States Look at ‘Recycling’ Medicine for the Poor
By Williams, Walt
It’s not just newspapers and aluminum cans that can be recycled.
A growing number of states are putting in place laws allowing medical facilities to “recycle” prescription medications in an effort to get medicine to low-income individuals. Among them are Virginia and Ohio, both of which have had programs for a few years now.
No such law exists in West Virginia, although it is something David Potters, executive director and general counsel of the West Virginia Board of Pharmacy, said his board has taken a look at over the past year or more.
“We’ve looked into it and not found anything that we are ready to put in place in West Virginia,” he said.
Under a drug recycling law, state programs, nursing homes and other medical facilities can return unused and sealed medications that will be given to needy individuals, according to the National Conference of State Legislatures. Laws vary from state to state, but they all share four common features:
- All donated drugs must not be expired and must have a verified future expiration date.
- Controlled substances as defined by the federal Drug Enforcement Administration are usually excluded and prohibited.
- A state-licensed pharmacist or pharmacy must be part of the verification and distribution process.
- Each patient who receives a drug must have a valid prescription form in his or her own name.
The NCSL reports that 36 states have laws allowing drug recycling, although not all of them are using them. Virginia, for example, allows hospitals to donate drugs that must first be checked by a pharmacist to make sure they’re safe. Ohio allows any person, drug manufacturer or health care facility to donate.
Six states – Colorado, Florida, Kentucky, Minnesota, Nebraska and Wisconsin – specifically focus on cancer medications.
The idea behind each program is to get medicine in the hands of those people who otherwise may not be able to afford it. Pharmacists redistribute the drugs to eligible individuals.
The medical community in the state did at one time consider a drug depository program for surplus mediations, which would have been very much like having a drug recycling law. The idea didn’t go anywhere because of various issues that popped up in implementing it.
“The issue with hospitals is that a hospital pharmacy may not have many drugs to donate simply because what happens is the hospital would send most of the drugs back to the manufacturer for credit once they expired,” said Tony Gregory, vice president of legislation affairs for the West Virginia Hospital Association.
Potters said every state has in place very tight restrictions about the medications that are returned. The safety of the medicine must be assured because there are many ways it can go bad.
Many medications must be kept in a controlled environment at low temperatures. A sunny afternoon in a hot car may be enough to spoil some medicines. Also, medication goes bad after a certain amount of time, and without proper labeling it is impossible to tell the expirations dates on most drugs.
Potters said the programs in other states are fairly new. West Virginia doesn’t want to hop on board just because other states are doing it.
“We want to take a measured approached so when we do it, we get it done right the first time,” he said.
Richard Stevens, executive director of the West Virginia Pharmacists Association, raised similar concerns about safety, noting public health scares in recent years with tampered over-the- counter medications. Capsules can be opened, tampered with and then reassembled, and it would be easy for that to go unnoticed.
“In today’s counterfeit market, we don’t think it is a feasible, plausible idea,” he said.
West Virginians are the most medicated people in the nation. A 2008 report by BlueCross BlueShield of Tennessee found state residents have an average of 17.4 prescriptions per person, the most of any state. Prescription drug abuse also has become a leading killer in the state.
Those facts make Stevens a little wary about implementing a drug recycling program.
“I would suggest that much of the problem we have with prescriptions… is because of the access that irresponsible, unlicensed persons may have to those medications,” he said.
Whatever the case, West Virginia has recently launched a program to get medication to low-income people, although it doesn’t involved drug recycling. West Virginia Rx provides medication at no cost to eligible people between the ages 18 and 65. In most cases, the medicines are donated from pharmaceutical companies.
The program is sponsored by the Governor’s Office, Heinz Family Philanthropies and the Claude Worthington Benedum Foundation.