Most free drug samples go to wealthy and insured, study finds

Free drug samples are more likely to go to wealthy and insured people than to poor or uninsured Americans, according to a study by Boston-area doctors that conflicts with the view that giving away prescription medications forms a safety net for low-income patients.

Less than one-third of all people who received samples in a 32,000-person, nationally representative survey had low incomes, and less than one-fifth who got the free drugs were uninsured at any point in 2003, the year analyzed by researchers at Cambridge Health Alliance and Harvard Medical School. Low income was defined as less than 200 percent of the federal poverty line.

"Doctors are trying to target samples to needy patients, but their individual efforts failed to counteract society-wide factors that determine access to care," lead author Dr. Sarah L. Cutrona said in an interview today. The study appears in the February issue of the American Journal of Public Health.

A pharmaceutical industry group called the study flawed.

"Instead of second-guessing motives, Harvard researchers would better serve patients by examining health outcomes," Ken Johnson, senior vice president of the Pharmaceutical Research and Manufacturers of America, said in a statement. "Clearly, free samples often lead to improved quality of life for millions of Americans, regardless of their income."

Johnson called free samples a safety net for many uninsured and low-income patients in a 2006 letter to the editor of the New York Times.

Cutrona said the authors were not blaming physicians.

Where people received their health care is an important factor in whether they receive free samples, an analysis of the survey data showed. Insured people with better access to medical care were more likely to see their doctors in offices, rather than hospital emergency rooms or hospital clinics. Patients who saw their doctors in offices were more likely to be given free drug samples.

"That finding suggests that the samples were a marketing tool and not a safety net because the poor and uninsured patients were not finding their way to where the samples were," Cutrona said.

Free samples with a retail value of $16.4 billion were given out in 2004, the study says, up from $4.9 billion in 1996. Most were the newest, most expensive drugs, Cutrona said. Giving them away to patients is a way for pharmaceutical companies to introduce their new products to doctors and patients.

Drug samples raise patient safety concerns, Cutrona added. The study found that in 2002, the most commonly distributed free samples were for Vioxx, a painkiller that was later taken off the market by its manufacturer, Merck, after some patients developed heart complications. She also said that samples bypass pharmacists, who serve as a safeguard by checking for drug interactions.