Free is good, right? Unfortunately, when it comes to no-cost drug samples given to you by your doctor, you would be wrong, expensively wrong. Stanford researchers found that dermatologists with access to free samples are more likely to write prescriptions for higher price tag medicines when compared to their peers who did not receive samples. “Physicians may not be aware of the cost difference between brand-name and generic drugs,” said Dr. Alfred Lane, emeritus professor of dermatology and of pediatrics at Stanford, “and patients may not realize that, by accepting samples, they could be unintentionally channeled into subsequently receiving a prescription for a more expensive medication.” His new study appears online in JAMA Dermatology.

How It Began

In 2006, Stanford Medicine instituted a new policy which prohibited physicians from accepting samples or other gifts from pharmaceutical companies. After this change, Lane started to notice what he thought of as unusual drugs being prescribed by other physicians. “I realized that patients were referred to Stanford with prescriptions for newly introduced, branded generics that were unfamiliar to me,” Lane said in a press release. “Sometimes I had to look up what they actually were. It wasn’t clear to me that there was much benefit to these drugs, and they were definitely very expensive.”

To begin an investigation of this matter, Lane and his colleagues, Dr. Michael P. Hurley and Dr. Randall S. Stafford, examined the prescribing patterns of dermatologists in a database called the National Disease and Therapeutic Index, a survey of community doctors. They focused their investigation on medications prescribed to treat adult acne and rosacea. They saw how in the years 2001, 2005, and 2010, the top five medications prescribed for these skin conditions changed, reflecting differences in treatment approaches. Yet within any individual year, they discovered the most commonly prescribed medications were linked to the availability of free samples for those medications. In 2005, for instance, the top four most commonly prescribed medications were also the top four medications for which the doctors had been given a sample from the drug makers.

Next, the researchers looked into the prescribing patterns of physicians at academic medical centers, where free samples are prohibited. They compared these patterns with those of the community doctors, and then calculated the retail price of prescribed medications for a single visit in 2010. The average cost of prescriptions for a patient treated by a doctor who received samples was around $465, versus about $200 for patients treated by a doctor without access to samples.

A full 83 percent of prescriptions from the academic medical center were for cost-saving generic drugs. By contrast, only 21 percent of prescriptions written by doctors in the national database were for the cheaper generic drugs. During the period when he and other doctors at Stanford were allowed to give free samples, “it seemed a good way to help poorer patients, who maybe couldn’t afford to pay for medications out-of-pocket,” Lane said. “We had the perception that this was very beneficial for patients.” Too often free means hidden costs and so matters may not be as simple as they appear at first blush.

Source: Hurley MP, Stafford RS, Lane AT. Characterizing the Relationship Between Free Drug Samples and Prescription Patterns for Acne Vulgaris and Rosacea. JAMA Dermatology. 2014.