Many small community health clinics accept sample diabetes medications from drug representatives. Providers often give sample drugs to those who cannot afford them and prescribe the drug to those who can pay. The diabetes educator is tasked with making medication management recommendations to mid-level providers in the treatment of diabetes and has a duty to be aware of the implications of the use of free sample medications.
Ethical issues involved
There are several ethical issues involved when a clinic accepts sample drugs from pharmaceutical representatives. Primarily, it suggests a quid pro quo relationship between a pharmaceutical representative and a provider. Providers could assume that in return for free samples, they should increase prescription of the drug to those who have the capacity to pay. This could lead the provider to suggest the drug for a patient when other, less expensive drugs would work just as well. The pharmaceutical representative also could exert pressure on providers with low prescription rates by not offering the free samples.
When sample drugs no longer are available, providers could become frustrated because they might feel that other medications are not appropriate for their patients. Patients might feel frustrated if a medication that was working well for them is no longer available. Before using free samples, providers must consider the possibility the drug could become unavailable with little notice. It is important that patients also understand this, and the provider, in collaboration with the patient, should develop an alternative treatment plan.
If specific guidelines are not established to address ethical concerns around distribution of free samples to patients, conflicts can arise between providers and patients. Providers can have differing views about the use of free sample medications, and patients can have legitimate concerns when one provider withholds free samples while another one offers them.
Responding to the challenge
There are four potential resolutions to the conflict around dispensing free sample medications to patients. First, the provider could never use the free sample medications. Second, he or she could use them whenever they are available. Third, the provider could dispense the free samples only to those patients who have no other options in terms of purchasing medications. Finally, the provider could use the samples as actual samples and offer them only to patients who can afford to purchase the medication under their insurance policies.
The benefits of using sample medications include helping patients control an illness that has been refractory to other therapy and giving providers more treatment options in patient care. When providers accept free sample medications, though, they risk having some patients believe they are paying for their medications so others can receive them for free. Also, providers might be compelled to prescribe new, more expensive drugs when less expensive medications are working well for patients. Finally, providers must guard against the development of an unbalanced relationship with the pharmaceutical sales representative.
The ANA Code of Ethics for Nurses states succinctly that the nurses primary commitment is to the patient and that nurses are obligated to promote, advocate for and strive to protect the health, safety and rights of the patient. Diabetes educators must be aware that conflicts exist about how best to serve the patient population and must take the time and effort to be educated on the risks and benefits of the alternative treatments. Diabetes educators are responsible for making medication management suggestions to mid-level providers in the care of patients with diabetes.
When conflicts arise, educators should be willing to serve on a committee or task force that seeks to resolve the particular issue. Once a protocol has been developed by a local committee or task force, they must be willing to abide by the guidelines set. If they do not agree with the protocol, it is their duty to bring their concerns to the committee or task force that developed the guideline.
Educators are bombarded with ethical conflicts regarding free sample medications and their judicious use. Solutions to ethical dilemmas are not always clear. The first step is to be aware that a potential conflict exist and to be prepared to make the best ethical decision by researching all possible alternatives to treatment.
Evans, Kari L.; Brown, Steven R.; Smetana, Gerald W. (2013). Sample closet medications are neither novel nor useful. Journal of the American Board of Family Medicine, 26(4), 380-387. Retrieved from http://www.jabfm.org/content/26/4/380.full
Erlen, J.A. (2008). Conflict of interest: Nurses at risk! Orthopaedic Nursing, 27(2), 135-139. Retrieved from http://journals.lww.com/orthopaedicnursing/pages/default.aspx