Quit Wasting My Healthcare

The Doctor is In: Free Samples Driving Up Costs

One month’s supply of Cozaar–$59.  One month’s supply of generic Lisinopril–$4.  Ninety-five percent of patients on Cozaar could be on Lisinopril instead.   However, the majority of the patients I see in the hospital who have high blood pressure have been put on a class of medications called ARBs (Cozaar is an ARB) by their primary care physician.  Why are so many patients on the more expensive medication?

I posed this question to one of the outpatient primary care physicians whose office is next to the hospital.  His answer was two words:  Free Samples.  Drug reps fill doctor’s offices with free samples of expensive brand name medications.  If a patient needs a new blood pressure medication, the doctor just reaches for a month’s supply of free samples, writes the patient a prescription for the medication for when the samples run out and then “abracadabra” the patient is on an expensive, brand name medication for a condition (high blood pressure) he will likely have for the rest of his life.  Cozaar costs $660 more a year than Lisinopril.

So how do doctors, patients and employers stop this wasteful prescription madness?  Ban drug reps from doctor’s offices?  I don’t think so.  The drug industry and doctors are intimately intertwined and I don’t forsee them ending their relationship anytime soon.

Instead, patients should ask their doctor how much a medication is going to cost them over the long run.  The doctor-patient relationship is such that the fastest way to drive change in physician behavior is to have the patient demand it.  All doctors know… the patient comes first, and most doctors are responsive to patient concerns. 

Doctors hate it when employer sponsored insurance companies tell them what to do; therefore, employers need to leverage the doctor-patient relationship.  Employers can do this through a benefit structure that promotes consumerism, such as a high-deductible healthplan with first-dollar coinsurance.  If a patient has to pay a percentage of the cost, she is likely to be more cost sensitive.  Patients and employers can save a lot of money–$660 per year for just this one medication–without sacrificing a lick of quality.  My advice to patients: BEWARE OF FREE SAMPLES–they will cost you more than you think.