What do you do with your drug samples? Do you give them away like candy so theyre gone a few days after you receive them? Or, do you stock them away and forget about them until your shelves are overflowing with expired samples? If you answered yes to either of these questions, you can find a happy medium.

To effectively use your samples, reserve them for patients who cannot afford prescriptions, use them to find the medication that works best for patients and save them for use in emergencies.

Obtaining Samples
In order to make the most of your samples, you must first have them on-hand. So, consider the potential benefits of taking the time to develop relationships with your representatives. A pharmaceutical company sales representative is the number one source for obtaining samples, says optometrist Milton Hom, of Azusa, Calif. If your rep has a great relationship with you and visits frequently, you will have plenty of samples. But if your rep does not visit you, you will be left dry, he says.

You can also request samples, but some companies will only accommodate requests by fax or letter with a doctors signature, says optometrist Sarah Marossy, of Coeur dAlene, Idaho. When completing a request form, be careful, says Dr. Hom. If the form is completed wrong, your request is typically rejected, and the only response you get is no samples, he says.

If your samples are running low, request more, says optometrist John Schachet, of Englewood, Colo. Companies have always accommodated my requests, he says. However, keep in mind that pharmaceutical companies detail doctors by how many prescriptions they write for their drugs, Dr. Schachet warns. So, the response to your request may depend on how many prescriptions you write for the requested drug.

Companies unveiling new drugs tend to provide more samples of the new drugs than drugs that have been available for a while, Dr. Marossy says. Pharmaceutical companies with a new drug want doctors to try it, so their sample quantities may not be limited, she says. However, we should not experiment with sample drugs that we have never used before. We should read studies and journal reports about a new drug before administering samples, she says.

Help Patients in Need
Some patients can make good use of samples because they cannot afford their prescriptions. But, how do you determine who these patients are? Ive learned that financial need is hard to determine and should never be judged by a patients appearance or age, says Dr. Marossy. Some patients, such as the elderly, who are often on fixed incomes, are not shy about needing help filling their prescriptions, Dr. Schachet says. O.D.s should be cautious, however, to not be fooled by patients who do not want to pay for medications, but can afford them, Dr. Marossy says. Ive also been fooled by patients who cannot afford to pay, but are too proud or ashamed to tell me about their financial situation, she says. So, to determine need, optometrist Glenda Secor, of Huntington Beach, Calif., asks patients directly whether they have prescription drug coverage.

If you determine that patients cannot afford their medications, samples can help to alleviate this problem. I provide samples for patients who cannot afford their medications due to extenuating circumstances. Sometimes, I will provide them for patients who have chronic, long-term diseases, such as glaucoma, especially since I see these patients more often each year, says Dr. Schachet. Another option is referring patients in financial need to the pharmaceutical companys assistance program. (See Patient Assistance Programs, below.)

Patient Assistance Programs

Program	Phone number	Web site
Alcon Cares Patient Assistance Program	1-800-222-8103, opt. 2	www.alconlabs.com/us/aj/humanitarian_srvc/ US_patient_assistance_programs.jhtml
Allergan Patient Assistance Program	1-800-553-6783	www.allergan.com/download/patientassistance. pdf
Bausch and Lomb Indigent Patient Program	1-800-323-0000	No Web site available.
Merck Patient Assistance Program	1-800-727-5400	www.merck.com/pap/pap/consumer/index.jsp
Pfizer Connection to Care	1-800-707-8900	www.pfizer.com/pfizer/subsites/philanthropy/ access/connection.care.applications.jsp

For a complete list of companies and programs, go to www.needymeds.com/company_list.taf.

Most big pharmaceutical companies offer drug assistance programs that will provide medications to patients in financial need at a reduced fee or no fee at all, says Dr. Marossy. My experience is that most pharmaceutical companies will generously help patients in need if their condition is sight-threatening if left untreated, she says. For example, pharmaceutical companies are more likely to assist patients who need a glaucoma drug versus those who need an ocular allergy drug, Dr. Marossy says.

Other patients claim to need samples because they are in excessive pain and require a narcotic immediately. Medication seekers will say and do anything to obtain samples or prescriptions for oral pain medications, such as Vicodin (acetaminophen and hydrocodone, Abbott), Darvocet (acetaminophen and propoxyphene, AAI Pharma) and Lortab (acetaminophen and hydrocodone, UCB), says Dr. Marossy. Some patients will even self-inflict eye wounds, such as corneal abrasions, so eye doctors provide them with oral narcotics, she says. These types of patients often demand a particular narcotic and claim that other pain medications cause an allergic response, Dr. Marossy says. To avoid this, we never keep narcotics in the office and prescribe only non-narcotic pain medications, she says.

Test Drive a Drug
Samples can help patients find the medication that works best for them. I start my glaucoma patients on samples to determine if a specific medication works and should be prescribed, Dr. Schachet says. Dr. Marossy tests the effectiveness of medications in the same way: If a patient presents to me with seasonal allergic conjunctivitis, I begin treatment with a sample of a mast cell stabilizer/antihistamine combination drug. I also give patients a prescription at this time but tell them not to fill it unless they feel at least 75% better in one week, she says. If they do not feel better, she asks them to return to her office for further evaluation. This strategy works well because patients do not buy a prescription that doesnt work, and I can re-evaluate their condition, if necessary, she says.

Reserve Samples for Emergencies
Patients sometimes need to be treated immediately, and samples can be useful in these situations. I prefer to treat iritis with Pred Forte 1% (prednisolone acetate, Allergan), not a generic substitute, says Dr. Marossy. However, many pharmacies only stock the generic formula, and it typically takes them a day or two to obtain the non-generic formula. But, by administering a sample of the brand drug, I can start treating my patients iritis immediately while the pharmacy orders the non-generic formula.

In addition to helping your patients, sample administration represents optometry as a profession because it shows patients that O.D.s can administer and prescribe medications. Drug companies sometimes do not even detail O.D.s because some do not think that O.D.s can prescribe their drugs, Dr. Secor says. So, it is important to give samples to patients along with a prescription for the medication. O.D.s must keep in mind that prescribing rates also represent optometry as a profession and ultimately determine how pharmaceutical companies detail O.D.s and thus whether they should be given samples, Dr. Schachet says.