Are Samples a Safety Net?
By now you’ve probably read news accounts of a study in the American Journal of Public Health that found that rich people are more likely than poor to receive free samples of prescription drugs. If you actually read the numbers though, it turns out that things aren’t quite as simple as the headlines suggest.
The study was based on the 2003 Medical Expenditure Panel Survey (MEPS) conducted by the Agency for Healthcare Research and Quality. Several times a year, MEPS surveyors asked panel members detailed questions on healthcare expenditures, insurance, and so forth—including questions on prescription drug use and whether respondents had received any free drug samples.
The first pass through the numbers produced the results you’ve probably heard about: White people were more likely to receive samples than blacks or Hispanics; rich people were more likely than poor; the insured more likely than the uninsured. But take another pass through the data and something funny happens.
It turns out that you’re also more likely to get a sample if you go to a physician’s office, less likely if you go to an emergency room or clinic, and less likely still if you report no usual provider of healthcare. And who reported that they had no usual provider? You’ve got it—the uninsured. And they are substantially less likely than the insured to receive healthcare of any sort. When the authors took that fact into consideration, here’s what happened:
If we include site of medical care in our multivariate model, uninsured persons appear more likely to receive a free sample than do insured persons. We interpret this finding to reflect office-based practitioners’ sincere effort to give free samples to their neediest patients. Unfortunately, these efforts do not appear to compensate for larger access barriers that prevent uninsured and other disadvantaged patients from consulting physicians who are office based.
Another problem with the study: The MEPS surveys don’t ask how many pills respondents received, so it’s not possible to distinguish between the patient who just got a starter kit and the patient who’s receiving all of his or her drug in the form of samples. If the goal is to study “safety net” use of samples, that’s a big shortcoming.
For more critiques of the study and its conclusions, see this PhRMA press release. For an article on the potential risks of sampling programs, look here.
