Monday, June 15, 2009

Care for a Sample?

A family friend (already on metformin) recently visited his doctor for high blood sugars and got put on an expensive, brand name medication (Janumet) which I view as being completely inappropriate at this stage in his initial treatment. To my simple mind, the prescriber seems to have leapfrogged over several other steps in the algorithm for Type 2 diabetes treatment.

I was curious and asked him if he'd filled the prescription yet, and how much it had cost. "Oh, I didn't fill it yet" he said, "the doctor gave me a whole bunch of samples, so I'm good for a while."

Damn, that irritates me. Does the doctor (who I know is kind of an old-timer) just pick this drug because he's got a bunch of samples to unload? Makes him look like a nice guy to give free drugs to this elderly patient? And what happens when the samples run out and the patient goes to fill the prescription? Yep, you got it ---- the duty falls to a pharmacist like you or me to break the bad news ---- either it's not covered at all, or the copay is astronomical.

This friend lives in a different part of the country than I do. The clinic system I work in, with very few exceptions, no longer accepts samples. I can remember a few times in the past where physician samples occasionally came in handy --- like, for someone who couldn't pay for a prescription, or lost it, or spilled it, etc. --- kind of a one-time deal. And I can honestly see where a physician might want to give a patient something to 'try', without committing them to a full month's supply of a medication. But it became too much of a hassle to document the dispensing of samples and of course the accepting of gifts and samples from drug companies is now being reined in. I can remember sifting through PILES of samples in an out-patient clinic where I used to work, checking for outdates and looking at drugs I'd never even heard of !

Now we're not supposed to have ANYTHING, even behind the pharmacy counter, with a drug company logo on it. But I don't have a sense if there are certain areas or independent practitioners out there who still readily accept these.

I actually don't think that these things affect the prescribing habits of a doctor who really knows his/her stuff. Any more than having a beautiful "Airborne" travel thermos would ever make me recommend the stuff to anyone.

But this incident with my friend's diabetes treatment was, shall we say, disappointing.


Grumpy, M.D. said...

In my neck of the woods we get samples by the boatload, but I try my best not to let it change my prescribing.

I'm a big believer in generics when possible.

Anonymous said...

dermatologists in my area are the absolute worst offenders of this type of practice. "Well he gave me some samples" always follows "I'm sorry its not covered." When coming from Dr Dermolotigist. I don't know if its that they just hope something new and fancy will work better since dermatology is so hard to diagnose and treat, or just that the reps have big tits and smile a lot

pharmacy chick said...

I'm gonna miss the free pens, actually.....

Phathead said...

I miss the free pens and pads of paper already. Had to by pens for work for the first time ever two weeks ago.

I've only been in this for a tad over 8 years and I can remember when 'samples' were usually a week or two of a med. Funny how quickly things have changed.

Stacey said...

(Again another late late comment but just going through your blog to read all the old posts as they are very good.) Glad you feel the same way. I am in Ontario but on disability so only some medications are covered for me. My one dr wanted to put me on a new medication, said it was pricey but that he could guarantee the first month free and we could 'see what happens' after that. I (politely) refused as even if it worked great, I wouldnt be able to pay out of pocket for it after the 'trial' was over. Thankfully that dr is amazing and agreed so we tried a different route.