State pockets savings on reused prescription meds

Thomas Buckley stood under the blinding stage lights at Central Connecticut State University and, between cheers from the boisterous crowd, the professor laid out his ambitious plan for helping poor people get access to costly prescription drugs.

“Every year in the United States, $5 billion worth of perfectly good medicines are wasted. Thrown away!” he said, his pitch rising. “Despite the fact that the medicine has not expired and can still be used by those in need.”

Buckley told the throng of 1,500 supporters gathered in CCSU’s auditorium on that October day that 38 states have enacted laws allowing health officials to collect and redistribute unused prescription drugs. The medication is put through rigorous quality checks and then directed to people who could not otherwise afford it.

“But wait, ladies and gentlemen,” he said. “Connecticut is not one of those states.”

The crowd unleashed a chorus of boos.

“In Connecticut alone,” Buckley continued, “we have over $50 million of wasted, needlessly discarded medicine in our nursing homes, correctional facilities and other institutions.” He paused dramatically before adding: “GHIAA is going to change that!” The room rang with applause. Buckley, who teaches pharmacy at the University of Connecticut, is a member of the newly formed Greater Hartford Interfaith Action Alliance, a group of faith leaders and community organizers that devised a series of proposals for legislative reform. Its ambitious agenda, unveiled at GHIAA’s inaugural forum at Central, includes antiracism training in schools, a push to expunge the criminal records of exoffenders and plans to join national efforts tackling gun violence.

In the hotbutton arena of health care, the group’s leaders are focused on a widespread issue — access to necessarybutexpensive prescription medication. Their plan seems like a nobrainer: Scoop up millions of dollars in wasted, unexpired drugs from the state’s nursing homes and prisons and reroute them to charity pharmacies that serve uninsured and underinsured residents.

There’s only one problem. Someone else already thought of it. But instead of turning the medications over to people who need them, the state of Connecticut pockets the money.

A littleknown, 20yearold law mandates that the unused drugs go back to vendor pharmacies, which reimburse the state. The program is saving Connecticut more than a million dollars year, according to figures from the Department of Social Services, one of the agencies overseeing it.

The law, adopted in 2000, requires nursing home operators to send their unopened, unexpired prescription drugs back to pharmacies for a credit. The recycled medication can then be repackaged for distribution. Similar legislation was passed for correctional facilities a year later.

Despite the program’s savings, officials across multiple state departments and in Connecticut’s nursing home industry were unaware it even existed, and little is known about its operations.

A report by the National Conference of State Legislatures, which tracked drug recycling efforts in all 50 states, notes that Connecticut passed laws on the issue but listed its program as defunct.

The head of the state’s nursing home association needed a week to confirm that longterm care facilities were still participating in the initiative, and could offer no details about how much medication was being recycled each year. An official overseeing drug control in the consumer protection department was unsure about the program’s status. And a DSS employee managing the endeavor declined to speak with The CT Mirror.

No one — not the Department of Energy and Environmental Protection, the Department of Social Services, the correction department nor the Department of Consumer Protection — could say how much, if any, unexpired medication was being tossed out by the state or its nursing homes on an annual basis.

An obscure program

Every year, nursing homes and other longterm care facilities across the country throw away tons of potentially reusable drugs. The unexpired medication is tossed after a patient dies, leaves or stops taking it.

The drugs are wide ranging — capsules for diabetes, syringes of blood thinners, highpriced pills for dementia and seizures.

A 2017 ProPublica investigation found some states were discarding millions in unused medication each year.

Colorado officials told ProPublica that their state’s 220 longterm care facilities were throwing away a whopping 17.5 tons of potentially reusable drugs every year, with a price tag of about $10 million. The Environmental Protection Agency estimated in 2015 that about 740 tons of drugs are wasted by nursing homes each year.

Researchers at the University of Chicago have said about $2 billion worth of unused medication is squandered each year at care facilities in the United States.

Connecticut was one of the earliest states to try to blunt that problem. In 2000, the General Assembly passed a bill requiring nursing homes to send their unopened, unexpired prescription drugs back to vendor pharmacies for credit. ThenGov. John G. Rowland signed it into law that June.

Under the statute, drugs that are packaged in unitdose or multipledose blister packs must be returned to the pharmacies. Nursing homes that do not comply may be fined up to $30,000 for each violation.

Controlled substances are not included in the program, nor are drugs packaged in bulk dispensing containers. The consumer protection department was charged with adopting regulations for the repackaging and labeling of the drugs, and care facilities were tasked with creating protocols for the return of the medication.

A nearly identical law for the state’s prison system was approved during a 2001 special session.

A report by Connecticut’s Office of Legislative Research shows the nursing home portion saved the state $4 million in 2005, $3.4 million in 2006, and $2.2 million in 2007.

By 2009, though, the figure had plummeted to $696,179. No one could point to an exact cause, but some state officials suggested that with the advent of Medicare Part D, certain drugs became more affordable, so it was cheaper to purchase new medication than to recycle it. It was unclear if the program ever temporarily ceased operation, or if the volume of drugs being reused simply dwindled.

Data provided by DSS show the savings ramped back up in recent years — to $2.3 million in 2015; $2.7 million in 2016; $2.9 million in 2017; $4.3 million in 2018; and $3.2 million so far in 2019. The totals are divided between the state and federal government — Medicaid is a joint program — so the state is holding onto $1 million to $2 million annually.

The savings are achieved through claim adjustments, said DSS spokesman David Dearborn. Medicaid purchases the drugs through claims made by pharmacies. When the unused medication is returned, the claims are reversed.

Dearborn said officials at DSS had several theories for why the savings swelled in recent years. Medications are more expensive and more prevalent, and people are living longer with chronic illness.

Drug recycling in the state’s prisons also yielded early success. Connecticut saved $1.1 million in 2008, the program’s first year; $1.2 million in 2009; and $1.4 million in 2010, according to the Office of Legislative Research. But sometime over the last decade, those savings tapered off.

Officials at UConn Health, which oversaw inmate care under a nowsevered contract with the correction department, said the addition of Pyxis machines, cabinetlike structures that allow drugs to be dispensed in smaller quantities, cut down on bulk orders, eventually eliminating excess medication. UConn Health was not able to say when the machines replaced the larger shipments entirely, or how long the program stopped operating.

DOC resumed management of inmate care last year, and in October signed a new pharmacy contract that brought back the bulk shipments. Karen Martucci, a spokeswoman for the department, confirmed that DOC is again participating in the drug recycling program.

In both the longterm care facilities and the prisons, it was unclear if all of the unexpired medications were being returned to vendor pharmacies. A handful of nursing home operators and pharmacists contacted by The CT Mirror did not return calls seeking comment.

“On the fundamental question of ‘Is there a program functioning?’ I can say yes, there is,” said Matthew Barrett, president of the Connecticut Association of Health Care Facilities. “But what I can’t say is the full extent of what the volume is, or what the level of participation is across all 213 nursing homes.”

Asked for records of fines levied on care facilities that don’t comply, Dearborn said DSS was unaware of any penalties imposed on the nursing homes.

To collect penalties, the law gives the social services commissioner permission to offset payments due to those facilities. Fines received by DSS must be deposited in the state’s general fund and credited to the Medicaid account.

“We’re not aware of documentation of any fines levied for possible noncompliance,” Dearborn wrote in an email to the CT Mirror.

Advocates want to recycle wasted prescription drugs. The state says it’s already doing that.