It happens all the time. A patient is prescribed a medication in the primary care office. The nurse practitioner (NP) gives the patient some samples of the prescribed medication. The patient is thankful and happy to save some money.

Samples allow the NP to initiate immediate therapy for urgent or painful conditions. Also, the NP can evaluate the effect of the drug, detect any early side effects, and adjust the dose before a patient pays for a prescription. However, although sample medications offer benefits to patients and providers, NPs must maintain diligence and responsibility.

Do Samples Cause Bias?

Although pharmaceutical samples are readily available in primary care offices and clinics, basing treatment decisions on their accessibility may ultimately harm patient care in the long term. The perceived cost savings may be offset by the higher cost of prescribing the sampled medications. In a recent study, investigators observed 29 internal medicine residents in a primary care clinic. 1 During a 6-month period, the authors observed 390 decisions to begin drug therapy for patients. The residents were randomized either to not use available free drug samples or to use them at their discretion. Five drug-class pairs were chosen for study prospectively, with highly advertised drugs matched with drugs commonly used for that same indication but in less-expensive, over-the-counter (OTC), or generic formulation. Although the residents felt they were less influenced by marketing than their peers, and that samples were more acceptable than gifts for personal use, they did report that when samples ran out, they prescribed the sample drugs instead of preferred drugs. 1 The authors concluded that the prescribers in the study who had access to samples were more likely to write new prescriptions for heavily advertised drugs and less likely to recommend OTC and generic drugs than those without access to drug samples. 1

Responsibility When Sampling

State pharmacy laws and state practice acts define the scope of advanced nursing practice. Policies may vary from state to state. Pharmacy laws are silent about who may dispense samples in primary care offices, however, each state's Nurse Practice Act clearly defines the scope of practice for NPs. Nurse practitioners are well advised to check their state's Act to determine whether or not dispensing medications is within their scope of practice.

Even if an NP has the legal authority to dispense medications, there must be an underlying order from a practitioner who is authorized to prescribe them. Additionally, the samples must be specifically labeled and kept secure from anyone who does not have the authority to dispense and prescribe.

When offering samples, the NP must educate the patient about the medication, and then document this consultation in the medical record. The patient must know the medication's purpose, why it was prescribed, how to administer it, how long and when to take it, any special factors associated with it, risks, complications, or side effects, as well as who to call with questions or concerns. The NP must also have established that the patient does not have a history of allergic reactions to the medication.

Nurse practitioners may want to check with the pharmaceutical representatives supplying the medications for practical guidance and information. Knowing the laws regarding the dispensing of pharmaceutical samples is not only important for legal reasons, it is also part of the NP's responsibility to patients.

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