Effect of Sample Medication Restrictions on Prescribing at a Private Clinic

Abstract

S ample medications allow physicians to quickly initiate therapy to evaluate initial patient response. However, sample closets primarily contain newer, costly brand name medications and rarely have generic options available. Studies now suggest that sample availability may affect the medications that physicians choose to subsequently prescribe, 1,2 but little data exist regarding this effect in private practice. In the present study, we explored the effect of removing samples of 3 medication classes on prescribing patterns at a private clinic. Methods. The primary objective of this study was to measure the effect of removing free samples of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins), levothyroxine products, and selective serotonin reuptake inhibitors (SSRIs) from a private clinic on the percentage of generic prescribing within each drug class and classes combined. Secondary objectives included the effect on generic prescribing for all medications and sustainability. This was a 150-day pre-post study (60-day run-in, 90day intervention) at Lakeview Internal Medicine in West Des Moines, Iowa. Prescribers participate in pay-forperformance and receive quarterly prescribing reports. Prior to the main intervention, all prescribers (n=5) attended an educational session presented by a clinical pharmacist reviewing current evidence on the study medication classes. Sample sign-out sheets were posted to demonstrate baseline sample use. All sampled statins, levothyroxine, and SSRIs were removed from the clinic for 90 days (December 1, 2007-February 28, 2008). No restriction was placed on the ability to prescribe these medicines. Data from a third-party payer were used to compare generic prescribing percentage during the samplefree period and a matched 90-day period prior to intervention (July 2, 2007-September 29, 2007). Data were analyzed using 2 as a test of proportions. PϽ.05 was considered statistically significant.

The Effect of Sample Medication Use on Subsequent Anti-VEGF Agent Selection for Neovascular Age-Related Macular Degeneration

“…11 One possible concern is that drug samples are a source of marketing that can have a major influence on physician prescribing behavior. 12 Previous studies have found that sample availability can lead physicians to prescribe drugs that are different from their preferred drug choice in an attempt to reduce costs to the patient. 5 Furthermore, samples may contribute to rising health care costs by increasing the subsequent use of more expensive products.…”

Drug Samples: Why Not?

“…The Madras Medical Group study showed reductions in branded drug use in certain categories [18]. Another study, conducted at Lakeview Internal Medicine, a private clinic in West Des Moines, Iowa, showed an increase in generic prescriptions following a 90-day removal of drug samples [27].…”