Simple Steps to Effectively Using DRUG
There are a number of perspectives on how to use drug samples. Which are
best for your practice?
BY ERNIE BOWLING, O.D., M.S., F.A.A.O., Summerville, Ga.
When drug samples arrive at my office, I'm like a kid at Christmas. My staff routinely handles all incoming mail, but they know to leave those boxes containing the drug samples for me. I impatiently rip open the boxes, heart racing, wondering what new and amazing medications my friendly drug reps have sent.
Once I sort through the freebies, I immediately set out dispensing them to anyone and everyone who needs them. Quickly, I'm once again completely out of samples, saving none for in-office use. I have to turn away patients who regularly come into the office for their free medications and they're often disappointed, sometimes angry.
This was the way I used to handle in-office drug sampling. Needless to say, I had to re-think the way I handled samples. I'll talk more about the art of dispensing drug samples and I'll share some input from our colleagues on the subject.
PHOTO BY PAT SIMIONE
Pharmaceutical companies use drug samples to help practitioners gain clinical confidence in the performance of their product. But how do the drug companies decide where they send samples?
Written requests for samples is one obvious means. Another method is through tracking prescriptions written. The more prescriptions for a specific drug an individual doctor writes, the more likely he'll get samples from the drug representatives.
Dave Sattler, director of Professional Relations for Alcon Laboratories, explains, "Field representative visits are based on the prescriptive opportunity of the office. Prescription tracking data is purchased from an independent third party. Field reps will then review that information to see where the prescriptions are coming from in their service area. Those are the doctors the field reps are most likely to call upon." (Which explains the [lack of] rep calls on my office.)
Radoiu, O.D., F.A.A.O., of Staunton, Va., "There is a symbiosis at work here. Patients, doctors and the pharmaceutical companies all benefit from sampling if done in moderation."
From my experience, I've found that the use of sample medications falls into one of the following categories:
New product on the market.
"With any new product on the market, it's nice to have a sample to see how it works on your patients and to gain a comfort level with the medication before prescribing it on a regular basis," says Daryl Mann,
O.D. of Chattanooga, Tenn.
Mr. Sattler adds, "The doctors must get clinically comfortable with new medications and pharmaceutical companies understand that."
Starting a new chronic therapy.
When starting, adding or changing a new drug for therapy, sampling provides an opportunity to evaluate the efficacy of the medication, patient comfort and compliance with the medication, and any adverse effects of the drug before you ask the patient to purchase a prescription. Perhaps nowhere is this more necessary than in glaucoma therapy.
Dr. Radoiu agrees. "In the diagnosis and treatment of glaucoma, I like to see if the medication can control the IOP adequately without the patient having to incur a needless cost at the outset," he says.
Emergency situations. While 24-hour pharmacies are prevalent in many locales, it's hard to find one out in rural America. Having samples on hand in-office to initiate therapy for emergency cases after hours or on weekends is essential for proper patient care. A patient can then get a prescription for the medication to take to their pharmacy when it reopens.
Dry eye therapy. Sampling enables the
O.D. to see which formulation provides the best relief to the patient.
"I always sample out ocular lubricants and ask a dry eye case if he's satisfied with any of them on a subsequent follow-up visit," relays Dr.
Also, Mr. Sattler points out that patients tend to purchase the product that their practitioner recommends. "The doctor's role in recommendation is powerful," he says. "Research studies have found that 80% of patients will obtain the product that their doctor recommends. The doctor's verbal and written recommendation is even more important than the sample."
The problem with samples
I find it difficult to justify handing out samples to patients who have other conditions. First, consider the size of samples. One milliliter
(mL) of medication usually yields about 17 drops. Using that calculation, a 5-mL bottle will last about three weeks. Most professional samples are smaller than regular prescription-sized containers (1 mL to 3
mLs), so it would take multiple samples to carry the patient for the length of therapy.
For patients who have acute conditions, such as acute allergic conjunctivitis, I tend to give a sample and a written prescription. That way, the patient can try the sample and then have a pharmacist fill the prescription once he's found the sample beneficial. I almost always write a patient a prescription for antibiotics and steroids, rather than give them samples because I've found that I need these samples more for in-office use.
Sampling to the needy
We've all had some experience with patients who have difficulty obtaining their medications. Unfortunately, it seems as though those who need the medications the most are least able to afford them. Many patients have prescription drug plans, but many of these have higher deductibles or co-pays for non-generic medications.
I have no problem initially sampling medications for patients who have financial hardships. (Better to control the patient's disease with samples than to have him lose his sight because he couldn't afford the medications.) On the other hand, I'm uncomfortable assessing need -- especially in an area where many of my patients are at or below the poverty line and are undoubtedly needy. Some patients will tell you flat out that they can't afford the medications. Others will say nothing and never fill the script. (You can imagine what that does to compliance.)
Fortunately, most drug companies have good patient assistance programs. We keep the contact numbers handy and provide them to patients who need long-term therapy. "Patient Assistance Programs for Ophthalmic Medications" on page 50 provides information for some common ocular pharmaceutical companies' patient assistance programs.
What are others saying?
Radoiu, "I am very selective about who gets samples. There has to be a benefit to both the patient and to myself as the attending doctor. I don't believe in giving out meds to be a nice guy or to market the practice. The former would be naive and the latter corrupt." Interestingly, he continues, "It would also undermine my professional standing, as I would take on the reputation as a 'candy man' ready to dole out any thing at any time. I feel that a selective sampling is much appreciated by patients (as an initial treatment) and that it demonstrates patient advocacy."
O.D., F.A.A.O. of Stamford, Conn., shares his opinion. "I think samples are a must. With so many insurance companies not covering prescription medications or making patients pay a portion of the costs, which can be a substantial amount of money, I like to sample a drug and make sure the patient responds before asking him to pay for it. And if you're going to support a particular company's product, they should be able to support you with samples."
Face the facts
Drug samples are essential to all optometrists who provide medical therapeutic services to their patients. And the number of optometrists that are prescribing therapeutic drugs is steadily increasing.
According to industry figures, 23,558 O.D.s prescribed an ophthalmic drug at least once in the past year. We can only hope that the pharmaceutical community will support us as we expand our therapeutic wings and increase our prescription numbers.
Patient Assistance Programs
for Ophthalmic Medications
Alcon Labs Glaucoma Patient Assistance Program
Azopt, Betoptic S, Timolol, Travatan (800) 222-8103 (option 1)
Alcon Labs Medical Need Program
Antibiotics, steroids, others (800) 222-8103 (option 3)
Allergan Patient Assistance Program
Alphagan, Betagan, Lumigan, Propine
(800) 553-6783 (7a.m.to 4p.m., PT); alt (800) 347-4500, x7791
Merck Patient Assistance Program
Cosopt, Timoptic, Timoptic XE, Trusopt
(800) 994-2111 (9a.m. to 7p.m. EST)
Pharmacia Patients in Need Program
Xalatan (800) 242-7014 M-F 9a.m. to 8p.m. EST (option 1) )
Bausch & Lomb
Alrex, Lotemax (800) 323-0000 (option 3)
Santen Patient Assistance Program
Betimol (866) 815-6874
Note: Most of these programs can only be accessed through an eye doctor's
office. The patient's role is to inform you of their inability to afford the medication and of their lack of prescription coverage. You or your patient can access a complete list of patient-assistance programs at
is optometric editor of Boucher Communication's Internet newsletters Diagnostic Digest and Comprehensive Optometry. He is a primary care diplomate of the American Academy of Optometry and is in private practice.
Optometric Management, Issue: February 2004