They say our health care system is confusing and complicated. But sometimes its problems are easy to grasp. So are solutions.
Take cost. If people cannot afford their medications, then they are not going to take their medications. A 2015 study revealed that over 1 million Americans do not receive the medications they need due to costs. Here in Minnesota, approximately 349,000 people live without health insurance, and roughly 10 percent live below the federal poverty line. Without disposable income or insurance, they cannot afford the health care they need.
Studies show that when individuals do not take their medications as instructed, they have poorer health and increased emergency room use and hospitalizations. Medication nonadherence costs the United States health care system $100 to $300 billion annually in avoidable health care costs — not to mention the emotional toll borne by patients who must choose between treatment and necessities like rent or food.
Some mothers are taking their children’s ashes to pharmaceutical companies to protest the high, and deadly, cost of medications.
Here’s another problem: even as individuals are dying because they cannot afford the drugs they need, every year long term care (LTC) facilities in the United States, including Minnesota, are throwing away billions of dollars worth of safe medication.
Medications at LTC facilities are often prepared for patients in single-use doses or in a monthly blister pack. Most repackaged medications are barred from being reused due to the federal packaging regulations. So when a patient is switched from one dosage form to another, or if the patient dies, these repackaged medications have to be disposed of.
Yet a repackaged medication does not lose any of its efficacy or safety if it was kept in a controlled setting, such as a LTC facility.
In 2014, researchers estimated that U.S. long-term care facilities are annually discarding over $2 billion worth of safe, unexpired medications due to these regulations. The Environmental Protection Agency has estimated that 740 tons of drugs are wasted by LTC facilities each year.
In Colorado alone, a state-specific study found that they were wasting approximately $10 million in medications annually. By way of comparison, Colorado has 220 LTC facilities; Minnesota has 365.
If you see a simple solution in the juxtaposition of these two problems, you aren’t alone. Medication repositories allow LTC facilities to donate unused, safe medications that would otherwise be wasted to patients who can’t otherwise afford them. Any medication accepted into these programs must undergo safety checks by a licensed pharmacist.
Many other states have created successful medication repository programs. Iowa started a repository program in 2008, and since then it has reallocated $17.7 million worth of medications donated to over 71,000 patients. Wyoming has a repository program which has been running since 2005, with $12.5 million worth of medications donated and over 150,000 prescriptions filled.
Medication repositories can lower the cost of medication, improve health outcomes, reduce health care spending at the state level, and even remove pollutants from the environment. But state law currently prohibits this common-sense solution in Minnesota.
The Public-Health Advocacy Student Alliance, a student organization at the University of Minnesota, has taken up this cause. We introduced a bill in the last legislative session that would allow a medication repository in Minnesota.
Unfortunately, our repository legislation fell victim to larger political forces. Although it was included in Minnesota’s supplemental budget omnibus bill for 2018 — over 900 pages of legislative text — the entire bill was vetoed by the governor. It will be brought back in the next legislative session.
There is no reason to not create a statewide medication repository program in Minnesota. It is that simple.
Lily Rowan Mahon is a graduate student at the University of Minnesota.