State program meant to redirect prescription drugs goes unused

JEFFERSON CITY, Mo. -- A few years ago, as prescription drug costs continued to soar and lawmakers heard concerns from voters, the Missouri Legislature created a new program to help redirect extra, unused prescription drugs to the needy.

But today, the state is aware of only one organization that offers to collect medications and share them with others who struggle to afford their cost -- and the phone number listed on the program Web site has been disconnected.

Pharmaceutical companies, hospitals and nursing homes -- the very groups the law was aimed at, who were thought to have a supply of drugs they hate to just throw out -- say it's not working as intended, and hardly anyone is participating.

When the bill passed in 2004, Sen. Charlie Shields, a project coordinator for Heartland Health System, said the new program could save the state millions of dollars in drug costs.

Missouri is not alone. At least 33 states have passed laws creating similar programs, but less than half are implemented at this point, according to the National Conference of State Legislatures. It's hard to determine whether those programs are more successful.

"There are several states where this has become a sort of popular idea. The all-important question is to what degree are these programs quantitatively successful?" said Richard Cauchi, health program director for the national group. "The question of exactly to what extent it's working is to be determined."

Missouri's program is up and running, but it's unclear whether the state is saving anything in medicine costs. The state Department of Health and Senior Services has no way to track any savings for the state, no oversight of the program, and groups are not even required to inform the state if they begin participating.

"Their hearts were all in the right place," said Susan McCann, who runs the Narcotics Bureau in the state health department. "I don't think there was an opportunity to find out what the obstacles were to begin with. Everybody wants to solve the problem, but the path from here to there is not necessarily as straight and clear as some might think."

The law allows a dispenser of drugs, such as a hospital, a wholesale drug distributor or an individual to donate medication. But there's a big catch -- the person must never have had control of the medication.

In other words, if a person is prescribed a drug while staying at a nursing home, but then the doctor changes to a different medicine, the unused portion of the prescription could be donated to another clinic, if the individual agrees. But the family of a person living at home who died before finishing a three months' supply of medicine would still have to throw it away.

McCann said the rules are tight because the state must ensure the drugs are safe. If one resident didn't store the medicine properly, the drug could be altered and a stranger suffer the consequences, she said.

As a result, the drug repository program has limited applications. The state's nursing home lobbying groups said the rules don't allow nursing homes to make use of the program either. Generally, nursing homes work with off-site pharmacies and only bring in what they need, so they don't have a lot of leftover drugs sitting around, Health Care Association executive director Jon Dolan said.

Also, the rules don't allow a nursing home to take drugs destined for one patient and instead give them to another within their home with the same prescriptions, but instead would have to send them to an outside clinic, pharmacy or hospital that's part of the program.

Missouri Association of Homes for the Aging chief executive officer Denise Clemonds wasn't even sure the program had been implemented and didn't know of any homes participating.

"We're throwing away thousands and thousands of dollars every day. The state of Missouri has paid for those prescriptions, and they're not being used," Clemonds said. "We all were hoping we would have a very user-friendly program where those could be basically utilized instead of being thrown away. We're not there at all."

Dolan said federal government rules guiding packaging and storage of prescription drugs also make it difficult for the concept to run smoothly.

Drug manufacturers are not getting involved in the state-level system, saying they are addressing high drug prices through a national program to make drugs available to those who can't afford them. Pharmacists also say they would rather direct patients to that program, where drugs are new, safe and available, than state collection sites that are limited and whose supply is inconsistent month to month.

"It's definitely not the grand vision and implementation that many legislators [sought] because the bureaucrats haven't let us go there," Dolan said.