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Approved Sample List

Last updated: June 2010
 
The following samples may be distributed to UW Health clinics as indicated.
 
General Exemptions (allowed in all clinics) 
  • Inhalers (oral and nasal)
  • Ophthalmic drops
  • Injections
  • Otic drops
  • Nonprescription (over-the-counter) products
  • Topical products

Clinic-Specific Exemptions

 
Medication(s)
Clinic
Otolaryngology drops, aerosols, sinus irrigations
Otolaryngology
Oral Contraceptives
Gynecology Clinic, Women’s Health Center,
Teenage and Young Adult Clinic, Pediatric West Clinic, OB Department East Clinic, UW Medical Foundation OB/Gyn, Pediatrics, Family Medicine, Internal Medicine
Floxin®, Cipro- HC®, Cortisporin® otic drops, Ciloxan® ophthalmic drops
Pediatric ENT Clinics (East and West)
Xalatan® ophthalmic drops
Ophthalmology Clinic
Requip ® (immediate release only), Mirapex ®, Betaseron ®, Comtan ®
Neurology Clinic
Bronchodilators for nebulization
Pulmonary Clinic
Miralax ®
Surgery Clinic
Coreg ®
Cardiology Clinic, Heart Failure Clinic
Lamictal ®
Epilepsy/Neurology, Peds Specialty
Aricept®
Neurology Clinic
NuvaRing®
Gyn Clinic – West, Teenage and Young Adult Clinic, UW Medical Foundation OB/Gyn, Pediatrics, Family Medicine, Internal Medicine
Ortho Evra transdermal patches Teenage and Young Adult Clinic, UW Medical Foundation OB/Gyn, Pediatrics, Family Medicine, Internal Medicine
Namenda® starter pack
Neurology Clinic, Neuro-Oncology Clinic
Requip® (immediate release only) for restless leg syndrome 
Neurology Clinic and Sleep Clinic
Neupro® transdermal patches starter kit Neurology Clinic
 
 
For more information on the UW Hospital and Clinics sample policy, see UW Health Administrative Policy & Procedure 8.36 - Trial Supplies of Medication: Samples, Drug Vouchers, and Starter Supplies (PDF), posted in the Policies section of the faculty and staff intranet site and the Vendor Liaison Office Web site, www.uwhealth.org/vendors.
 
WisPIC has an exemption for all samples.
 
Criteria for Granting Exemptions to the Drug Voucher System
 
Patient Education
  • Medication provided for use during the clinic visit to instruct the patient in proper use
  • Patient needs hands-on experience or must demonstrate technique to clinician 
  • No placebo educational tool exists
     
    Examples: Metered dose inhalers, nasal sprays, injections 

Dose Titration 

  • Complicated dose titration regimen (i.e., several dose changes during initiation of therapy)
  • Packaging provides compliance with dose titration 
  • Dose titration cannot be reasonably duplicated by the typical packaging of the medication 
     
    Examples: Pramipexole (Mirapex®)
    0.125 mg PO tid x 7 days
    0.25 mg PO tid x 7 days
    0.5 mg PO tid x 7 days
    0.75 mg PO tid x 7 days
    1 mg PO tid x 7 days
    1.25 mg PO tid x 7 days
    1.5 mg PO tid x 7 days

Lack of Commercial Equivalent

  • Available commercial sizes are of an inappropriate size to provide a trial quantity 
     
    Example: Topical creams and ointments, eye drops, otic drops

Patient Confidentiality

  • Sensitive or delicate situations where use of vouchers could compromise confidentiality and jeopardize patient care 
     
    Examples: Oral contraceptives in the Teen Clinic