Waste Not, Want Not: Unused Prescriptions

Unused, costly and life-saving medicines are now routinely thrown away, even when the state has paid for them. (photo by Hilary Niles)

Unused prescription drugs could soon be donated to some uninsured or underinsured patients in New Hampshire.

The Board of Pharmacy is working with three test sites in Hanover, Rochester and Exeter to roll out the Unused Prescription Drug Program created by the Legislature in 2006.

Under the program, some prescriptions that normally would get thrown away—due to a patient’s recovery, allergy or death, for example—could instead be re-dispensed to people who can’t afford them. This matters most to program advocates as a social cause, especially as insurance and health care costs increase and more people laid off are losing benefits.

The bonus is that it could also save the state money down the road.

“It has huge ramifications,” says Rep. Judy Day (D-North Hampton). She sponsored amendments to the program this year with House Bill 1184. It passed the House on Feb. 17, and it may help end the four-year delay in putting the original law to use.

the hold-up

Mostly for safety and liability reasons, the donated prescriptions have to be handled differently than prescriptions made fresh. From acceptable expiration dates and re-labeling to physical storage and database management, a host of details have bogged down progress.

House Bill 1184 allows for temporary storage, and clarifies that the system is voluntary and patients must know they are getting re-dispensed drugs. Immunity for pharmaceutical companies in the case of mishandling had already been provided, and HB 1184 extends that to the pharmacists who will do the re-dispensing, provided all rules are followed.

Rule-making authority for the program lies with the Board of Pharmacy. But as Day explains, they’ve faced a chicken-egg dilemma. “They couldn’t figure out the rules without knowing the programs the rules would be written for,” she says.

Enter the test sites, which actually more chose themselves than got chosen for the pilot. Representatives from Rochester Manor and SeaCare Health Services both brought the idea of an unused prescription drug program to the Board of Pharmacy, only to find out that it had already been created, but not yet implemented. They started working with the Board to help create the rules, and Dartmouth-Hitchcock also joined.

chain of control

The program depends on a strict “chain of control,” meaning no drugs that have been in the hands of patients are eligible for donation. Only doses dispensed individually by a professional can be used. This is why the three test sites are significant: They each have a different chain of control.

Chain of control can be simple, but it must be strictly documented. (photo by Hilary Niles)

Dartmouth-Hitchcock has its own pharmacy, but it’s not a retail site open to the public. Rochester Manor is a skilled care center with a consultant pharmacist, but without its own pharmacy. SeaCare Health Services in Rockingham County screens and refers uninsured patients through a pro bono physician network. It has no pharmacy, and it’s an open network rather than a closed system.

Each place dispenses medicine differently, so each will have to develop its own procedures for chain of control. Once operational, the sites will be models for more facilities like them to follow. But, depending on the site, the procedures could take anywhere from a few weeks to more than a year to put in place.

patience

“I’m leaving for Florida for a week on Monday,” says Rochester Manor consultant pharmacist Gene Johnson, “and I want to start this when I get back.”

Johnson is both a pharmacist and a lawyer—a background that likely helped him prompt the Board of Pharmacy to action. Johnson drafted his own procedures for Rochester Manor, and Day says his proposal gave a focus to the Board, around which it could start creating rules.

Gretchen Colpritt and Gene Johnson of Rochester Manor in Johnson's office, which will double as temporary storage for unused prescriptions. (photo by Hilary Niles)

His gumption also helped. “If people can benefit from something, why wait for the bureaucracy,” asks Johnson. “If you can identify a problem now, let’s fix it now.” He is clear that efficiency, more than patience, is his strong suit.

The Board of Pharmacy did not return calls or emails by press time to confirm that Rochester Manor is indeed empowered to move forward according to current rules, but Johnson is not expecting to wait.

It will be a different story at SeaCare. Given their decentralized operation, executive director Kathy Crompton expects it could take up to a year to finalize procedures.

But with the Board of Pharmacy’s recent progress, she has more clarity with which to return to the task. Since SeaCare serves the public in 21 towns, it has a much broader reach, and she is motivated to achieve it.

Dartmouth-Hitchcock could not be reached for an update on that facility’s progress.

potential

All involved are optimistic about the pilot, and see even more potential for the program. It could include controlled substances, and it could also be used in the state prison system.

Day says that’s where the state could really save money. Inmates lose Medicaid upon incarceration, she says, but the state is not allowed to deny heath care, so it must pick up the bill.

In the meantime, she’s thrilled with the current progress. She found that of the 30 or more other states that have created similar programs, very few have implemented them.

“I’m not saying it’s not hard to do,” she says, but she still expects it to get done.

Posted by Hilary Niles on Feb 19 2010. Filed under By the Issues, costs, Health, insurance, Medicaid, Money, prescriptions, prisons & jails. You can follow any responses to this entry through the RSS 2.0. You can leave a response or trackback to this entry