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So trial attorney Bill Cash was taking a deposition in Minnesota a couple weeks ago and ran across something at a doctor’s office he hadn't seen before. Bill wrties: In the old days if doctors wanted to distribute samples of drugs, they would typically get them from drug reps, and they would typically be samples of expensive brand-name drugs. The hope was that the doc would prescribe an expensive chronic drug like a Vioxx and get the patient taking it and paying for it regularly. The health insurance companies hated this, because it was getting people on expensive name-brand drugs when there are generic drugs that cost much less and are functionally equivalent. For example, atorvastatin (Lipitor) is a generic now, so why prescribe any other fancy new statin if this works just as well or good enough? Enter this drug sample machine. The doctor writes up the prescription for the sample on a chart, which is scanned in by the scanner at top right. Then on the touch screen, the nurse selects the drug that was supposed to be dispensed, and the right cabinet automatically pops open. One course of amoxicillin (or whatever) comes out, the pill bottle is scanned on the grocery scanner, and the machine automatically prints out the safety/usage warnings for the drug on the front, just like you’d get from the pharmacy. It is all linked to the patient’s EHR, so the practice knows exactly what it gave to the patient. When the machine runs out of drug, somebody comes by and restocks it and puts in more paper. What’s interesting is that the drugs are all generic, and they’re all free to the doctors and the patients. Who’s paying for this? According to this doc, it’s paid for by the three biggest health plans in town. The cost savings for getting patients onto generics is so great that they will make this service available to all patients, even those not insured by their plans. It’s mostly a mix of long-term maintenance drugs—generic Prozac, generic Effexor, generic Lipitor—and some “acute,” one-course drugs like clindamycin or amoxicillin. I asked, and the machine does not dispense anything controlled or scheduled. (And no Fosamax.) I’m not sure what the implications for our practice are, if any, but I thought it was pretty slick technologically and businesswise. Since they’re dosing generic drugs here (and they’re free), we may not have much of a product liability issue to complain about. I thought it was interesting that the warning comes out right with the sample, but that’s not much different than what’s stapled to the bag at the pharmacy. Theoretically, you could put some liability on whoever is writing the warning, or at least that is what’s being tried to impose liability on Wolters Kluwer (the Pennsylvania company that sometimes writes the pharmacy bag language). Presumably the brand companies could use this system, or one like it, to distribute their own samples, which could give us better proof of use in cases where we need that. I guess what I found most interesting was the lengths to which the health insurers would subsidize doctors, patients, and generic manufacturers in an effort to keep people off of name-brand drugs. In the long run, more pressure for generics means fewer people on brand drugs and maybe fewer clients. (I asked the doc about all the drugs on top of the machine. Those are name-brand samples, which they still dispense name-brand samples the old-fashioned way. Their practice was so open to drug reps they actually advertised their 4-hour drug rep daily calling window right on the front door of the clinic.)

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