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What’s in Your Medicine Cabinet?

June 6, 2018
Posted by: Gerald “Pharmacist Jerry” Finken, RPh, MS; Contributor: Martha Morton

What’s in Your Medicine Cabinet?

Take a look at your medicine cabinet and see what you find. While scanning through, did you find medications that you should no longer use or some that are expired?  If so, you are not alone! Last year on DEA’s National Drug Takeback Day, held in October, about 912,305 pounds of prescription drugs were returned. That’s insane, especially when all we hear about is the high costs of drugs! Note that this great weight does not include over-the-counter (OTC) medications, but solely drugs that were prescribed by a physician and filled by a pharmacist. That is a lot of medications going to waste and this is just one day out of the year. I can only imagine how much more there is out there and how much money has been wasted. And, this is not counting the waste associated with poor packaging.  One study estimated we waste $3 billion per year on oncology products alone.

This amount of waste really makes me wonder why we ever thought that giving a 90-day supply of a prescription medication is a good thing.  Especially, since most patients repackage their medication into their weekly dispenser.  Or, why do we have a bottle of 100 Tylenol® capsules in our medicine cabinet when all we really need is 6-12 tablets for a stint of pain or fever? In other words, why are medications still being “super-sized” when instead they should match the amount needed for the specific illness?  In essence, we have commoditized medication.

The term “super-sized” was coined by fast food restaurants when they distributed an excessively large drink or fry alongside a meal. This option was discontinued in most restaurants as it was tied to multiple health risks. Specifically, McDonald’s stopped supersizing their orders in 2004 as part of their “Eat Smart, Be Active” initiative.

Like food, medications and other supplements are to be taken in the appropriate amount at the appropriate time. Providing a medication in a mass supply can provide a chance for more misuse and waste, even though it may save the consumer a few bucks. But, does it really? We should not be receiving a medication in 90-day supplies, nor should we have a 100 capsule Tylenol bottle in our medicine cabinet. I understand that my view on this is probably seen as me not understanding the economics of the Model-T manufacturing methods in the current climate of dispensing in chain pharmacy and big-block stores, but I would argue that this old-mindset has not worked and does not work when it comes to healthcare.

I believe that the healthcare industry as a whole, as well as pharmacy specifically, should stray away from a cost-based system and refocus their efforts on building a value-based system. A value-based system that not only measures patient outcomes, but also how they are achieved. When it comes to the cost and best uses of medications, the pharmacist is THE expert to make a difference. With today’s technology, we need to move away from the super-sized prescription as well as address the concept of the manufacturing efficiency of producing the most cost-effective size, based upon the “production line” mentality.  With today’s supply chain technology, automation, and speed to deliver, there is no reason why the commoditized drug delivery system cannot deliver only what is needed and when it is needed—even Tylenol®.   As I have hinted at in other blogs, the super-sized prescription is one of the main reasons for the opioid epidemic. I’d also argue that the “economy-sized” package has led to the waste seen with cancer drugs.

As our technology advances so should we. Healthcare professionals should look at what the patient needs today or this week rather than what they need for the month or the year, because their needs may drastically change before their medication runs out.

In the meantime, since medications are not unit-dosed for you, perhaps you should consider keeping a medicine cabinet inventory to ensure the safest and best use of your medications.  And, to take this one step further, for any medication not used, send a request to your insurance carrier to reimburse you for the unused portion!  What do you think?

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