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
|
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
