Just Say No to (Free) Drugs!

I recently signed a pledge at NoFreeLunch.org that I will no longer dispense sample drugs. It wasn't an easy decision as I have many uninsured patients that would benefit from free medicine. But I often see patients come in who are no longer taking a much needed medicine because they cannot afford it. They were first prescribed the medicine as a sample. Sample drugs are almost exclusively new drugs that are still on patent and therefore expensive. Patients may not know that there are often cheaper and/or generic options to these medicines.

One example of this that I see frequently is Advair, a medication used to control asthma symptoms. Asthma care is broken down into a series of steps. The first step is to treat mild intermittent symptoms with albuterol only. If you have moderate persistent symptoms, you advance to Step Two and are prescribed an inhaled steroid. Patients who still need more control of symptoms go to Step Three where a third drug, a long acting beta agonist (LABA), is added.

Advair is a combination of the inhaled steroid fluticasone and the LABA salmeterol so it is a Step 3 medicine. However, it is also a new medicine that is on patent so samples are given to providers. Patients with and without insurance are given this medicine as a sample and later, when they run out of medicine, lose their insurance, and/or change providers, they find that it can cost around $180 per month. So folks now have to decide between spending money they may not have or deciding not to treat their or their child's asthma.

My experience has been that many of these people are probably at Step Two in the asthma treatment guideline and only need an inhaled steroid. These are also somewhat expensive, but at $75 per month, significantly cheaper than Advair.

There are times when the newer drug is the better drug but often these drugs are "me too" drugs.

Most of my patients understand why I am doing this. For patients that do need expensive medications, there are patient assistance programs where the pharmaceutical companies will provide with free medications.