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Characteristics of Patients Receiving Pharmaceutical Samples and Association Between Sample Receipt and Out-of-Pocket Prescription Costs

Alexander, G Caleb MD, MS*†‡§; Zhang, James PhD*‡¶; Basu, Anirban PhD*‡

doi: 10.1097/MLR.0b013e3181618ee0
Original Article

Background: Pharmaceutical samples are widely used for promotion and marketing, yet little is known about who receives samples or how their use is associated with patient's prescription costs.

Objective: To examine the characteristics of those receiving samples and the relationship between sample receipt and out-of-pocket prescription costs.

Design, Subjects, and Measures: We divided the 2002–2003 Medical Expenditure Panel Survey, a nationally representative, panel-design longitudinal study, into baseline and analysis periods. We conducted logistic and generalized linear regression analysis of 5709 individuals in the analysis period who did not receive samples during the baseline period. The primary outcome measures were sample receipt and prescription expenditures.

Results: Fourteen percent of individuals received at least 1 sample during the analysis period. On multivariate analyses sample receipt was greater among those who were younger and those not on Medicaid. In generalized linear regressions controlling for demographic characteristics and health care utilization, the predicted 180-day out-of-pocket prescription expenditures were $178 [standard error (SE), $3.9] for those never receiving samples. Among those receiving samples, the corresponding out-of-pocket expenditures were $166 (SE, $8.9) for periods before sample receipt (P = 0.16 for comparison with those not receiving samples), $244 (SE, $9.2) for periods during sample receipt (P < 0.001 for comparison with periods before sample receipt) and $212 (SE, $12.4) for periods following sample receipt (P = 0.008 for comparison with periods before sample receipt). Results were qualitatively similar when total prescription costs were examined.

Conclusions: Individuals receiving samples have higher prescription expenditures than their counterparts. These findings suggest that sample recipients remain disproportionately burdened by prescription costs even after sample receipt.

From the *Section of General Internal Medicine, Department of Medicine; †MacLean Center for Clinical Medical Ethics; ‡Center for Health and Social Sciences, University of Chicago; and §Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Illinois.

¶Dr. Zhang is now at the School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia.

Supported by career development awards from the Agency for Healthcare Research and Quality (K08 HS15699-01A1, to G.C.A) and the Robert Wood Johnson Physician Faculty Scholars Program (to G.C.A.).

The funding sources had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript for publication.

Reprints: G. Caleb Alexander, MD, MS, The University of Chicago, 5841 S. Maryland, MC 2007, Chicago, IL 60637. E-mail:

© 2008 Lippincott Williams & Wilkins, Inc.