Coming Out of the Closet: The Pharmaceutical Sample Closet

Evans, Steven, Brown, and Smetana published the following research in Journal of the American Board of Family Medicine (JABFM) “Sample Closet Medications Are Neither Novel Nor Useful”  PDF is here. No need to read further the headline does a great job. Well allow me to capture some of the more damning points.

  • In 2009 80% of cardiologists, 70% of family physicians, and 67% of internists reported receiving samples
  • Samples get handed out in 20% of office encounters
  • 12% of all Americans receive drug samples yearly
  • Physicians and their staff frequently use sample drugs. (Bank CEOs get helicopters HCP get samples)
  • 82% of patients being given sample were insured for the year and had income 200% above federal poverty line (So much for samples helping the poor)
  • Samples skip EMR and the pharmacist which mean no potential for counseling
  • Physicians using samples bypass preferred drug choice


Drug samples are “almost never time worn and well-tested drugs … and usually comprise the newest drugs on the market.” Many new drugs on the market are “me too” drugs, a new drug within an existing class of medications that offers minimal additional therapeutic benefit. In addition, the long-term safety of newly approved drugs is often unknown.

Newly approved drugs, including those most likely to be found in samples closets, are often not novel or useful. For example, in one analysis of new drugs approved by the US Food and Drug Administration (FDA) in 2008, not a single new drug was both novel and relevant to primary care. Many newly approved drugs are heavily marketed as samples.

Need we continue? Okay

  • Only 5 of the 23 medications are first in a new class. Can you say me too?
  • Most sampled medications are not useful (20 of 23 sample closet medications had no studies demonstrating superior patient outcomes)
  • Safety and tolerability data was only found for 26% of the sample closet drugs
  • The closet samples are not first line agents in published guidelines
  • As if you need to ask these samples are more expensive when compared to generics
  • Finally, when the free sample are gone patients continue with the same medication at a higher cost.

This is a small sample but is the first of its kind. Bravo. The authors note that the number of physicians accepting sample was 64% in 2009 down from 78% in 2004. 

The strategy has worked for pharma and perpetuates the use of name brand drugs over generics and uses the physician to be the detail person with the patient. This research shows this strategy works. What can be done by pharma to make the sample closet a truly productive and valuable place for helping those in financial need. Coupons may not fair any better. 

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