A program to collect and redistribute unused prescription drugs could benefit Vermont, but the state shouldn’t try to create that program on its own, officials say.
In a report to the Legislature, a group of governmental and health care industry representatives says Vermont should contract with an existing drug-repository initiative in another state.
That would still come at a cost – nearly $237,000 by one estimate. But advocates say the potential benefits include reducing drug waste and and helping “Vermonters in need of critical medications who cannot afford them.”
“From the perspective of the work group … the motivation is that the waste and expense of these drugs and the need out there means that it makes sense dollar-wise, and it makes sense from a human impact perspective,” said Shayla Livingston, a policy adviser with the Vermont Department of Health.
Livingston was part of a study group organized after the Legislature passed S.164 in April. The bill said the Agency of Human Services should “shall evaluate the feasibility of implementing an unused prescription drug repository program to accept and dispense donated prescription drugs and supplies to Vermont residents who meet specified eligibility standards.”
The motivation for that bill was, in part, the large amount of drug waste at medical and long-term care facilities. While there are no Vermont-specific numbers available, the federal government in 2015 estimated that nursing homes in the United States annually dispose of about 740 tons of drugs that are no longer needed by patients.
“When a patient is discharged or changes drugs, those (unused) drugs in their verifiably safe containers are thrown away, and they actually have to pay to have them incinerated,” state Sen. Claire Ayer, D-Addison, chair of the Senate Health and Welfare Committee, said earlier this year when S.164 was moving through the Legislature.
As further evidence of the amount of unused prescription drugs in circulation, officials point to the success of “drug take back” programs. A take back event in April yielded more than 3 tons of “unused, unwanted and expired medication” statewide.
While medication goes to waste, many also struggle to afford prescriptions as drug costs continue to rise. Drug prices are a priority for federal and state officials, and Vermont is pursuing a variety of potential remedies including a controversial proposal to import cheaper prescriptions from Canada.
An unused drug repository might be a way to get free medication into the hands of those who need it most, officials say. Those medications could be for diseases including cancer, which has particularly high treatment costs.
“They can make a very big difference, and they can be very expensive,” Livingston said.
The question, however, is how to get a repository started and keep it going in Vermont.
Livingston said the working group quickly set aside the notion of the state creating its own repository. One reason is that there likely wouldn’t be enough donated drugs – both in terms of amount and diversity – to support a Vermont-only program.
“No one in the work group thought that was the best way to go – the main reason being economies of scale,” she said. “You’re looking to match patients with drugs, so you want to have a broader range of drugs available.”
Infrastructure cost is another concern. The working group says startup costs “could be prohibitive” and include hiring pharmacists and pharmacy techs; leasing or buying warehouse space; and purchasing or creating inventory, shipping and collection systems.
Instead, Vermont should “contract or grant out the system to an existing program,” the group concluded.
One possible partner might be SafeNetRx, a nonprofit that runs an unused drug repository in Iowa. In testimony earlier this year before the Senate Health and Welfare Committee, a SafeNetRx representative said Iowa’s program is the biggest in the country and has served more than 78,000 people; provided more than $21.5 million in free medical supplies and medications; and partners with more than 230 medical facilities and pharmacies.
Contracting with SafeNetRx would cost Vermont $236,880 per year, the study group’s report says. That money likely would have to come via legislative appropriation, since the study group recommends that patients, pharmacies and medical facilities shouldn’t have to pay to use the repository program.
There would be some additional costs for Vermont. The group’s report estimates $25,000 for a part-time position to handle contracting and outreach, and $40,000 to $50,000 for the publicity campaign.
“To be successful, the program would have to come with an outreach campaign to providers and pharmacists to make them aware of its existence,” the group’s report says.
Otherwise, program logistics mostly would be handled by the out-of-state partner. Livingston said donating drugs to that partner “would probably be through some sort of shipping and courier service,” and Vermont pharmacies and clinics looking for drugs would place orders after checking availability via an online database.
It would be up to pharmacists and medical providers in Vermont, however, to identify potential recipients of recycled drugs. The working group recommended parameters for recipients including those with an income under 400 percent of federal poverty level; people in the Medicare “donut hole” coverage gap; the uninsured; and the underinsured.
Other recommendations from the working group included:
• Drugs should be collected only from “institutional settings” rather than from individuals, which “will limit the number of collection points, ensure greater volume per collection run and increase the probability that the medication will be usable.”
• Examples of possible donating institutions include long-term care pharmacies, U.S. Department of Veterans Affairs medical facilities, state prisons and hospitals.
• Donated drugs should be in sealed, original packaging or in tamper-evident packaging, “unless they are opened bulk bottles from a secured pharmacy.”
• Those drugs shouldn’t require refrigeration, and they shouldn’t be controlled substances as classified by the federal government in schedules II, III and IV. That includes opiates like methadone, oxycodone and fentanyl.
• All drugs in the program should be inspected by a licensed pharmacist for tampering and correct labeling, and all patient information must be removed.