If more than a handful of states activated their laws related to prescription drug reuse and donations they might put a dent in the estimated $5 billion worth of prescription drugs wasted annually in the U.S., according to officials at a California drug reuse and donation program.
Supporting Initiatives to Redistribute Unused Medicine — an online community matching drug donations with low-income health clinics whose patients could benefit from the medications — helped put California on the drug donation map.
SIRUM — cofounded by Kiah Williams, George Wang and Adam Kircher and launched in 2010 — connects safety-net clinics with unexpired, unopened donated drugs from suppliers, pharmacies and health facilities.
Playing the intermediary, SIRUM provides an online platform where health facilities can upload lists of surplus medicines. The platform, using proprietary technology, produces a list of clinics serving low-income patients and allows the donor facilities to select recipients. SIRUM handles the rest of the process, from producing labels and shipping boxes to tracking donations.
Drug donations go directly to pharmacies at participating clinics. SIRUM, housed at the Haas Center for Public Service at Stanford University, does not directly handle any of the medications.
So far, Santa Clara Valley Medical Center is the only recipient of unused medications through SIRUM’s program, but donations come from facilities across the state.
In Northern California, donors include Lincoln Glen Skilled Nursing Facility, Mt. Pleasant Nursing Center and Amberwood Gardens in San Jose; Villa Siena in Mountain View; Sunny View Manor in Cupertino; and Greenhills Manor in Campbell.
The number of donor organizations has grown from seven in 2010 to 150 in 2013. SIRUM anticipates adding 150 more California donors by the end of 2014.
SIRUM works with skilled nursing facilities, assisted living and other health care services in the state to increase the number of donors and recipients. Its platform uses a peer-to-peer model with the goal of making the system easier to replicate in other counties and states.
To date, SIRUM has administered the redistribution of 444,380 units of medicine worth about $1.5 million wholesale.
Although Williams said the idea of drug donation is not a new one, SIRUM has brought it to a new level. “We help remove barriers for those who cannot afford their medications because they may fall on and off insurance coverage and eliminate details complicating efforts by donors,” she said.
The high cost of drugs hits low-income and uninsured Americans the hardest, resulting in nearly 25% of uninsured people not taking their prescription drugs as recommended in 2011, according to the Centers for Disease Control and Prevention. This population was twice as likely as wealthier Americans to skip medications in order to save money.
In 2003, 23%, or 39 million people, did not fill their prescriptions. In 2012, those numbers jumped to 27%, or 50 million people, according to the Commonwealth Fund’s 2012 biennial health insurance survey.
According to an estimate by Capital Returns, a national firm that provides financial services to pharmaceutical companies, $5 billion worth of prescription drugs go to waste every year in the U.S. Some of those drugs are expired and destroyed, but a significant amount is usable if the right policies and procedures are in place, according to SIRUM officials.
State Legislation Paved Way
A group of Stanford University medical school students paved the way toward drug donation by proposing a change in California law through a “There Oughta Be a Law” contest sponsored by then state Sen. Joe Simitian (D-Palo Alto), now a Santa Clara County supervisor.
The result was SB 798. It was signed into law in 2005, allowing “counties to recover unused prescription medications from skilled nursing facilities, pharmaceutical manufacturers and wholesalers and distribute them without charge to people of modest means who need the medications.” The law is part of the state’s Good Samaritan legislation.
The law, however, has some caveats: Donated drugs must be unexpired, collected and maintained under the authority of a licensed pharmacist, stored properly and received and maintained in their unopened, tamper-proof packaging. Controlled substances are not allowed.
A second bill, SB 1329, also authored by Simitian, became law in 2012, further expanding drug donation. It eliminates county ordinances regulating drug donations, expands distribution to include not-for-profit clinics in addition to pharmacies and allows licensed physicians — not just pharmacists — to collect and maintain medications. SIRUM’s Williams said some regulations in the past had produced hurdles for the program.
SIRUM is preparing to take full advantage of the changes in the new law this year.
The Lucky Recipient
Santa Clara Valley Medical Center tried its own hand in developing a medication donation program in 2006 without much success. “Unfortunately,” said Mymy Phu, supervising pharmacist at the medical center, “there was not enough manpower to collect the medications.”
In 2009, Santa Clara found its savior in SIRUM.
“As a county hospital, we are able to provide indigent patients who may be uninsured with medications that would otherwise be wasted. Our patients pay nothing for these drugs. There is a great need to provide this kind of pharmaceutical opportunity,” Phu said.
Prior to hooking up with SIRUM, the medical center relied primarily on taxpayer dollars to secure prescription medicines for patients who could not afford them.
“SIRUM has eliminated inefficiencies and improved communication between donors and our organization, and digitized Santa Clara County’s online formulary to coordinate drugs with potential donors,” she said.
Quelan To, public health pharmacist at Santa Clara Valley Medical Center, said the program prevents patients from seeking help from the emergency or acute care departments because medications are usually available when they need them.
Although both Phu and To anticipate that the Affordable Care Act will provide some kind of insurance for their low-income patients, free drugs would still be available.
“SIRUM is another source of health services for those who may still remain without insurance even though the ACA has the potential to provide coverage for many of the them,” Williams said.
Challenges of Accepting Drug Donations
Phu said that while the program is operating efficiently, the medical center lacks sufficient storage for donated drugs, along with enough people to manage the extra work demanded by the program.
To cited another challenge: Regulation mandates that donated medications must be kept in their original packaging until they are dispensed. About 90% of the donated medications arrive in blister cards, which necessitate taking each pill out of the pack, recounting the pills and repackaging them in a container before dispensing — a time-consuming process for pharmacists and patients.
“There is also more potential for error because we are rushing to get the medications ready for patients,” To said.
Finally, she said it could be a logistical nightmare when the medical center receives more drugs than it can use and wants to send them to a sister pharmacy or an affiliate mental health center. “These facilities are seen as separate entities so that each transaction must be documented individually,” she said.
During the first half of 2013, Santa Clara Valley Medical Center received the equivalent of about $240,000 worth of medications, based on the average wholesale price.
One of the Good Samaritans
Rebecca Turner, nursing administrator of the Lincoln Glen Skilled Nursing Facility in San Jose, said her facility doesn’t donate a lot of drugs, but in total has given more than $10,000 worth of medicine and has assisted an estimated 150 patients in receiving one month of free drugs. Based on requests from Santa Clara Valley Medical Center, Lincoln Glen donates primarily respiratory, cardiovascular and behavioral health medicines on a quarterly basis.
Starting participation in SIRUM’s program in July 2010, it was the first skilled nursing facility in the state to donate its unused medicine to Santa Clara.
Deane Kirchner, director of nursing at Lincoln Glen, said most of the unused drugs come from changes in prescriptions, discontinuation of drug treatment, changes in drug doses, discharged patients and residents who have passed away.
Lincoln Glen added a tracking tool to its administrative system to accommodate the program.
“SIRUM offers a novel solution to address the fact that many unused drugs are thrown away or flushed down the toilet while millions of uninsured Americans are denied access to appropriate care,” said Brian Quinn, senior program officer and team director of the Robert Wood Johnson Foundation’s Pioneer Portfolio.
California HealthCare Foundation, which publishes California Healthline, and Robert Wood Johnson Foundation provided funding to SIRUM. CHCF has contributed nearly $350,000 since January 2012, and RWJF made a two-year grant of $409,430 in November 2012.
“The grant is to help SIRUM grow its operations in California, explore the program’s feasibility in other states and pilot a similar program in at least one state,” Quinn said.
Quinn said the SIRUM program is on the right track to alleviating the problem of wasted, unused drugs, but some wrinkles still need to be ironed out:
- Understanding state regulations;
- Ensuring that similar programs in other states conform to their laws related to drug donation;
- Increasing the number of donors and recipients;
- Streamlining donation transactions through information technology; and
- Making potential participants aware of the opportunity to donate.
“The model is intuitively appealing and shouldn’t take much to convince facilities to give or receive medications,” he said. “SIRUM’s approach is game-changing.”