OBJECTIVES: Pharmaceutical samples are widely used for promotion and marketing, yet little is known about who receives samples or how their use is associated with patient's out-of-pocket prescription costs. We sought to examine the characteristics of patients receiving samples and to describe the association between sample receipt and prescription costs METHODS: We divided the 2002-2003 Medical Expenditure Panel Survey, a nationally representative, panel-design longitudinal study, into a baseline period (the first two interview rounds) and an analysis period (the remaining three rounds). We conducted logistic and generalized linear regression analysis of 5,881 individuals receiving no sample during the baseline period. We defined our main outcome measures as: (1) sample receipt, (2) out-of-pocket prescription expenditures, and (3) total prescription expenditures. RESULTS: A total of 781 (14%) individuals received at least one pharmaceutical sample during the analysis period. On multivariate analyses sample receipt was greater among those who were younger and those not on Medicaid. In generalized linear regressions controlling for demographic characteristics and health care utilization, the 180-day out-of-pocket prescription expenditures were $178 (standard error [SE] $3.9) for those never receiving samples. Among those receiving samples, the corresponding out-of-pocket prescription expenditures were $166 (SE $8.9) for periods before sample receipt, $244 (SE $9.2) for periods during sample receipt, and $212 (SE $12.4) for periods following sample receipt. Results were similar when total prescription costs were examined. Analyses stratified by baseline health care utilization and by sample use for acute vs. chronic conditions suggested that “pent-up demand” failed to explain the associations observed. CONCLUSION: Individuals receiving samples have higher prescription expenditures than their counterparts. This finding suggests that sample recipients remain disproportionately burdened by prescription costs even after sample receipt.