CARE FOR A SAMPLE?

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What to consider when stocking a drug sample—from its true cost to when to use one.

As I walk the square in Cape May, NJ, all of the fudge shops are handing out free samples. Of course, I partake then succumb to the need to buy one or two pounds of the treat. How is this different than your patients who need a medication but have gotten used to you handing them free samples? Drug samples come with a cost. Take contact lenses, for example. Patients assume that the trial lens is “free” – but in actuality there is a cost. The practitioner must purchase revenue boxes to be able to obtain additional diagnostic lenses. Pharmaceutical companies offer limited free sampling to enhance the recognition of the product by the practitioner and to encourage writing of the prescription for the patient. And  then there is the potential outcomes of clinical decisions.

DOCS AND PHARMA
It is usually the contact with the pharmaceutical sales representative that will influence the utilization of the drug more so than peer-reviewed data, (which can be influenced by the selection of study investigators). This suggests that the adoption of a new drug is more likely related to commercial influences rather than to a doctor’s professional insight and knowledge of research on treatment outcomes. The strategy is if one can see it on the shelf or on the counter, they will more likely prescribe it.

The utilization of certain medications based on company-prepared, marketing-based information can be very informative—but also very biased. As such, the physicians’ utilization of drug samples may place a higher level of risk against clinically guided decision making. Company representatives with similar products  will typically present information and statistics about the prowess of their drug and demean the other pharmaceuticals. To guard against treatment risks, physicians should not depend on the provided information and consider declining drug samples if they are unsure of the clinical outcomes or the risks to the patient.

WHEN SAMPLES MATTER
Topical drops are the mainstay in which samples are particularly useful in an emergency situation or after-hours prescribing. I will often receive a call from a patient after hours about “red eye” and email the prescription only to have the pharmacy already closed. In this situation, the antibiotic or steroid sample is sorely needed to start therapy and avoid potentially catastrophic delay of care.

In dry eye therapy, a sample will never get you to the therapeutic threshold to understand the clinical outcomes. It requires multiple weeks to determine a subjective and objective effect. In this case, we use the sample to simply explain how to administer the drop and what the packaging looks like to avoid errors at the pharmacy. Glaucoma falls into the same category. A  1 ml sample will last one or two days, but you can’t realistically determine the clinical success of therapy in that time. The only time a sample anti-glaucoma agent is useful, for example, is a post-operative cataract IOP spike or the use of a sample bottle for post-refractive infection and/or inflammation.

Lastly, if affordability is an issue, there are many sources from the pharmaceutical companies to assist based on financial need. Direct your patients to utilize rebates and pharmaceutical coupons to assist in cost reduction. We offer a page on our website for such programs and refer patients to the URL.

Samples are not bad, but like too many pieces of fudge, they just need to be utilized in moderation.

Kenneth Daniels, OD, FAAO,  is in private practice at SeeLife Hopewell and Lambertville Eye Associates in NJ.

SAMPLE CHECKLIST
To avoid risk with samples, the physician should have a SOP (standard operating procedure) in place to monitor the inventory and reduce risks. Here are a few items to include:
Avoid giving medication samples for long-term use unless they are part of a program that includes pharmacy review and dispensing.
Always check the expiration date and the sample package integrity.
Ask patients to bring their medications to the visit and review. Examine the bottles for samples versus prescribed and expiration dates.
Store medication samples in accordance with manufacturers’ labeling and in locked cabinets away from patient and staff traffic.
Maintain a log of samples to avoid theft and discard old samples.
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