A recent report from Kaiser Permanente Institute for Health Policy provide insights into the type of marketing strategies used by pharmaceutical companies and the negative impact on patients, providers and health care systems. Direct to consumer, coupons and discounts are profitable ways to promote medications that may not be needed or away from less expensive, but effective alternatives. A more recent marketing stream is through patient advocacy groups. Product education for providers can be useful but can also promote expensive medications. Billions is spent on free samples, promotional materials or funding of clinicians or research institutes, which has also been shown to increase prescribing of more expensive medication choices.