PDMA law is spurring growth of vouchers in place of samples
Physician sampling could become a footnote in medical history. That's one possible outcome as an increasing number of physicians give patients vouchers for prescription samples instead of handing out medication in their office.
While there are no industrywide statistics on how many sample vouchers are issued or redeemed each year, 81% of pharmacists surveyed by the Kansas Pharmacists Association said they are seeing an increase in sample coupons.
"We hope coupons take off," said Susan Winckler, group director of policy & advocacy for the American Pharmaceutical Association. "Giving patients vouchers instead of samples brings pharmacists back into the loop." Typical use of a sample voucher would be for the patient to take the coupon with an accompanying prescription to a pharmacy where it is filled free of charge. The pharmacy, in turn, submits the voucher for payment, which can oftentimes be adjudicated on-line through the pharmacy's computer system.
APhA policy has supported pharmacy-based drug sample distribution since the 1970s, Winckler said. Physician sampling has come under increasing fire, including regulations specific to sampling listed under the Prescription Drug Marketing Act (PDMA), she added. PDMA requires physicians who distribute drug samples to meet requirements similar to those of retail pharmacy dispensing practices, she noted. Voucher programs let physicians sidestep PDMA by stocking coupons instead of drugs.
"Vouchers go through like any other third-party claim," said Harold Washington, owner of Bevans' Pharmacy in Los Angeles and president of the California Pharmacists Association. "Fees are about the same as with any other claim, but these are patients we probably wouldn't see any other way, so it's a net financial benefit."
Vouchers are a health benefit, too, said Kam Capoccia, clinical assistant professor at the University of Washington School of Pharmacy and clinical pharmacist at UW's Family Medical Center in Seattle. Voucher patients get the same screening and consultation as other retail patients. Patients who get samples from a physician usually get only the drugno pharmacy consultation including screening for allergies or contraindications, and no comprehensive patient medication record.
"A voucher system is incredibly simple for the patient," Capoccia said. "And the pharmacy has all the patient records and clinical reviews that go with every prescription. I think vouchers work quite well."
So do companies that promote vouchers to physicians, drugmakers, and patients. Two such companies are MedManage Systems and AdvancePCS, which, according to Capoccia, are the most visible. The companies issue, redeem, and track vouchers for every major pharmaceutical manufacturer in the country.
AdvancePCS, with headquarters in Irving, Texas, handles vouchers for about 30 products, said pharmacist Peter Kounelis, director of strategic alliance marketing for the company. He called AdvancePCS' program, Performance Script, an alternative to traditional sampling programs, not a replacement. "Many clinic-type settings do not participate in sampling programs," he explained. "Vouchers give manufacturers access they would not otherwise have."
MedManage Systems, based in Bothell, Wash., also indicated that vouchers will supplement, not replace, physical samples. But COO Steve Singer, who is a pharmacist, sees stronger growth in vouchers as more physicians close the door to pharmaceutical sales calls. In 1989, he said, 15% of U.S. physicians surveyed declined to see drug company sales reps. In 2000, 35% said that they were too busy to take samples or their practice setting does not allow it.
"Vouchers help control those problems," said Singer. "Vouchers also recreate the patient-pharmacist-physician triangle that we pharmacists always talk about."
Conversion from vouchers to paid Rxs varies dramatically. Singer claims MedManage has seen 100% conversion for chronic cardiovascular products to just 14% for a non-sedating antihistamine. He said there are no good data on conversion of traditional samples to paid scripts.
AdvancePCS is concentrating on vouchers distributed by physicians, as opposed to those dispensed on-line. Some programs, such as AstraZeneca's promotion of Nexium (esomeprazole magnesium), allow patients to download vouchers from the Web, visit with a physician for a prescription, then take the voucher and the Rx to a pharmacy for a free seven-day trial.
Overall, redemption is higher when physicians hand out coupons, Kounelis said. Either way, he added, health plan sponsors appreciate not having to pay for the initial course of therapy.
MedManage also distributes physical vouchers but is pushing electronic distribution. Physicians, or more likely office staff, download sample vouchers that can be given to patients. Surveys suggest that physicians are evenly divided between never using vouchers and preferring vouchers to physical samples, Singer said.
Some vouchers are part of a broader direct-to-consumer marketing campaign. One of MedManage's largest DTC voucher programs promotes Famvir (famciclovir, Novartis). The Famvir Web site encourages patients to download a voucher for a five-day trial of 125-mg tablets, the recommended treatment for recurrent genital herpes. The voucher must be signed by a physician, who then must also write an Rx for the product.
"Coupons also give patients talking points to take to their physician and pharmacist," Singer said. "They increase traffic in the pharmacy."
Fred Gebhart. Pharmacists welcome vouchers in place of drug samples.