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Original Investigation |

Characterizing the Relationship Between Free Drug Samples and Prescription Patterns for Acne Vulgaris and Rosacea

Michael P. Hurley, MS1; Randall S. Stafford, MD, PhD2; Alfred T. Lane, MD, MA3
[+] Author Affiliations
1Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California
2Stanford Prevention Research Center, Program on Prevention Outcomes and Practices, Stanford University School of Medicine, Stanford, California
3Department of Dermatology and Pediatrics, Stanford University School of Medicine, Stanford, California
JAMA Dermatol. 2014;150(5):487-493. doi:10.1001/jamadermatol.2013.9715.
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Importance  Describing the relationship between the availability of free prescription drug samples and dermatologists’ prescribing patterns on a national scale can help inform policy guidelines on the use of free samples in a physician’s office.

Objectives  To investigate the relationships between free drug samples and dermatologists’ local and national prescribing patterns and between the availability of free drug samples and prescription costs.

Design, Setting, and Participants  Cross-sectional study investigating prescribing practices for acne, a common dermatologic condition for which free samples are often available. The settings were, first, the offices of nationally representative dermatologists from the National Disease and Therapeutic Index (an IMS Health Incorporated database) and, second, an academic medical center clinic without samples. Participants were ambulatory patients who received a prescription from a dermatologist for a primary initial diagnosis of acne vulgaris or rosacea in 2010.

Main Outcomes and Measures  National trends in dermatologist prescribing patterns, the degree of correlation between the availability of free samples and the prescribing of brand-name medications, and the mean cost of acne medications prescribed per office visit nationally and at an academic medical center without samples.

Results  On a national level, the provision of samples with a prescription by dermatologists has been increasing over time, and this increase is correlated (r = 0.92) with the use of the branded generic drugs promoted by these samples. Branded and branded generic drugs comprised most of the prescriptions written nationally (79%), while they represented only 17% at an academic medical center clinic without samples. Because of the increased use of branded and branded generic drugs, the national mean total retail cost of prescriptions at an office visit for acne was conservatively estimated to be 2 times higher (approximately $465 nationally vs $200 at an academic medical center without samples).

Conclusions and Relevance  Free drug samples can alter the prescribing habits of physicians away from the use of less expensive generic medications. The benefits of free samples in dermatology must be weighed against potential negative effects on prescribing behavior and prescription costs.

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Figure 1.
Trend in the Percentage of Prescriptions Written With a Sample by Dermatologists Compared With Physicians in Other Medical Specialties on a Nationally Projected Basis

“Other” specialties include allergy, cardiology, surgery, endocrinology, family practice, general practice, gastroenterology, geriatrics, hematology, internal medicine, nephrology, neurology, obstetrics/gynecology, oncology, ophthalmology, pediatrics, psychiatry, pulmonary diseases, rheumatology, and urology. From the National Disease and Therapeutic Index, January 2001 to December 2010, IMS Health Incorporated.23

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Figure 2.
Percentage of Prescriptions Written With a Sample and the Percentage of Branded Generic Drugs as Prescribed by Office-Based Dermatologists for Patients With Acne Vulgaris and Rosacea on a Nationally Projected Basis

From the National Disease and Therapeutic Index, January 2001 to December 2010, IMS Health Incorporated.23

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Figure 3.
Percentage of All Branded, Branded Generic, and Generic Drugs for Acne Vulgaris and Rosacea Prescribed During a Patient’s Initial Visit in 2010 at an Academic Medical Center (AMC) and on a Nationally Projected Basis

Analyses are restricted to prescriptions written more than 3 times in 2010 at the AMC. From the Stanford Translational Research Integrated Database Environment (STRIDE) project22 and the National Disease and Therapeutic Index, January 2001 to December 2010, IMS Health Incorporated.23

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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