ABSTRACT
Background
New policies regulating physician/pharmaceutical company relationships propose to eliminate access to free prescription drug samples. Little is known about the prevalence of patient activity in requesting or receiving free prescription drug samples, or the characteristics of patients who access drug samples.
Objective
To determine the prevalence of free sample access and to examine demographic, clinical, and insurance characteristics of Medicare beneficiaries who access free samples.
Design
Cross-sectional study.
Participants
A national sample of 13,847 Medicare beneficiaries participating in the fall 2004 Medicare Current Beneficiary Survey.
Measurements and Main Results
Prevalence of free prescription drug sample access (self-reported request for or receipt of free drug samples) and the demographic, clinical, and insurance characteristics of Medicare beneficiaries who accessed drug samples. Overall, 48.3% (95% confidence of interval [CI]: 46.6%, 49.9%) of Medicare beneficiaries reported accessing free drug samples. Access was higher among beneficiaries reporting cost-related medication nonadherence compared to those without (77.7% (95% CI: 74.5%, 80.6%) vs 43.0% (95% CI: 41.4%, 44.7%)). Multivariable analysis revealed cost-related medication nonadherence (CRN) to have the strongest relationship with accessing drug samples (adjusted odds ratio [AOR] 4.43 [95% CI: 3.64, 5.39]). Compared to beneficiaries with generous drug benefits from Medicaid, beneficiaries who lacked prescription drug benefits were more likely to access drug samples (AOR 2.42 [95% CI: 2.06, 2.85]). Beneficiaries with drug coverage from employer-sponsored plans or partial coverage (Medicare HMO, self-purchased Medicare supplement, or state-sponsored low-income plans) were also more likely to access drug samples (AOR 2.02, 1.74, respectively). Having 2–3 or ≥4 comorbidities (vs 0–1 comorbidities) also increased the likelihood of accessing drug samples (AOR 1.60 (95% CI: 1.44, 1.79) and 2.00 (95% CI: 1.74, 2.29).
Conclusions
Accessing free prescription drug samples is prevalent among many categories of beneficiaries, especially among individuals with cost-related medication nonadherence and poor health status. Policies restricting or prohibiting drug sample distribution may adversely impact access to medications among patients in high-risk groups.
Similar content being viewed by others
References
Blumenthal D. Doctors and drug companies. N Engl J Med. 2004;351:1885–90.
Coleman DL, Kazdin AE, Miller LA, Morrow JS, Udelsman R. Guidelines for interactions between clinical faculty and the pharmaceutical industry: one medical school’s approach. Acad Med. 2006;81:154–60.
HUP/CPUP policy #1-07-10 “Guidelines for Interactions between Healthcare Professionals and Industry": Hospital of the University of Pennsylvania Clinical Practices of the University of Pennsylvania; 2006. http://www.uphs.upenn.edu/cep/resources/PhARMA%202-202006%20prof-industry.pdf. Accessed on February 20, 2008.
HUP/CPUP policy #1-12-41 “Pharmaceutical Company Representative Activity": Hospital of the University of Pennsylvania Clinical Practices of the University of Pennsylvania; 2007. http://www.uphs.upenn.edu/cep/resources/1_12_41%20pharma%20policy.pdf. Accessed on February 20, 2008.
Policy and Guidelines for Interactions between the Stanford University School of Medicine, the Stanford Hospital and Clinics, and Lucile Packard Children’s Hospital with the Pharmaceutical, Biotech, Medial Device, and Hospital and Research Equipment and Supplies Industries (“Industry”): Stanford Hospital and Clinics; 2006. http://med.stanford.edu/coi/siip/policy.html Accessed on February 20, 2008.
U-M Health System: drug samples, drug reps and beyond. http://www.med.umich.edu/opm/newspage/2006/drugreps.htm. Accessed February 20, 2008.
Soumerai SB, Pierre-Jacques M, Zhang F, et al. Cost-related medication nonadherence among elderly and disabled Medicare beneficiaries: a national survey one year before the medicare drug benefit. Arch Intern Med. 2006;166:1829–35.
Safran DG, Neuman P, Schoen C, et al. Prescription drug coverage and seniors: findings from a 2003 national survey. Health Aff (Millwood). Jan–Jun 2005;Suppl Web Exclusives:W5-152-W155-166.
Government Accountability Office. Table 1. Prescription Drug Promotion and Research and Development, 1997 through 2005 in GAO-07-54 Report to Congressional Requesters. Prescription Drugs: Improvements Needed in FDA’s Oversight of Direct-to-Consumer Advertising. United States Government Accountability Office. November 2006.
Chew LD, O’Young TS, Hazlet TK, Bradley KA, Maynard C, Lessler DS. A physician survey of the effect of drug sample availability on physicians’ behavior. J Gen Intern Med. 2000;15:478–83.
Zweifler J, Hughes S, Schafer S, Garcia B, Grasser A, Salazar L. Are sample medicines hurting the uninsured? J Am Board Fam Pract. 2002;15:361–6.
Taira DA, Iwane KA, Chung RS. Prescription drugs: elderly beneficiary reports of financial access, receipt of drug samples, and discussion of generic equivalents related to type of coverage. Am J Manag Care. 2003;9(4):305–12.
Kaiser Family Foundation. National survey of physicians. Part 2. Doctors and prescription drugs. http://www.kff.org/rxdrugs/loader.cfm?url=/commonspot/security/getfile.cfm&PageID=13965. Accessed February 20, 2008.
IMS Health. U.S. Physicians Responsive to Patient Requests for Brand-Name Drugs. http://www.imshealth.com/ims/portal/front/articleC/0,2777,6599_3665_1003811,00.html. Accessed February 20, 2008.
Wazana A. Physicians and the pharmaceutical industry: is a gift ever just a gift? JAMA. 2000;283:373–80.
Adler GS. A profile of the Medicare Current Beneficiary Survey. Health Care Financ Rev. 1994;15:153–63.
Centers for Medicare and Medicaid Services. Medicare Current Beneficiary Survey (MCBS). www.cms.hhs.gov/mcbs. Accessed February 20, 2008.
DeSalvo KB, Fan VS, McDonell MB, Fihn SD. Predicting mortality and healthcare utilization with a single question. Health Serv Res. 2005;40:1234–46.
Department of Health and Human Services 2004 Poverty Guidelines, 69 Federal Register 7336–7338 (February 13, 2004). http://aspe.hhs.gov/poverty/04computations.shtml. Accessed February 20, 2008.
Adams AS, Soumerai SB, Ross-Degnan D. Use of antihypertensive drugs by Medicare beneficiaries: does type of drug coverage matter? Health Aff (Millwood). 2001;20:276–86.
Centers for Medicare and Medicaid Services. Technical Documentation for the Medicare Current Beneficiary Survey, MCBS, 2003 Access to Care, Section 5: Sample Design and Guidelines for Preparing Statistics 2003. [Book on CD-ROM]. Baltimore, MD: Center for Medicare and Medicaid Services, Office of the Actuary; 2005.
Korn E, Graubard B. Analysis of Health Surveys. New York: Wiley & Sons, Inc; 1999.
Archer K, Lemeshow S. Goodness-of-fit test for a logistic regression model fitted using survey sample data. Stata Journal. 2006;5:97–105.
Cutrona SL, Woolhandler S, Lasser KE, et al. Characteristics of recipients of free prescription drug samples: a nationally representative analysis. Am J Public Health. 2008;98:284–89.
Piette JD, Heisler M, Wagner TH. Cost-related medication underuse: do patients with chronic illnesses tell their doctors? Arch Intern Med. 2004;164:1749–55.
Goldman DP, Joyce GF, Escarce JJ, et al. Pharmacy benefits and the use of drugs by the chronically ill. JAMA. 2004;291:2344–50.
Tseng CW, Brook RH, Keeler E, Mangione CM. Impact of an annual dollar limit or “cap” on prescription drug benefits for Medicare patients. JAMA. 2003;290:222–7.
Soumerai SB, Avorn J, Ross-Degnan D, et al. Payment restrictions for prescription drugs under Medicaid: effects on therapy, cost, and equity. N Engl J Med. 1987;317:550–6.
Campbell EG, Gruen RL, Mountford J, Miller LG, Cleary PD, Blumenthal D. A national survey of physician–industry relationships. N Engl J Med. 2007;56:1742–50.
Rabin R. Free Drug Samples? Bad Idea, Some Say. New York Times. May 1, 2007.
Stuart B, Briesacher BA, Shea DG, Cooper B, Baysac FS, Limcangco MR. Riding the rollercoaster: the ups and downs in out-of-pocket spending under the standard Medicare drug benefit. Health Aff (Millwood). 2005;4:1022–31.
Tjia J, Schwartz J. Will the Medicare prescription drug benefit eliminate cost barriers for older adults with diabetes mellitus? J Am Geriatr Soc. 2006;4:606–12.
Acknowledgments
We acknowledge the contribution of Dana Safran, ScD, without whom, this project would not have been possible.
Funding/support
This study was supported by a grant from the National Institute on Aging to Dr. Soumerai (Grant #R01 AG 022362) and the Harvard Pilgrim Health Care Foundation. Dr. Tjia was supported by a Mentored Clinical Scientist Career Development Award from the National Institute on Aging (Grant #K08 AG021527). Drs. Soumerai, Gurwitz, Ross-Degnan, and Zhang are investigators in the HMO Research Network Center for Education and Research in Therapeutics, supported by the U.S. Agency for Healthcare Research and Quality (Grant #2U18HS010391). Dr. Gurwitz is also supported by a grant under the Attorney General Consumer and Prescriber Education Grant Program.
Conflict of Interest
Dr. Tjia has received financial support from a Pfizer/American Geriatrics Society Junior Faculty Award for Research on Health Outcomes in Geriatrics. Dr. Briesacher has received unrestricted research grants from and served as a consultant for Novartis Pharmaceuticals Corporation within the last 3 years.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tjia, J., Briesacher, B.A., Soumerai, S.B. et al. Medicare Beneficiaries and Free Prescription Drug Samples: A National Survey. J GEN INTERN MED 23, 709–714 (2008). https://doi.org/10.1007/s11606-008-0568-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-008-0568-2