E-DRUG: Recycling of medicines in the US (3)
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Below is the text of the Scientific American article on recycling of
drugs in the US.
PS, it is not only the "poor" who do not have insurance - many young
healthy people choose not to have insurance since it's so expensive.
It's definitely not just an issue of people being considered
"second-hand" who might benefit from recycled drugs. Other people have
insurance but the coverage either ends too soon, or doesn't kick in
early enough - some have $5000 deductibles for example - they have to
spend $5000 before insurance kicks in. Under the recent extension of
reimbursement for medicines for Medicare there is a "doughnut hole" -
people have to pay 100% of costs in the "doughnut hole" between $2250
and $5100 and the elderly are on their own there. (this is likely to be
fixed soon under the Obama administration.) So the issues is more
complex than it first appears. These recycling programs might indeed be
helpful for specific drugs for specific patients. And better they be
exchanged through a pharmacy than between individuals on E-bay or
Craigslist....
best wishes,
Susie Foster
--
Susan Foster, PhD
Director of Public Policy and Education
Alliance for the Prudent Use of Antibiotics
75 Kneeland Street, 2nd Floor
Boston, MA 02111
617 636 3961 (phone)
617 636 3999 (fax)
www.apua.org
[Copied as fair use]
Section: NEWS SCAN
MEDICINE
Repositories for donated, unused drugs still face hurdles
Americans spend some $200 billion annually on prescription drugs. Since
1997, in an effort to keep a lid on costs, 37 states have enacted
legislation allowing patients, their families and health care facilities
to recycle good, unused pills through local pharmacies for donation to
patients lacking sufficient insurance. Thousands of patients could in
principle benefit from these "drug repository" laws, But as well
intentioned as these efforts are, practical problems have prevented
widespread implementation of such programs.
The guidelines for these laws, which began thanks to the lobbying
efforts of families of cancer patients, are fairly consistent throughout
the country. Donated medications must be in sealed, tamper-evident
packaging and usually must be within no more than six months of their
expiration date. Pharmacies are not held liable should the drug's next
owner come to unexpected harm from the medication. Some repositories
accept cancer drugs only; others take all prescriptions (minus narcotics
and sleep aids). Some states accept unused pills from home medicine
cabinets, whereas others, as a safety measure, permit donations only
from professional facilities such as nursing homes.
Under the rules, Iowa collected more than 300,000 pills with a retail
value of approximate!) $290,000 in 2007 and distributed them to some 780
patients. Recycling medicines from Tuba-area nursing homes saves
Oklahoma about $120,000 a year. These successes, though, are small when
compared with the potential of the practice. According to the American
Cancer Society, as of June 2008 only about one third of the states with
repository laws had up-and-running programs. Part of the problem is
money: pharmacies accepting donations do not want to incur the cost of
hazardous waste disposal if the drugs go unused. With no reimbursement
code for handling and processing donated meds, pharmacies have to be
willing to operate as a repository on a completely charitable basis. And
despite the letter of the law, many pharmacists tear lawsuits if the
drugs prove faulty. Storing the drugs, especially when refrigeration is
required, also poses its own issues and costs.
Physicians themselves have felt reluctant to steer patients toward the
repositories. Many consider donated drugs too risky because their
pedigree cannot be established. "We don't give any drug to any body
without knowing exactly where it's been at all times," says Roger Lyons,
a private hematologist and oncologist in San Antonio, who regards the
process as akin to filling prescriptions through the Internet or foreign
pharmacies. "I am ultimately responsible for making sure a patient under
my care gets the right medicine, so I'm not taking the risk." Lyons also
sees little need for repositories: " There are very few patients for
whom we can't get free drugs if they can't otherwise afford it."
The inability to ensure a ready supply is also problematic. Doug
Englebert, who over-sees Wisconsin's drug repository program, notes that
patients could suffer a potentially harmful gap m treatment if a
pharmacy has a donated drug one month but not the next. Physicians, he
says, "might have concerns with a repository because it's not a
guaranteed supply."
Englebert cites some of the legal demands as hampering the usefulness of
these programs. For example, the exclusion of drugs due to expire in
less than six months, which dramatically reduces the supply of eligible
donations, may be overly cautious because many of the medicines would be
claimed and used well with in that tune frame. Because the
tamper-evident seal cannot be broken, even a nearly full bottle cannot
be given. The requirement essentially limits donations to pills sealed
in blister packs--otherwise known in the industry as unit-dose packaging.
"There are very few medications that are in unit-dose packaging,"
Englebert remarks, "and so therefore very few that are eligible for
donation." In addition, the lack of funding renders many programs
cumbersome. Without databases of participating pharmacies and their
current inventory, for instance, would-be recipients need to call every
registered outlet to inquire whether their prescription is available.
To increase the utility of the repository laws, health counselors,
pharmacists and volunteers have deployed various strategies. Some
clinics are incorporating repositories into their ongoing patient
assistance programs. Other efforts focus on specific medications, such
as high-cost cancer drugs to which patients often prove intolerant.
Education is also key: pharmacy counters could provide information about
what consumers can do with unused medications. And as Englebert points
out, tackling packaging issues up front--such as increased use of
blister seals--might help satisfy security requirements.
Many experts and patient advocates remain optimistic about drug
repositories. Sarah Barber, who is a senior policy analyst at the
American Cancer Society, notes that the nationwide trend indicates a
definite need. These programs, she thinks, "will become much easier and
much more usable in the future."
By Jessica Wapner
Jessica Wapner, based in New York City, writes frequently about health
care issues.
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--
Susan Foster, PhD
Director of Public Policy and Education
Alliance for the Prudent Use of Antibiotics
75 Kneeland Street, 2nd Floor
Boston, MA 02111
617 636 3961 (phone)
617 636 3999 (fax)
www.apua.org