‘No reps’ means no starter (sample) medication packs. Won’t patients miss out?

Of course, all samples are paid for by someone: in fact, sample packs containing a few tablets, personally delivered by a pharmaceutical rep, are probably considerably more expensive than full medication packs purchased in the usual way from the pharmacist.

However, this cost is dissociated from both the doctor and patient because the rep delivers the samples for free, in the knowledge that any cost will, on average, be recouped many times over due to the subsequent altered prescribing habits of the doctor. If pharmaceutical companies had any doubts that sample packs influence doctors’ prescribing habits, they would not manufacture sample packs.

In an Australian study, GPs were asked to name ten medications they would ideally like in their sample cupboard. Of the 4660 items actually found in their sample cupboard, just 0.6% matched the GPs’ wish list. (Spurling)

A few quotes from Fugh-Berman and Ahari (see ref below):

The purpose of supplying drug samples is to gain entry into doctors’ offices, and to habituate physicians to prescribing targeted drugs…The convenience of an in-house pharmacy increases loyalty to both the reps and the drugs they represent.

Among the aims of one industry sample-tracking program are to “reallocate samples to high-opportunity prescribers most receptive to sampling as a promotional vehicle” and “identify prescribers who were oversampled [doctors who try to use samples as an entire course of treatment: Ed.] and take corrective action immediately”.

Studies consistently show that samples influence prescribing choices. Reps provide samples only of the most promoted, usually most expensive, drugs, and patients given a sample for part of a course of treatment almost always receive a prescription for the same drug. (Fugh-Berman)

To use a recent example, a US study published in the April 2014 JAMA compared prescribing habits in private dermatological practices (where drug samples are widespread) with an academic medical centre which did not accept drug samples. Branded drugs comprised 79% of prescriptions in private practice compared to 17% at the medical centre. The US average prescription cost following an office visit for acne was $465, but was just $200 at the medical centre. (Hurley)

The authors summarised:

In other words, dermatologists are providing more samples, are prescribing more branded generic drugs as sample use increases, and are mirroring the specific medications they are prescribing to what is distributed to them by pharmaceutical representatives. (Hurley)

So, yes: if a doctor doesn’t see drug reps, their patients will miss out on free sample packs.

If so, the choice of which long-term medication to commence for chronic diseases would then be based on expert guidelines, individual patient factors and the doctor’s independent judgement. Evidence shows that this choice is likely to be more appropriate, and on average will be of more benefit to the patient’s health. Evidence also shows that it will, on average, be more cost effective. The cost saved by the patient or health system is the cost lost by the pharmaceutical company…which is why they spend money producing and hand-delivering sample packs.