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MeritCare to dump sample meds

Fargo-based MeritCare will ban free drug samples from its clinics and hospitals starting May 1.

The health system is the latest to say "no" to handouts because of the time it takes to manage the drugs and concerns about how samples may influence a doctor's drug choice for patients.

"It's become a question of 'Where are you putting your resources?' and 'Is it appropriate for the patient?' " said Bob Biberdorf, MeritCare's executive partner for pharmacy services.

Details of the program still need to be worked out. There may be some exceptions to the ban, including drugs such as insulin that require hands-on education, Biberdorf said.

Discount vouchers for drugs will remain, he said.

The role of drug samples in patient care has been debated and researched for several years.

Advocates argue that samples make drugs more affordable for patients and help physicians become familiar with new treatments. Others say samples lead to an overuse of new drugs and higher prescription costs.

Several health systems in the region have already adopted sample-free policies.

Altru Health System in Grand Forks, N.D., eliminated the freebies in November.

Minnesota's St. Mary's Duluth Clinic became a sample-free campus in 2001. It dropped the free drugs because it took too much time to track samples and because of concerns for patient safety, said Dianne Witten, director of retail pharmacy services. Free samples of oral contraceptives, inhalers, topical creams and some injected medications are still allowed.

Innovis Health, based in Fargo, will consider a similar policy within the next few months, said Dr. Mike Briggs, chief medical officer for the health system's sites in the metro area.

"My own opinion is it's time we got rid of them," he said. "I think that will be the end result."

The internal medicine department at MeritCare's metro sites stopped accepting free drug samples in 2005, said Dr. Julie Blehm, who oversees residents.

Nurses now spend more time with patients and less time organizing and dispensing drugs. Doctors initially heard some complaints from patients, but not as many as they expected, Blehm said.

After the policy was in place for six months, some "excellent internists" acknowledged that the free samples subconsciously influenced what drugs they prescribed to patients, she said.

"Most of our doctors felt they weren't influenced by the samples," Blehm said. "It was an eye-opener. It made all of us think more carefully about what's best for the patient."

Tracking the free samples also takes time.

The Joint Commission, which accredits health-care organizations, requires strict documentation for drug samples. MeritCare estimates that nurses spend four hours per week per location managing drug samples. This costs the system about $350,000 a year in labor.

Patients who have no insurance or who can't afford medications without the samples will be referred to the Prescription Assistance Program in Fargo, Biberdorf said.

The program funded by Dakota Medical Foundation helps eligible people access free and reduced-cost drugs from pharmaceutical companies, said coordinator Megan McGillvrey.

In 2007, the program helped 484 clients save more than $2 million on medication. MeritCare's policy will send more patients their way, she said.

"But I think that will be positive," McGillvrey said.

Many patients obtain samples because they're easy and quick, but patients suffer when the samples - usually only for the newest drugs - are no longer available.

"We're a more stable program," McGillvrey said. "They're approved for 12 months."

Geraldine Doyle, 78, of Fargo has received many free drug samples since she was diagnosed with arthritis three decades ago.

The samples allow her to see if a new medication works before spending money on a 90-day supply, she said.

"I don't think giving a lot of free drugs away is a good idea, but I think it helps people find out if they can handle the medicine," she said. "Otherwise you have to throw out a lot of expensive pills that don't work."

Readers can reach Forum reporter Erin Hemme Froslie at (701) 241-5534

National statistics on free drug samples

- More than $16 billion in free drug samples were handed out by pharmaceutical companies in 2004.

- Fifty-eight percent of doctors say they give patients office samples.

- In 2003, 12 percent of Americans received at least one free sample.

Sources: Henry J. Kaiser Family Foundation; American Journal of Public Health

More information

-The Prescription Assistance Program, funded by Dakota Medical Foundation, helps clients with and without insurance access discount programs for nearly 4,000 drugs. For more information, call (701) 364-0398 or (877) 460-9996.