A Sample Plan

With the annual cost to the pharmaceutical industry totaling more than $10 billion, sampling represents perhaps the greatest example of single-industry largess across the American corporate spectrum. But in an age of cost-cutting and belt-tightening, many pharmaceutical companies are taking a second look at their sampling practices and considering sharply cutting back on this massive, uncompensated contribution to patient care.

Of course, reducing samples will save money, but is it a good idea? To address this question ImpactRX, a New Jersey-based pharmaceutical industry promotional research organization, began collecting extensive, longitudinal sample usage data from more than 3,000 high-volume prescribing primary care physicians and specialists in 2001. Writing in a recent issue of Pharmaceutical Executive Magazine, ImpactRX’s president Nancy Lurker and senior VP Bob Caprara describe the unique and critical role samples play in the complex American healthcare system.

1. The Quiet Subsidy
ImpactRX’s research shows physicians today view samples as a form of subsidized healthcare offered to patients by the pharmaceutical industry. The doctors report that without samples many patients lacking prescription insurance coverage would have to go without critical medications. These physicians also tend to express appreciation for these efforts and support the companies for offering samples.

Based on the way physicians use samples it’s safe to assume that the sampling process underpins the entire American healthcare system by providing a giant network of support. An end to sampling would threaten to undermine the substantial goodwill pharmaceutical companies have established with the nation’s physicians. But, as Lurker and Caprara point out, the industry currently receives little to no credit from the public for providing this subsidy to the underinsured.

2. Destination Unknown
If sampling is to be reduced, then it behooves the industry to at least understand what happens to samples after they leave reps’ hands. There are three primary destinations for most samples:

1. newly diagnosed patients with a prescription (25%)
2. previously diagnosed patients with a prescription (15%)
3. patients with no prescription (60%).

These are broad averages and don’t take into account wide variations across therapeutic classes. For example, nearly 75% of the oral solid antibiotics and COX-2 samples go to patients without prescriptions. Regardless of these variations, Lurker and Caprara say it’s clear that a significant percentage of samples cut into paid prescriptions by going to customers who have the ability to pay. The industry’s goal, then, should be to reduce physicians’ tendency to dispense free therapies to patients who can afford paid prescriptions.

3. The Next Step
Lurker and Caprara recognize that ending sampling altogether would be foolhardy, as it would destroy physician goodwill and expose the industry to even more government supervision. Instead, they suggest a three-tiered approach to adjust the current system.

1. Conduct a media blitz. As noted, most of the public is unaware of the huge service pharmaceutical companies provide through free samples. This hidden subsidy should be brought to light through aggressive media efforts.
2. Check the figures. Pharmaceutical companies are legendary for their data collecting prowess. On a brand-by-brand basis, companies need to know precisely what’s being handed out to patients as opposed to what’s dropped off in the nation’s sample closets.
3. Implement a voucher system. Instead of handing out actual samples, physicians would provide patients with vouchers redeemable at pharmacies. The vouchers could include a check-box system where patients indicate the reason why they received samples. Those checking lack of prescription coverage would provide the industry with hard data about the extent of the hidden subsidy.

Vouchers offer other benefits as well. In an environment where 40% of samples are dispensed with a prescription but an unknown number go unfilled, vouchers would help increase fulfillment rates. They’d also dramatically reduce the number of samples that wind up being thrown away by physicians’ staff.

4. Making It Happen
Establishing a goal of making changes aimed at reducing the number of samples is one thing, making it happen is quite another. Two of the key stumbling blocks Lurker and Caprara identify include:

• Getting all drug companies to agree to a new approach simultaneously, thus avoiding exposing only some manufacturers to competitive pressure with no samples at their disposal, and
• Designing a replacement sampling system. Sample usage currently varies widely across therapeutic classes, product lifecycles and even internally in individual companies. Any new direction will inevitably create winners and losers.

Nevertheless, Lurker and Caprara remain guardedly optimistic. For one thing, they note changes are already afoot. Coupon use is growing slowly and sales reps, physicians, patients and pharmacists are adapting accordingly. For the most part, they say, the optimism stems from the fact that the industry simply cannot ignore the current system’s poor returns forever. Change will undoubtedly cause pain, but in the end all stakeholders – companies, physicians, other healthcare providers, patients and even the government – stand to gain from a new, more streamlined sampling process.

For more information visit www.ImpactRX.com.