Sample medications and detailing visits add to costs, Guglielmo argues

Free samples of medications provided by pharmaceutical companies and “detailing visits,” where company representatives visit primary care offices to explain the value of various medications, are costly to the health system and ultimately to patients, B. Joseph Guglielmo, PharmD, dean of the UCSF School of Pharmacy, argues in a commentary for the January 27, 2020, issue of JAMA Internal Medicine.

As part of their marketing strategies, pharmaceutical companies regularly dispatch representatives to raise awareness of various drugs and distribute samples to health care providers to give to their patients for free. Both of these practices are common, with about 50 percent of clinicians reporting weekly detailing visits and approximately 60 percent maintaining a supply of drug samples.

These practices increase health care costs well beyond those required to give away free medications or hire pharmaceutical company representatives to make these routine visits. They can lead to the prescription of medications that aren’t the most biologically or cost-effective drugs available, or aren’t needed at all. These practices create further burdens on the health system by unnecessarily increasing physician visits, the use of emergency services, and hospital admissions—all due to unneeded or incorrect prescriptions.

“Over the next decade, the cost of prescription drugs is likely to continue to increase, and the costs associated with pharmaceutical detailing and use of samples are likely to be an important reason why,” writes Guglielmo, citing the $5.6 billion spent by pharmaceutical companies on detailing visits and the $13.5 billion spent on sample medications each year.

While a month of sample medication might seem like a gift to a patient, “over the next 11 months, however, the putatively free samples will cost the patient, a third-party payer, and the health care system,” Guglielmo says.

Detailing is very effective from a drug company’s point of view, with one visit increasing a general practitioner’s preference for prescribing the marketed drug more than two-fold—a boon for the company’s bottom line. For the health system, however, the practice “contributes to other costs, such as those associated with the prescribing of inappropriate or low-quality medications and the preferential prescribing of brand-name drugs instead of less-expensive and equally effective generic drugs,” Guglielmo writes.

Guglielmo says maintaining a value-based formulary, the term for the list of medicines that may be prescribed by an institution, “can achieve significant cost savings without unintended outcomes on health service utilization.”

Such value-based formularies are common in health care systems and practices affiliated with academic centers but not at independent primary care offices, where “pharmaceutical detailing and the use of medication samples will continue to create unnecessary costs for patients and health care organizations,” writes Guglielmo.

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The Cost of Pharmaceutical Company Detailing Visits and Medication Samples (JAMA Internal Medicine)