.  This study compared national data on prescribing patterns, in which free samples are thought to be ubiquitous, with the prescribing patterns for the same conditions at a large academic medical center (LAMC), at which free samples have been banned. On a national-level, this study showed that prescription patterns of brand-name drugs and brand-name generics have increased and were correlated with increased provision of samples of these drugs. A strength of this study was the inclusion of pooled data from two national databases. However, limitations exist. The authors did not look into other forms of marketing that may influence physicians, including visits from pharmaceutical representatives and co-payment discount cards. Furthermore there was no multivariate regression analysis to account for the different demographics of patients seen at the LAMC, which consisted of a reported larger Medicare and Medicaid population as compared to those seen in national practice.  Such a difference may have the potential to influence the choice of brand-name vs. generic medication.

Click to read the study in JAMA Dermatology

Relevant Reading: Drug Samples in Dermatology: Out of the Closet, Into the Dustbin

In-Depth [cross-sectional study]: The study pooled national data on prescriptions for acne vulgaris and rosacea, two of the most common dermatologic conditions, from the National Disease and Therapeutic Index (NDTI), a survey of US physicians that provides nationally representative information on diagnosis and treatment of various diseases and compared this with prescriptions of medications for the same treatments at a LAMC that banned free drug samples. Analysis of NDTI showed the overall percentage of samples provided to dermatologic patients increased from 12% in 2001 to 18% in 2010, as compared to the composite decrease of free samples prescribed from other specialties, which was down to 4% in 2010 from 7% in 2001. For acne vulgaris particularly, NDTI data showed free samples increased from 10% in 2001 to 25% in 2010. Using Pearson product moment correlation they analyzed the relationship between sample availability and the proportion of branded-generic prescriptions written. There was strong correlation between the most frequently prescribed acne medications and those commonly prescribed with samples (r=0.92). 9 of the 10 most popular drugs prescribed for acne nationwide in 2010 were brand-name generics, as compared to the LAMC, at which 9 of the 10 most popular acne drugs were generic drugs.

More from this author: Teledermatology may be reliable in triaging inpatient dermatology consultations, Atopic dermatitis may be more persistent than previously understood 

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