Bruce A. Bornstein, MD, MBA¹, Francis X. Campion, MD², David Libby, MBA¹, Adam W. Rizika, SM¹, and James M. Richter, MD². (1) Kendall Partners, 15 Tudor Street, Cambridge, MA 02139, 617-930-3691, bornstein@alum.mit.edu, (2) Caritas Christi Health Care System, 736 Cambridge Street, Boston, MA 02135

OBJECTIVES: In order provide an alternative to pharmaceutical prescription drug sampling and to increase cost-effective drug prescribing among primary care physicians, a generic sample certificate system was developed for physicians offering their patients certificates for a free first month of a new therapy. This pilot study investigated the use of a generic certificate system and the effect on physician prescribing behavior. METHODS: Nineteen participating physicians were issued a generic sample checkbook and participated in a 2-month pilot study. The checkbook contained certificates that could be offered to patients, along with their drug prescription, providing a free first month of therapy if just starting therapy or 3 free months of therapy if switching from a branded agent to a generic. Certificates were completed by patients and sent by mail with proof of purchase for a rebate of out-of-pocket co-payments, effectively giving, the patient a free month or 3-month trial of therapy. Sample certificates were broadly available to insured and medicaid patients. Medicare patients were not eligible. The sample certificates included: Antidepressants: fluoxetine. Antihypertensives: hydrochlorothiazide, lisinopril, atenolol, verapamil. NSAIDs: diclofenac, naproxen. GI: omeprazole, ranitidine. Statins: lovastatin. Oral Diabetes: metformin, glyburide. RESULTS: A total of 108 certificates were distributed to patients of the 19 participating physicians. Seventy-six certificates (70%) were New Starts and 32 were medication Switches (30%). Patients redeemed 21 certificates (19%). Leading drugs sampled were lovastatin (24%), lisinopril (19%) and naproxen (12%). Of note, 50% of Switches were to lovastatin, and 19% were to lisinopril. In the two-month study period, approximately 51 new generic prescriptions were issued that otherwise would not have been. The annual savings per patient would be approximately $180 per year. CONCLUSIONS: The certificate system is simple to use and integrates smoothly into the physician’s workflow, however to ensure continued physician use it must be broadly applicable to the physician’s patient population. In the next phase, the program will be expanded to include Medicare patients. Patients have proven interest by redeeming certificates at a rate greater than the industry standard for rebates. If the program were expanded to 1,000 physicians and run over a year period, the estimated savings to payers, would be $15 million, realized over a three-year period ($15,000 per physician). Savings generated by the program are significant and worthy of further consideration.

Learning Objectives: At the conclusion of the session the participant in this session will be able to

• Assess a unique drug sampling system to increase generic drug prescribing by physicians.
• Evaluate the physician prescribing behavior demonstrated in a pilot study using the generic drug sampling system.
• Discuss the financial implications of the pilot study.

Keywords: Prescription Drug Use Patterns, Healthcare Costs

Presenting author's disclosure statement:
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Principal of Kendall Partners that developed the sampling system piloted.