The Effect of Sample Medication Use on Subsequent Anti-VEGF Agent Selection for Neovascular Age-Related Macular Degeneration.

PURPOSE: Medication samples of anti-VEGF agents can represent a good option for retina specialists to provide timely treatment for newly converted neovascular age-related macular degeneration (nvAMD) while prior-authorizations (PA) are pending. Our study examines the effect of medication sample use (ranibizumab or aflibercept) on future anti-vascular endothelial growth factor (VEGF) agent selection in nvAMD. DESIGN: Retrospective cohort study. PARTICIPANTS: nvAMD patients who underwent an initial anti-VEGF injection with a sample medication were compared to nvAMD control patients who never received a medication sample. METHODS: Charts from 2017 through 2020 were reviewed for data regarding demographics, anti-VEGF agent selection, and visual acuity outcomes for both groups. The utilization of different anti-VEGF agents in each group was compared at various time points using chi-square tests for independence of proportions. MAIN OUTCOME MEASURES: Anti-VEGF agent selection for the first four injections and at one year were examined. RESULTS: Adherence to the initial agent was high between first and subsequent injections (2nd, 3rd, 4th injection, and 1 year) in sample (96.2%, 95.9%, 91.9%, 93.4%, respectively), and control groups (98.1%, 94.2%, 94.9%, 87.8%, respectively). Bevacizumab usage was significantly lower among eyes receiving samples relative to controls at the second (1.9% vs. 38.7%, p < .001), third (3.1% vs. 41.3%, p < .001), fourth injections (4.7% vs. 40.4%, p < .001), and at 1 year (0% vs. 33.8%, p < .001). Aflibercept usage was significantly higher in sample eyes relative to controls at the second (78.3% vs. 43.4%, p < .001), third (76.3% vs. 41.5%, p < .001), and fourth injections (76.7% vs. 43.4%, p < .001), and at 1 year (77.0% vs. 52.7%, p < .001). CONCLUSIONS: Sample medications in nvAMD may be initiated for many reasons, including awaiting PA approval. Our study found that eyes receiving a sample anti-VEGF agent (ranibizumab or aflibercept) for their initial injection were less likely to receive bevacizumab at future visits relative to eyes that did not receive an anti-VEGF sample, even after one year of treatment. Given the persistent use of more expensive medications at subsequent injections for patients who were initiated on samples, insurance payors may consider waiving PA requirements for bevacizumab to avoid a paradoxical increase in health-care costs.

Higher insulin expenditures associated with utilization of free medication samples.

BACKGROUND: Insulin prescription prices have been a barometer of the complexities and concerns in the United States drug supply chain. The influence of free samples of medications have not been explored in this context. OBJECTIVE: To examine the trends in insulin prescription prices among sample users and non-users. METHODS: Medical Expenditure Panel Survey (MEPS) data from the years 2009-2015 were used. Insulin users were identified and grouped according to self-reported sample use and as new users based on year of treatment initiation variables. Prevalence of sample use was discerned using Cochran-Armitage Trend tests. Per prescription costs were summed as both the total costs and the patient out-of-pocket costs (OOP) and compared between users and non-users of samples. MEPS weights were used to create a nationally representative analytic sample. RESULTS: The weighted analytic sample included 5.3 million insulin users in 2009, which increased to 7.7 million insulin users in 2015. Among these, 5.6% reported sample use in 2009, which peaked in 2014 (8.1%), and was 6.2% in 2015 (p < 0.001). In 2015, the average OOP and overall costs were higher for sample users vs. non-users ($232 vs. $108, P < 0.001). This pattern was consistent each year. Per prescription costs per insulin prescription increased by 62% between 2009 and 2015 for sample users ($232 vs. $143, p < 0.001) and increased 35% for non-users ($108 vs. $80, p < 0.001). CONCLUSIONS: Sample use has increased among insulin users and is associated with higher per prescription costs. Patients and prescribers should consider the implications of sample use in the long-term.

Utilization of free medication samples in the United States in a nationally representative sample: 2009-2013.

BACKGROUND: Manufacturers provide free sample medications as a means to increase use of branded medications. Sample use varies year-to-year as branded product patents expire and new products come to market. OBJECTIVE: This study sought to describe the use of sample medications during 2009-2013 and assess individual characteristics associated with sample use. METHODS: Data from the 2009-2013 U.S. Medical Expenditure Panel Survey (MEPS) were used. MEPS asks participants whether they received each medication they are taking as a sample. The top 10 medications and medication classes used each year by volume were identified as well as the proportion of people who used at least one sample medication. The proportion of new initiators of medications were also classified as the percent who received a sample for the specific medication. Logistic regression was used to assess individual demographics, insurance, and medication characteristics associated with use. RESULTS: Prevalence of sample use ranged from 9.3% in 2009 to 6.2% in 2013. The most widely used sample medications included statins during 2009-2011, which changed to inhaled ß-agonists in 2012-2013, as atorvastatin became available as a generic. The overall volume of the top 10 free sample medications decreased by one-third over this study period. In 2013, 12.6% of new insulin analog users and 11.0% of new oral contraceptive users receive these medications through samples. Regression analysis showed that U.S. Medicaid- and Medicare-insured persons were less likely to use samples compared to those with private insurance. CONCLUSIONS: Sample medication use has decreased as generic medications are becoming more used in the U.S.