With most drugs, a less costly generic will work just as effectively as the expensive brand name only medication. However, in some cases, this isn't true. Antibiotics is one class of drugs in particular that this can be a real problem.
I would venture to guess that at least 70% of the antibiotic prescriptions we dispense are completely unnecessary. The common cold is caused by a virus. Nearly all upper respiratory tract infections are viral. Bronchitis is usually viral. The Flu is a virus (obviously). We go through ZPaks like water, but most patients don't need azithromycin.
However, there are some cases where antibiotics are warranted. Pneumonia is one of them. One of my coworkers recently was diagnosed with pneumonia. We asked him what his doctor prescribed for him, and he told us he was taking Cipro. The generic version of Cipro is on a local pharmacies free antibiotic list, so he thought it would be a great way for him to save money and get better at the same time.
Any pharmacist should have cringed upon reading that. Yes, we can use quinolones to treat community acquired pneumonia, and while Cipro is a quinolone, you will not see it on any pneumonia treatment guideline. It is not considered a first line therapy for treatment of communitry acquired pneumonia as it has poor activity against Streptococcus pneumoniae (a major cause of pneumonia). Avelox and Levaquin are first line treatments, but those are expensive brand name medications.
This pharmacy's commitment to "help out the public" by providing free antibiotics caused a doctor to prescribe an inferior therapy.
The whole free antibiotic idea is absolutely asinine. It actually does more harm to the public than good. First of all, if you mark something as free, people will inevitably flock to get some of it. It doesn't matter what the product is. We used to get free samples of things like Prilosec OTC, Metamucil, and other various OTC products. Within an hour of putting those things on the pharmacy counter, they'd be gone. You'd see people taking handfuls of stuff even if they've never used it before and had no reason to use it at the time. It was free, so they had to have it.
The same thing applies to antibiotics, except overprescribing antibiotics can have some very dire consequences. Antibiotic resistance is a growing problem, and by giving them away for free, you're encouraging their use in situations they are not merited.
Let's not even mention the fact how pharmacies make absolutely no money off this idea. In fact, the more antibiotic prescriptions a free-antibiotic pharmacy fills, the more money it loses. Remember, they are taking a loss on every antibiotic sold. Yes, it's usually a very small loss, but these are products on which pharmacies used to make a pretty decent profit. I suppose the idea is that people will bring in their other prescriptions along with the antibiotics. We all know this doesn't happen though, at least not to the point of significance. People will chase the free antibiotics just like they chase coupons and gift cards.
The other argument is that it will increase traffic in the store and lead to increased sales in other departments. Maybe that is the case. However, let's just break it down a bit. Say you're a grocery store pharmacy giving out free antibiotics, and let's say that the antibiotics have increased your script volume a little. Although your script volume has slightly increased, your gross profit either stayed the same or went down, so it hasn't helped your pharmacy's business one bit. However, let's say that the entire store's sales increased slightly after implementing the free antibiotic plan. Suddenly, the pharmacy is in a situation where they're doing less business as a percentage of total store sales. Since the corporate guys cannot positively tie the increased store sales to the free antibiotic program, all they see is a pharmacy department with a decreasing gross profit. The pharmacy is making less money, so the corporate bosses decide that they need to cut hours to cope with the falling profit margin.
Now, you're stuck in a situation where you're filling more scripts, making less of a profit, and doing so with less help. The whole store might reap the benefits, but the pharmacy department suffers.
No matter how you look at it, these free antibiotic programs are just stupid. Clinically they lead to poor prescribing habits. Financially, they do more harm than good.