Recycling Expensive Medication: Why Not?

Jay M. Pomerantz, MD

Disclosures

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

In This Article

Rationale for Medicine Recycling

Although other countries have opted for pharmaceutical price controls and/or curtailing patent protection, such actions run counter to American free-market ideology and political realities. Pharmaceutical manufacturers point out that their industry spent more than $30 billion on drug research and development in 2001, as compared with the total National Institutes of Health operating budget of $20 billion.[8] There is also evidence of a competitive marketplace; in the first year that a medicine goes off patent, its generic equivalent sells for about half the price of the brand-name drug.[9] These and other arguments are sure to be heard by politicians, since pharmaceutical industry political contributions have escalated dramatically and doubled between 1998 and 2002.[9] During the 2002 election campaign, the drug industry contributed $21 million to federal political campaigns for parties and candidates. According to the Center for Responsive Politics, that makes the group the largest contributor.[10]

Drug benefit managers and preferred drug lists or formulary restrictions provide some pressure to keep prices down, but that strategy fails for unique, brand name compounds without any available equivalent. The marketplace seems to be missing a way of enhancing competition for medicines still under patent. One possibility is to allow competition from exactly the same molecule made by the same manufacturer while still under patent protection. Reimporting medicine made in the United States from Canada or Mexico is an example of such a gambit. Unfortunately, the drug makers are already undercutting the effectiveness of this tool. For example, GlaxoSmithKline (GSK) announced in January 2003 that it would no longer sell products to Canadian pharmacies and wholesalers that market GSK drugs over the Internet to other countries.[11] Pfizer, the world's biggest drug maker, following along after GSK (as well as AstraZeneca and Wyeth), is carefully monitoring the orders of Canadian pharmacies it believes are exporting to the United States and now limiting orders to those pharmacies.[12] The manufacturers have the capacity to know who is exporting, since data-tracking companies and drug benefit managers monitor individual doctors' prescriptions. When pharmacy orders spike at a particular pharmacy in the absence of a similar jump in nearby doctors' prescriptions, manufacturers are alerted.

Another possible supply for expensive medication still under patent exists. It is the unused supply that patients are left with when they stop or change medicines. Could we somehow get those unused tablets and capsules to those in need at a reasonable price? Why not recycle widely used expensive medications like atypical antipsychotics, where each tablet may cost $7-$14 each,[13] or Zofran (an antinausea medication often used for cancer patients undergoing chemotherapy), which costs close to $30 per tablet? How about an effort to recycle Gleevec capsules, which cost approximately $27,000 per year for the treatment of a single patient with chronic myelogenous leukemia, a price based in part on the price of interferon, the next best available drug treatment for that disease.[14]

Recycling may also offer a free-market solution to the problem of artificially stimulated demand for a product often paid for by others. The current emphasis on marketing is illustrated by a Families USA analysis[15] of the pharmaceutical industry's brand-name leading companies' 2001 annual financial statements. Brand-name drug makers in the United States employ 81% more people in marketing than in research. Whereas marketing staffs increased by 59% between 1995 and 2000, research staffs declined by 2%. On average, the 9 leading companies spent 11% of revenue on research and development compared with 27% of revenue on marketing, advertising, and administration in 2001.

However, with a recycling program in place, overmarketing expensive, brand-name medicines might backfire on the manufacturer. High initial sales based on unrealistic patient expectations would result in a large supply of abandoned medication available to re-enter the market place at a low price, thereby undercutting sales of newly manufactured tablets. For example, the current blitz of advertising for a variety of brand medications to treat male erectile dysfunction will likely end up with many unused tablets in patients' bathroom cabinets as the medicines do not always work for everyone, nor do they automatically result in happy marriages. Currently, the huge collection of oversold, unused tablets does not adversely affect future sales to other users. However, with medication recycling in place, those unused tablets for erectile dysfunction will come back into the marketplace, offering a cheap alternative to newly produced tablets.

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