Journal of the American Board of Family Medicine

Wayne S. Strouse, MD
Pen Yan, NY

To the Editor: I read with interest and some concern the article by Zweifler et al in the 2002 September-October issue of the JABFP (Zweifler J, Hughes S, Schafer S, et al. Are Sample Medications Hurting the Uninsured? J Am Board Fam Pract 2002; 15:361–6). The only conclusion I reach after reading the study is that we still do not know and that this study has added little to our knowledge.

I will state my bias at the onset. I give out samples—lots of them—to my Medicare patients without medication coverage and to my uninsured patients, as well as to some of my insured patients who are on so much medicine as to make even the co-payments prohibitive. I realize doing so is much easier in my private solo practice than it would be in a large clinic. Therein lies my first objection—the data are not necessarily generalizable.

In addition, it appears patients using samples were required to have a follow-up appointment to get more supplies. This financial cost to the uninsured patient would be expected to be prohibitive, even if a sliding scale were offered. A fairer way to compare the effect of using sample medications with outcomes from filling prescription medications would be to allow patients to call in for “refills” of samples without the need to be seen. We do this frequently at my office with good results. Patients are less likely to be noncompliant (and thus have higher blood pressures). The medication outcomes will not be evenly comparable, because some patients are embarrassed to come to the office frequently to pick up their samples, but it makes any comparison fairer.

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