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Prescription “take back” programs expose intolerable waste

National Prescription Drug Take-Back Day is this Saturday, April 26th. It's a good opportunity for people to properly dispose of unused or expired medications at a safe location. You can find a drop off spot here. Consumers can also find convenient access to disposal locations more than twice a year with a program operated by the National Community Pharmacists Association (NCPA). It's called the Dispose My Meds program and you can find locations in our area by entering your zip code here.  These programs offer a safe and convenient way to help avoid the potential for abuse of medications, a major national epidemic according to The White House.

It's amazing how much waste there is with unused prescriptions. Pharmacists participating in these "take back" programs have been cataloguing some of it. It seems that a good deal of it might be resulting from automatic refill systems. Pharmacies often ask people taking chronic medications if they'd like to sign up for an automatic prescription refill program. Upon refill, you'll get an e-mail or text message or the system can contact you by telephone to remind you that your prescription refill is due and ready for pick-up.

I wrote about automatic refill systems earlier because there are a lot of plusses. They're convenient because they eliminate the need for the patient to remember to request a refill. That helps patients comply with their doctor's instructions. There's less urgency to dispense on demand, so patients don't need to stand by in the pharmacy until the prescription is ready. That in turn helps improve safety since staff at the pharmacy can better prioritize their work flow and they won't feel so rushed.

There are downsides too. Did you know that doctor's rarely, if ever, notify the pharmacy directly when they discontinue one of your medications or change the dosage?  Incredibly, the software used with the electronic prescribing systems now widely used by doctors is not designed to send discontinuations to the pharmacy. So it's up to you to let your pharmacist know when a drug is discontinued or changed. Once you opt-in for an automatic refill service, as long as there are remaining refills, they will just keep coming unless you stop them.  If you accidentally continue to take a discontinued medicine that could obviously spell trouble. The scenario is a set up for inadvertently taking the same medicine twice. I think any pharmacist working in a pharmacy that does automatic refills can recall situations where a discontinued medication was inadvertently dispensed.

Another issue is waste. I'm sure there's some with when prescriptions you don't really need are picked up from local pharmacies. But when you're notified by your local pharmacy that a refill is available, if you know your doctor has discontinued it, you can just refuse it. That might not be so easy with mail order pharmacies though, since the notification you get isn't by phone, it's when it shows up in the mail. Pharmacists participating in the NCPA Dispose My Meds program say that many of the medications being dropped off for safe disposal at community pharmacies come from excess mail order prescriptions that are auto-shipped to patients, whether they want the medication or not.  The group has begun to compile a collection of photos of mail order waste, along with dollars wasted, here.

Given the cost of prescription drugs these days, prescription drug waste, no matter what generates it, should be a major concern to healthcare leaders.  At the very least it should drive insurers and pharmacy benefit managers to put more pressure on e-prescription software vendors to develop software to automatically notify the patient's pharmacy when something is discontinued by the doctor. I'm not sure why that hasn't happened yet. It sure makes sense knowing that unused medications can hurt patients and waste a great deal of money.

Automatic refill programs can help patients adhere to their prescribed medication regimens. They’re convenient, you don’t need to remember to call, and your prescription will be ready once you get your pharmacy’s message, so there’s no needless waiting at the pharmacy. But good communication between you and your pharmacist about therapy changes is essential to avoid errors. And waste!

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