When I was a kid we never threw out unused prescription medications. Antibiotics and pain relievers were especially always saved and used, sometimes not necessarily by the person to whom they were prescribed. Of course, drugs that had a very specific purpose like my mother’s thyroid medication were not shared for obvious reasons. If a prescription brand or strength was change the old pills would languish in the bathroom medicine cabinet. As unorthodox as this may sound, it’s catching on with states, sort of.
A lot of expensive drugs are thrown out each year. I recall public service announcements advising people where they could dispose of unused pain pills and other supposedly dangerous drugs. The National Conference of State Legislatures (NCSL) estimates that $3 billion worth of prescription drugs are disposed of by hospitals and another $2 billion are trashed by long-term care centers each year. Perhaps $6 billion more are thrown away by patients outside of institutions. All told, an estimated $11 billion worth of prescription drugs are disposed of annually. Many states are setting up programs, or at least a legal mechanism, to allow unused drug donations and dispense them to help people in need. According to the NCSL:
As of September 2023, 44 states, Washington D.C., and Guam, have laws establishing prescription drug repository programs. Twenty-eight states have operational programs, with three more expected to be operational within the next year. Eighteen states, Guam, and Washington D.C. have laws enacted but are not operational. Operational programs are those with participating pharmacies, charitable clinics or hospitals approved by the state to collect and redistribute donated drugs.
Most state laws also permit the donation of cancer drugs within their existing drug repository programs. In addition to their general drug repository program, Florida, Michigan and Montana, also have a separate repository program specific for cancer drugs.
An article in Kaiser Health News reported on a prescription drug donation program in Colorado Springs, Colorado.
Open Bible Medical Clinic and Pharmacy runs Colorado’s only current drug donation program. Most of the medications it dispenses come from nursing homes across the state.
“We take any and all of it,” said founding pharmacist Frieda Martin, who used those donations to fill 1,900 prescriptions for 200 low-income and uninsured adults last year. Participants pay a $15 annual registration fee for free medications and care at the adjoining clinic.
There are approximately 258 million adults in the United States, of which about 8% were prescribed a drug in 2021. That means 21 million were prescribed an Rx drug but 9 million do not fill (or refill) their prescriptions due to cost. Some of the drugs donated are injectable drugs, including oncology drugs for cancer. It would be a travesty to throw out drugs worth thousands of dollars that someone could use.
Although nearly nine-in-ten states have programs to share donated Rx drugs, not all of them are yet operational. Furthermore, where programs exist they are often isolated, serving a relatively small area. For example, the program in Colorado currently only covers Colorado Springs. It will take time for drug donation programs to spread and when they do donated drugs can only help a small number of people. Perhaps programs can partner with drug distributors, pharmacies and drug makers to expand the numbers served. Or maybe pharmacies can help collect unused drugs donated by their customers although it may be hard to trust a drug that has been in someone else’s medicine cabinet.
These programs are worthwhile but only a stopgap measure. Another way to help those who cannot afford their medications would be to switch some generic drugs from Rx-only to either over the counter (OTC) or establish a third class of drugs called behind-the-counter. The latter are drugs safe enough to be dispensed by a pharmacist without a doctor’s prescription. When drugs are switched to OTC their price falls by 95% or more.