Case Study of the Effects of Office-Based Generic Drug Sampling on Antibiotic Drug Costs and First-Line Antibiotic Prescribing Ratios

Abstract

R ising health care costs continue to prompt health plans, among other stakeholders, to identify and promote costeffective health care services. There is an inherent value in the promotion of lower-cost drug therapies (e.g., generic drugs) that achieve the same outcome as a higher-cost drug. 1 ABSTRACT BACKGROUND: Health plans and members benefit from the substitution of lower-cost drug therapies that achieve the same clinical outcomes as higher-cost drugs. Previous research suggests that generic sampling programs produce drug cost savings overall, but the effects attributable to acute therapies are unknown. Encouraging physicians to prescribe less expensive, first-line antibiotics may help reduce direct drug costs associated with prescribing potentially unnecessary, and more expensive, second-line agents.OBJECTIVES: To determine the effects of an automated, office-based generic drug sampling kiosk on (a) prescribing of first-line oral antibiotic agents as a ratio of total antibiotic prescribing and (b) average antibiotic drug cost per claim.METHODS: This managed care organization of 2.3 million members with pharmacy benefits collaborated with a vendor that developed an automated generic drug kiosk that allows for the dispensing of samples of generic medications within the prescriber's office. Among the samples contained in the kiosk were 6 generic, first-line oral antibiotics, representing 8 unique drug-strength options. Drug costs were defined as the ingredient cost of the drug claim, which includes plan cost, member cost share, and any dispensing fees or administrative program costs associated with the sampling program. In a difference-in-difference analysis, changes in outcome measures (antibiotic drug cost per claim and dispensing rates of first-line antibiotics) from 2003 (baseline year) to 2005 (post-implementation year) were compared among kiosk prescribers (n = 179) and nonkiosk prescribers who were part of the same provider network (n = 7,236). A cross-sectional analysis of the same outcome measures compared kiosk (n = 396) and nonkiosk prescribers (n = 10,267) in 2006. All statistical analyses were performed using t-tests of logtransformed data. for the nonkiosk prescribers, but the difference-in-difference analysis showed that the change was not statistically significant (P = 0.901). A cross-sectional analysis of 2006 data revealed significant differences between the kiosk prescribers versus their nonkiosk network counterparts for both first-line antibiotic prescribing rates (42.0% and 41.4%, respectively; P = 0.028) and antibiotic cost per claim ($28.44 and $32.40, respectively; P < 0.001). While the results of the cross-sectional analysis are statistically significant, the practical significance of the results is less evident.CONCLUSIONS: The benefits of including short-term medications such as first-line antibiotics in a generic drug sampling program are difficult to quantify, and the cost outcomes are unlikely on their own to justify generic drug sampling. However, acute (short-term) medications ...

The Effect of Medication Samples on Self-Reported Prescribing Practices: A Statewide, Cross-Sectional Survey

“…Research on this strategy is ongoing, and appears promising. [15][16][17][18] A similar strategy to stocking generic samples is offering vouchers for generic medications that a prescriber could provide to the patient in lieu of a sample. 19 This would potentially offer the same benefits as a generic sample, but without the administrative issues of restocking, managing inventory, etc.…”

Resistance to In-Office Dispensing of Generic Antibiotic Samples

“…1 A similar report describing the result of this initiative on overall rates of generic product use and cost was previously published in the June 2007 issue of JMCP. 2 In the current study examining the impact of the kiosk program on prescribing of antimicrobial drugs specifically, the authors found that rates of "first-line" (generic) antimicrobial use, measured as a proportion of all antimicrobial prescriptions, were similar among network prescribers with versus without access to the medication kiosks (42.0% vs. 41.4%, respectively; P = 0.028) in 2006, the most recent year measured.…”

“…The authors note that the program targeted high-volume prescribers and those having below average generic use rates. 1,2 Yet no data are provided to present these characteristics in comparison with those of network prescribers without access to the samples kiosks. Stratification according these and other characteristics would have likely yielded interesting findings.…”

Drug samples in dermatology: Special considerations and recommendations for the future

“…Generic drug sampling funded by insurance companies has been shown to significantly increase the use of generic drugs. 25,26 More study of generic sampling is required to determine if the cost of these programs justifies the outcomes that were obtained. 25 Waste associated with sampling.…”