The Dangers of Drug Samples

April 1, 2009

A physician uses her drug samples to help out needy patients, but worries she’s putting herself at risk. Who gets her goodies?

Q Times are tough for many of our patients. As always, we do what we can to provide drug samples to needy patients who can’t afford prescriptions. We always document the “sampling” in the chart.

I’m worried about the liability of this, though.

Still, I’m 100 percent sure that if some of my patients don’t get samples they will have a decreased life expectancy.

How do I do the right thing?

A It is tempting to help out patients by using drug samples as free prescriptions. While you say you are 100 percent sure you are helping your needy patients, it might be worth another look. The evidence suggests that, in reality, heavy sampling doesn’t end up helping poor patients.

According to research published in the October 2008 issue of Pediatrics, poor children -those with family incomes well below the federal poverty level - were no more likely to receive free samples than were those with incomes 400 percent higher than the poverty level. Eighty-four percent of all sample recipients were insured.

In the flow of practice, it’s not whether a patient is poor that determines whether he gets samples as a sort of free prescription but the fact that he visits a private practice. Having more than three provider visits in a given year was the best indicator of whether kids got handouts. Children who visit free clinics, roving mobile clinics for the poor, or who don’t visit anyone regularly don’t get free drugs.

Adults get the same treatment. A survey of nearly 33,000 adults published in the February 2008 issue of the American Journal of Public Health found only 28 percent of those who got samples were poor, whether insured or not.

If you really want to help the poor, you might do better to volunteer at a free clinic than to hand out drugs.

Here are some other concerns: Samples don’t help patients with chronic diseases who need the drugs on an ongoing basis. Also, most samples are for expensive, new drugs, not generics. These samples make it easier to ignore cheaper generic options that could be saving patients and the system cash over time.

Your worries about safety are another concern. Sample handouts tend to fly under the radar; they don’t get into the chart and there’s often no way to track things and contact patients if there is a recall. Practices are also notoriously bad about keeping on top of the supply cabinet; old drugs might sit there for years. Those safety issues are especially troubling if you do, in fact, manage to give samples only to poor patients. Why should they be the ones at risk?

I know of several practices that stopped giving samples because they accidentally gave out expired samples and their patients told on them. One contacted the state board of medicine. In another case, an employee sued because of an expired sample that she (and her employee colleagues) took from the sample closet.

Still, physicians feel good dispensing samples. It’s a hard habit to break. When the University of Washington officially put the kibosh on samples, doctors there simply took the samples from drug reps and stored them in their cars and briefcases. They ignored the rules.

So, if you insist on dispensing samples, here are some guidelines to follow:

  • Don’t “dispense” to employees, or, if you do, follow the same steps that you would for patients.

 

  • Contact your malpractice carrier and get their advice - in writing - about your policies and procedures.

 

  • Lock the sample closet.

 

  • Make it a monthly requirement for staff to dispose of expired samples.

 

  • Record samples dispensed in the patient’s chart along with the lot number and other information you can use to follow up should something go wrong.

 

  • Ask sales reps for generic samples.

Pamela L. Moore is director of content and strategy for Physicians Practice. She can be reached for solutions at mailto:pam.moore@cmpmedica.com or share your samples closet nightmare at forum.physicianspractice.com.

This article originally appeared in the April 2009 issue of

Physicians Practice.