Original Research

Journal of General Internal Medicine

, Volume 26, Issue 12, pp 1458-1464

First online:

Use of Prescription Drug Samples and Patient Assistance Programs, and the Role of Doctor–Patient Communication

  • Walid F. GelladAffiliated withPittsburgh Veterans Affairs Medical Center and the Center for Health Equity Research and PromotionUniversity of Pittsburgh School of MedicineRAND Corporation Email author 
  • , Haiden A. HuskampAffiliated withDepartment of Health Care Policy, Harvard Medical School
  • , Angela LiAffiliated withThe Health Institute, Tufts Medical CenterBlue Cross Blue Shield of Massachusetts
  • , Yuting ZhangAffiliated withUniversity of Pittsburgh Graduate School of Public Health
  • , Dana Gelb SafranAffiliated withThe Health Institute, Tufts Medical CenterBlue Cross Blue Shield of Massachusetts
  • , Julie M. DonohueAffiliated withUniversity of Pittsburgh Graduate School of Public Health

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Cost-related underuse of medications is common among older adults, who seldom discuss medication costs with their physicians. Some older adults may use free drug samples or industry-sponsored patient assistance programs (PAP) in hopes of lowering out-of-pocket costs, although the long-term effect of these programs on drug spending is unclear.


To examine older adults’ use of industry-sponsored strategies to reduce out-of-pocket drug costs and the association between doctor–patient communication and use of these programs.


Cross-sectional analysis of a 2006 nationally representative survey of Medicare beneficiaries.


14,322 community-dwelling Medicare beneficiaries age ≥65.


We conducted bivariate and multivariate analyses of the association between receipt of free samples and participation in PAPs with sociodemographic characteristics, health status, access to care, drug coverage, medication cost burden, and doctor–patient communication.


51.4% of seniors reported receiving at least one free sample over the last 12 months and 29.2% reported receiving free samples more than once. In contrast, only 1.3% of seniors reported participating in an industry-sponsored PAP. Higher income respondents were more likely to report free sample receipt than low-income respondents (50.8% vs. 43.8%, p < 0.001) and less likely to report participating in a PAP (0.42% vs. 2.2%, p < 0.001). In multivariate analyses, those who reported talking to their doctor about the cost of their medications had more than twice the odds of receiving samples as those who did not (OR 2.17, 95% CI 1.95–2.42).


In 2006, over half of seniors in Medicare received free samples, but only 1.3% reported receiving any medications from a patient assistance program. Doctor–patient communication is strongly associated with use of these programs, which has important implications for clinical care regardless of whether these programs are viewed as drivers of prescription costs or a remedy for them.


free drug samples prescription assistance programs Medicare physician–patient communication