Medication Samples: Should Physicians Provide them To Patients?

Have you ever received a sample of a medication from your doctor?

Medication samples are provided to physicians by drug companies. Physicians can then choose to provide these samples “free” of charge to their patients for a small duration, in order to determine if the patient tolerates the medication before they receive a prescription for a larger quantity and must pay for the medication themselves. This sounds like a great program at first glance, but there are many built in problems when physicians provide free samples to their patients.  Lets take a closer look.

Here is a real life example, showing how and why samples given to patients by physicians can be dangerous.

One of our patients went in for a regular specialist visit.  The specialist decided that the patient may benefit from a new medication that has come onto the market and provided the patient with a 1 month sample along with a prescription for the new medication to take to the pharmacy once the sample was complete. The patient then went home and started taking the sample from the doctor as directed. After about 2 weeks the patient started to feel “off”, with symptoms including a new tremor, confusion, sweating and shivering, but didn’t know what was causing the symptoms. The patient then decided to bring the new prescription to our pharmacy to put on file so as not to have to worry about losing the prescription. One of our pharmacists received the prescription from this patient and realized that this new medication was contraindicated for this patient due to a very severe interaction with one of the patients other medications. The symptoms that the patient was experiencing were related to a potentially life threatening drug interaction between the sample that the patient received and another medication the patient was already taking.  Thankfully, the patient came into the pharmacy before the interaction became life-threatening in this case. Our pharmacist immediately advised the patient to STOP taking the new sample medication and notified the doctor of the incident. The patients symptoms gradually disappeared after stopping the offending agent.

Here are the major problems that exist with physician providing medication samples:

  • The pharmacist is not part of the equation. Meaning no pharmacist will check if the new medication is safe for the patient or if it interacts with any of the patients current medications (including over-the-counter supplements and vitamins). Additionally, when a patient receives a sample medication from the doctor, they are rarely counseled on the efficacy and the potential side effects of the medication as this is the pharmacists role. This presents a safety risk for the patient.
  • Samples raise healthcare costs by promoting the the use of expensive products. Samples are generally for the newest medications on the market, therefore the most expensive. Drug companies provide the new and expensive medications as samples to doctors in  hopes that patients will end up taking them long term. Expensive samples are started, even when a cheaper and equally effective alternative is available. This increases healthcare costs for both the government (when it a government sponsored plan is involved) and the patient.
  • The sample medication may not be covered. In many cases the patient takes the sample for a month, then when they need more they find out they can’t afford the medication and must then be switched to a medication that is covered. This creates unnecessary switching of medications, and can lead to detrimental effects to the patient’s care.
This raises the question, should physicians be the ones giving out samples of medications to patients?   This pharmacist says no.  Free samples of medications should not be given out at all as it promotes improper medication use and increases drug costs.
However, if drug samples are going to be made available for patients on a trial basis, it would seem more logical that patients would received these samples from their pharmacist, as requested by their physician, but only after the medication is verified to be the first and best choice for the patient.  At the same time, the patient would receive appropriate counseling on the benefits of the new medication as well as what side effects to watch for and what to do if those adverse effects are experienced, which would include contacting the pharmacist for advice about what to do in the case of such an event.   As part of the pharmacist’s normal routine, these side effects or adverse reactions to the trialed medication would be documented in the patient’s file and the entire experience would be communicated to the physician who requested the trial prescription.
Drug coverage was mentioned as another issue that would certainly be solved at the time the drug sample was requested.  What better time to find out that the proposed new medication is not covered by a patient’s drug plan than before starting the medication rather than later.  This would prevent the scenario where the patient is forced to change medications because the trial medication is not covered.
As well, if the requested trial medication is not covered but another medication that is covered by the patient’s plan is available and a good option, the pharmacist can discuss that option with the patient and the physician ahead of a long unnecessary trial.
Pharmacists are responsible for ensuring the medications patients receive are safe and effective, because they are considered to medication experts.   They also work within that important Triad of Physician – Patient – Pharmacist, ensuring that not only are the medications used properly but that the patient is part of their treatment decision process.  The patient must be kept informed about their treatment options before medication regimens are chosen and not after bad things happen.   This important function is missing when patients receive samples directly from physicians.
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