Health Care Realities: Samples

People often express a naive and rather touching belief that people who really need assistance with health care costs in the United States can get it, despite ample evidence to the contrary. Sure, there are high profile cases in the media now and then covering people who clearly need health care and are not getting it, or don’t until the media kicks up a stink, but these are treated as outliers, rather than a daily reality.

Common assumption: Everyone who needs medication to treat medical conditions can access it.

Let’s assume that we are talking about people who have health insurance, in which case the answer to this assumption is: actually, no. Health insurance does not cover all medications. It covers those it deems necessary. If a patient needs a specific medication that insurance does not cover, an appeal can be filed, but it can take a while to hear back on this, and in the meantime, the patient must pay out of pocket, or go without, which is the more likely state of affairs because, guess what, medication insurance companies do not want to pay for is usually extremely expensive. If the insurance company does cover it, the patient still needs to pay copays and deductibles. Prescription coverage is often inadequate and the patient share of cost can be very high. The patient may have to fight the drug company for every refill. Imagine doing that for the rest of your life.

As for people without insurance, well. Some people qualify for government assistance and may be able to access medications through that. Again, not all medications are covered. And other people cannot afford health insurance, but also cannot access government assistance because their incomes are too high. These individuals are between a rock and a hard place. Some may qualify for assistance with specific drugs; the government recognises that some medications are really, really expensive and may help out. Sometimes drug companies offer compassionate use programmes.

Both of these have limited enrollment. If you don’t get in before the cutoff, no drugs for you. If you don’t comply with specific terms, you may be dropped from the program. Or you may be dropped anyway when funding is cut and the price of drugs rises and people need to be ‘eliminated’ from assistance programs. What do you think happens to people who were getting medication for free and now can’t access it? Do you think they shrug and pull out their credit cards at the pharmacy? No, they stop taking their medications, and they get sicker. Maybe they get so sick that they qualify for compassionate use again, until they start getting better and get booted out.

Which is where samples come in. I know an alarming number of people who rely heavily on free samples passed out by pharmaceutical reps. People talk about the problems with samples; that it can be manipulative, that doctors can feel like they need to prescribe those medications since they got freebies, that drug companies use underhanded tactics to get doctors to use their products. But one thing they don’t talk about is the public function served by samples.

Some people rely entirely on samples. They hope their doctors ask the reps for samples as often as possible, and they hope their doctors don’t hand them out to other patients, get to the bottom of the box, and go ‘oh well, next time.’ Others may use samples to bridge the gap; if you can, say, get medications nine months of the year, maybe then you can cobble together the remaining three with samples to survive until you can afford medications again. Or they are waiting for insurance approval and taking samples while they wait. And hoping they don’t run out and go through withdrawal while the insurance company dilly dallies and draws the process out.

As medication supplies dwindle, you start splitting doses. Skipping doses. Trying to parcel out the medication as long as possible because you don’t know when you will be able to get more. Guess what tends to be really bad for most chronic conditions? Irregular access to medications. Skipping doses or not taking enough is a really good way to create flareups, to experience more rapid degeneration. People do not do this by choice or because they are lazy or forgetful. They do it because they have no choice, because the alternative is going off medications entirely, which would be even more dangerous.

People should not have to rely on pharmaceutical samples when it comes to getting the medications they need, but they do. I see people talking smugly about how drug companies should not be allowed to hand out samples at all, how reform of ‘prescription drug culture’ should start with cutting off the supply of freebies to doctors. And I get where they are coming from. I, too, am troubled by junkets and free gewgaws and an assortment of other things drug companies use to woo doctors. But I also know that cutting off the sample supply doesn’t affect doctors: It affects patients. It affects people who cannot access that medication any other way.

I know that some drug reps know this because I see them overreaching the official limit when it comes to handing out samples, I see them pulling together medication for impoverished clinics where it could make a big difference for many patients. We can talk about drug companies and their reps as soullness, by all means, but we should probably also talk about how soulless it is to see people forced to relying on the charity of a drug rep to get treatment for their conditions.