Free Samples Might Carry Heavy Cost — Health

“There’s no such thing as a free lunch” – but there are plenty of free samples when you go to your doctor’s office for a prescription.

Be wary of free samples.

What? Am I asking you to look a gift pill in the mouth? Drugs are expensive, even the co-pay for drugs can be expensive.  What’s wrong with getting a freebie?

First, the drug companies that make them do not give them out forever.  Usually, they give out samples on a newer drug as part of a launch – kinda like a “grand opening” at a store.  The prices are really great that first week and it gets you trained to go to that store.

Another reason drug companies discontinue free samples is that, very often, the insurance companies or government programs may not have them on the “formulary” (the list of available drugs) right away.  As soon as the relevant insurance (mediCal in California) starts paying for them, you can say “Bye-bye” to free samples.

And often, the drug isn’t cheap.  Going from free to outrageously expensive causes some problems.  For example, in the context of private insurance, that the same medication becomes financially inaccessible, in terms of the patient’s copay.

Financial considerations aside, get your doctor to establish the reason for change of medication.  Is the new one really better, or is it just the drug company representative who said it was?

If your (chronic) condition is stable, and the new medication does not have any kind of good reason to improve your health – and it generally does not – don’t let the doctor switch you off of your regular medicine just because a new drug is giving out free samples.  Stick with your old tried-and-true.

The worst thing that could happen is that you get transferred to a new drug because it is temporarily free, and then you want to switch again when they stop giving samples – but there is a long withdrawal time before you can transition to another drug.

It happens – I have had a lot of trouble transitioning people from one antidepressant to another, and sometimes it can take over a month.

Doctors are given lots of free samples by drug reps and are supposed to accept this joyously, as drug samples that are “free,” are supposed to be a good thing. Rest assured they will get given out to patients. First, if they are not, or even if they are left around until they expire, they are notoriously difficult for a doctor to get rid of.  Government attempts to “collect” expired drugs will usually be limited to places where the doctor has to pay money to use.  If they get dumped (or flushed) into water, at least in San Diego, they could actually go to sea and cause some really sick fish and screw up the environment in unknown ways – and eventually end up in the drinking water of the whole population. As much as I care about Flipper and Shamu and the environmental “footprint” of this sort of thing, I really do care about humans more.  Lots more. Assuming for the moment that your doctor has given you a convincing argument and you have actually accepted a free sample of a pill, don’t take it!  At least, do not take it right away.  Get a free second opinion from a professional person who will love you for your consultation. Take your free sample to your pharmacist to “check it out” before you actually take it.  They have special drug interaction databases that doctors either may not have, or may not have the time or will to consult.  They might know lots of counter-indications that the doctor didn’t know or neglected to consider.

For example, if your pharmacist knows you are also taking heart medication, (s)he may realize that this new antidepressant can cause cardiac problems.  Same with blood pressure or diabetes or other problems.  The specialist (such as a psychiatrist) may not know about your other conditions or medicines, whereas your pharmacist may have the whole picture.

Drug-drug interactions are horrendous things that cause lots of death, but they are wildly preventable because there are wonderful databases that have lots of possibilities listed, including some that may be too delicate to actually happen or to be observed.  I am glad there are some going in that direction.  Humans are precious. First things first.  You should be getting all of your prescriptions filled at the same pharmacy.  If for some reason you have filled wildly different prescriptions in wildly different places, choose one pharmacist and make him/her keep a master list.  No, they won’t complain.  You are respecting their prowess.

Pharmaceutical consumer organizations have been lobbying against free samples for a long time, precisely because nobody knows about the interactions.  Sure, once in a while you can check out something at drugs.com, but there is nothing like turfing the ultimate responsibility to a smiling professional (who you can joyously sue later if something goes dreadfully wrong).

Pharmaceutical companies have started issuing vouchers to doctors to give out to patients to use at their favorite pharmacy to get their Rx filled instead of free samples.

This is good for the pharmacist, who gets paid retail cost (allegedly) by the drug company, and good for you because the pharmacist will check drug interactions.   They have great databases.  Doctors generally do not check (except me; there may be somebody else but I don’t know them).

The one thing I can think of that may actually be good about free samples is that they have copies of the package insert inside.  Now drugs have patient instruction sheets, which are lovely and simple, as well as package inserts, which are not simple and probably miss plenty of stuff, but it is stuff you have to know. Don’t worry if you can’t get them.  Everything is online, generally at a website that is titled with the brand name of the drug.

Remember – better safe than sorry.  Don’t let potential savings of a few dollars cost you your life.  It is much more worth saving.