Recycling Expensive Medication: Why Not?

Jay M. Pomerantz, MD

Disclosures

Medscape General Medicine. 2004;6(2):4 

In This Article

Program Structure

Obviously, much discussion and planning is needed before medicine recycling could become a reality -- new laws, regulations about what might be recycled, individual pill packaging for the selected items, rules about who might be eligible to return medication, who might be able to purchase it, rules for exchanging the old pills for a new prescription, how to pay for the infrastructure support, etc.

It might be wise to concentrate at first on recycling from nursing homes and other facilities where there is an unbroken chain of accountability for the medicine. Such medication has never been out of the hands of accountable healthcare workers, and there is a clear trail of when it was purchased for whom and why it was not used. Recycled medicine would have to be individually packaged or still in its sealed original container.

Another approach might be to limit an initial recycling program to only new prescriptions, making them returnable at a discounted rate, perhaps within 1 month of original issue. The consumer would have to bring the medicine back to the same place where it was purchased, with the sales receipt, and fill out a form establishing that the medicine was properly stored and checking off the reason(s) for which it was being returned (eg, allergy, didn't work, side effects, condition cleared sooner than expected, medicine changed, etc.).

Credit for returned medicines might be a fixed percentage of the selling price, with credit going back to the original payers. That would allow the recycling programs to sell or exchange medicine at a sizeable discount. Medicine recyclers might use the difference between acquisition cost and sales price to fund expenses, including overhead, and profit. It would be up to the consumer whether to purchase medicine from regular pharmacies or recycling pharmacies. Indeed, since it is likely that the major recyclers would be retail pharmacy chains, the consumer might be offered the alternative of brand new vs recycled medicine at the same point of sale. Such a system is already in place at certain vendors such as Amazon.com, where returned books are offered for sale alongside of brand new books of the same title. In any event, a valid prescription would be required for any medication. Medication insurance coverage might apply to purchases of recycled medication, although copays might be entirely waived for this cheaper source.

Commercial insurers as well as government programs would benefit from the lower prices and might offer consumers incentives for returning or purchasing medicine at recycling pharmacies that were even greater than just decreased or waived copays. Whatever the rules for who could return or purchase recycled medicine, care would be needed to prevent fraudulent schemes. There should be no chance to recycle for personal gain, especially when the original medication was purchased for the patient by some third party, public or private.

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