Monday, January 11, 2010

Update on Charitable Prescription Drug Program

As I noted a few months ago, the drug repository bill passed here in Oregon. The Oregon State Board of Pharmacy is currently in the rule-making phase and I met with their director. She wanted to know if I had any suggestions or wanted to give her any feedback about any rules that might be written. She also explained all the research she's done in order to implement this rule.

There are over 30 states that have a drug repository laws on the books. Only 14 are operational, but of those, only 4 states really have a repository in which drugs are donated and prescription drugs are dispensed. The best of these is in Iowa and the only reason why it works as well as it does is that it gets state funding to the tune of $1 million a year.

The upshot is that states must follow federal law with regard to prescription drugs. Under federal law, once a prescription drug leaves a licensed pharmacy or other licensed medical facility, the drug is considered "adulterated" and it is against federal law to dispense adulterated drugs. In other words, once a person has received a drug, even if they have not opened the package (even if it is bubble-wrapped), it is considered adulterated and therefore it is illegal to give to another patient.

She (Paige Clark) talked to pharmacy boards in the four states and all note that the majority (98% or something) of the donated drugs in their repositories come from nursing homes or other care facilities (licensed medical facility). And, they also noted that they usually don't even accept meds from individuals even if their rules allow for it.

Well, crap. I'd hoped I could donate drugs that I was prescribed but didn't use. It's time to think outside the box here . . . if you think of what we can do, I'm all ears! One thing is to try to change the federal law with regard to the definition of "adulterated prescription drugs". Probably a long shot . . .

In the meantime, this law does give a mechanism through which nursing homes and other medical facilities like it can donate their unused medications and it creates a repository that can dispense these meds to uninsured or underinsured individuals.

I guess that there's an organization in Portland (called Inside Out) that has managed to get pharmaceutical companies to donate medications to their facility that they then make available to indigent populations free of charge. I wondered if we can use a similar mechanism so that the same companies could donate medications to a drug repository throughout the state.

Paige also wanted to know that with regard to the "storage" issue (after a patient receives a drug, they aren't sure how it's stored - remember some meds must be refrigerated, etc.), if it would be a problem for patients receiving drugs to undergo a brief consultation about the proper way to store a drug. In other words, would it be too onerous for me, as a patient, to have the pharmacist give me clear instructions about how to store the medication. I told her that I wouldn't mind and I don't think most patients would mind at all.

So, that would solve the storage problem. But it still leaves the problem of adulterated drugs under federal law.

Another idea would be to create an informal matching service in which patients with unused prescription drugs could be paired with patients needing those drugs ... and while this may be happening informally anyway, it would be nice to make it a more formal kind of service. Unfortunately, I think there are laws against this . . .

Okay, I think that sums up the conversation. A bit frustrating . . . but it seems like something good will come of it at some level.

I also wondered if there was a way to match up patients with unused prescription drugs with patients who need them. A kind of "" for patients. I'm sure it's illegal somehow, but wouldn't that be great if we could work that out safely?


Liz Kreger said...

I can see where this would be a problem, Dee. Even if you are an honest, wonderful person who would never think of tampering with a drug and then donating it ... there will always be someone out there that will. I’d love to be able to donate drugs that I haven’t used, but I know that probably won’t happen because of this. Matching up a patient with another would be ideal, but I can still see where the program would have a problem with this.

What would be ideal is for these pharmaceutical companies to donate drugs that are on the cusp of being outdated. Everyone knows they’re still good, but the companies will be unable to sell them. Why not make them available to those who cannot afford it otherwise?

Dee said...

Hi Liz, Yes, wouldn't it be wonderful if the pharmaceutical companies did what you suggested? Let's hope that this becomes part of what they do to help patients out!

Clerk said...
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