I want it for FREE!!....Wait....I don't???

Currently in the Johns Hopkins Hospital there is a "sample prohibition" on the way. What is a "sample"? In health care, it refers to those free drug samples you get from your physician, or that discount card you receive to get a free medication from your community pharmacist. From a consumer and patient perspective, it's hard to see the any drawbacks to receiving free drugs. I have to admit, I was puzzled when I attended meetings discussing how Johns Hopkins was going to get rid of all the free drug samples in the hospital, and prevent vendors from donating products to any of the health system's satellite hospitals and clinics.

As a future pharmacist, I want all of my patients to have access to necessary medication. If companies are willing to give away their brand-name drugs for free, who am I to stand in their way? I finally had to ask for an explanation. The response I received was somewhat surprising.

Samples come from a manufacturer trying to promote its product, but not all manufacturers supply free samples to hospitals. Let's say a patient comes into a hospital/clinic and is diagnosed with mild form of asthma. The physician knows that the patient lacks prescription drug coverage and believes that the cost of medication therapy would deter the patient from getting his/her medication. So the physician decides to give the patient a free sample of Advair, because that's what he has on hand. But is Advair the right drug to give this patient? Not according to the physician's initial diagnosis. Advair is reserved for moderate to severe asthmatic symptoms, which is not the diagnosis.

So what happens if the patient runs out of the free Advair sample? If the patient is responding well to the drug therapy, standard protocol is to keep the patient on the drug. But Advair is one of the most expensive inhalers on the market. What now? The patient may have had difficulty paying for an albuterol inhaler or nebulizer, but a single cycle of Advair can exceed $350. So how will the patient pay for prescription refills?

Well I will tell you how they get their refills, the hospital pharmacy gives it to them for free, or the patient gets Medical Assistance which will then pay for the drug. Both option cause the health system and the hospital time, money and stress. All of this from one sample of a drug, now multiply that by the nearly 100,000 samples given out by the Hopkins hospital alone last year and the picture becomes a little less hazy. Samples aren't only restricted to drugs, when new moms and their babies leave the hospital companies give them free cases of their formula for the baby. It's a way to hook them on their product from day one, a lot of times the free product is the most expensive product and not necessarily the best product.

I know a lot of you may be thinking, well if we get rid of samples how can we ensure that the patient gets the medication they need. Well that all comes full circle back to one of my previous postings when I talked about 340B. We can offer patients drugs at our 340B pricing which is more than free but usually less than a dollar or give away generic drugs for pennies. Either way it saves the system and hospital in the long run. All very interesting when you change your perspective.