Policies to Prevent Pharmaceutical Waste: Looking at Sample Waste Product Stewardship Institute, Inc. June 4, 2012

For a recording of and presentations from this webinar please see the Product Stewardship Institute website at: Recordings from previous webinars are also available: –Unused Medications: Just how much are we throwing away? –Policies to Prevent Pharmaceutical Pollution: Initial Prescription Limitations and Pro-rating Co-pays Other Webinars 2

Who is the Product Stewardship Institute? Non-profit founded in 2000 Membership: 47 States 200+ Local governments Partnerships (75+) Companies Organizations Universities Non-US Governments Board of Directors: 7 states, 4 local agencies Advisory Council: Multi-stakeholder (14 members) 3

How to Participate Today To ask a question (verbally) via phone or VOIP … please use the hand-raising function. To type in a question, use the Question tab. Technical Difficulties? Dial You can connect to the Audio portion using VoIP or your telephone. 4

Spoken: Use the “hand-raising function” on your control panel so we can unmute you. –Speak through a microphone on your computer OR – Be dialed-in through a telephone (and enter your Audio PIN) Written: Write your question in the Question box at any time. Please tell us to whom you are addressing your question. For the Audience: 2 ways to ask questions 5

Catherine Zimmer, MS, BSMT, Industry Leader, Environmental and Regulatory, PSC Healthcare Services Julie Granillo, Director of Outreach - Dispensary of Hope Dan Simpson, Chief Development Officer - Dispensary of Hope Today’s Panelists 6

Rx 2 : reducing pharmaceutical sample waste Catherine Zimmer, MS, BSMT Industry Leader, Environmental & Regulatory PSC Healthcare Services Product Stewardship Institute webinar June 4, 2012

PHARMACEUTICAL SAMPLES What are they? What are the concerns? 8

BEST WASTE PRACTICE 9 Source reduction Reuse Recycling Treatment Disposal

SAMPLE EXAMPLES Large hospital with clinics 25% short dated 210 pounds Small clinic system 22 pounds Retail ~ $20K Cost $6K 10

RECOMMENDATIONS  No samples Voucher CMS rule change  Policy Top Ten 11

ENVIRONMENTAL AND PUBLIC HEALTH Drinking drugs? Wonky wildlife? Percent attribution Benefits

QUESTIONS? Catherine Zimmer PSC Healthcare Services

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The Right Thing to Do  Avoid Waste  Compliance  Acknowledgement  Time/Cost Savings  Enhanced Tax Benefit  Help Patients

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National Scope, Local Impact 25 States Providers of Hope - 75 Dispensaries

Policies to Reduce Sample Waste 22 Note: Samples used by their expiry dates may reduce waste by allowing patients to try a new medication that they receive in a small quantity before filling a full prescription.

How can we reduce sample waste? 1. Develop a sample management plan 2. Require drug company representatives to take responsibility for managing samples 3. Use vouchers instead of samples 4. Discontinue the use of samples

Develop a Sample Management Plan Sample management plans can be developed voluntarily by clinics and practices. Plans could also be required by state or federal law. By developing a plan, the clinic or practice could: a. Track the type and quantity of samples that go unused before their expiration date. b. Identify types of samples which should be accepted because they help to meet patient needs, as well as those which should be refused because they are likely to accumulate as waste. c. Track the disposal costs and savings that result from refusing certain samples. d. Specify practice or clinic policies regarding the responsibilities of drug company representatives

Require drug company representatives take responsibility for managing samples This can be done to varying degrees, but clinics can require representatives to: a. Sign-in and provide the expiration dates of the samples they are leaving. This step facilitates the implementation of a sample management plan. The step can also be useful without a plan because it enables staff to track when samples with near-term expiration dates are being dropped off and if they are relatively more likely to expire on the shelf than to be used by patients. b. Remove expired samples from their company. This can reduce, or even eliminate, the costs associated with disposal for the doctor’s office or clinic. Additionally, sample waste is less likely to be disposed of improperly if it is handled by the manufacturer.

Use vouchers in place of samples Companies can provide vouchers instead of actual drug samples Patient can then take the voucher to the pharmacy to receive a small amount of the medication Pharmacy compensated for dispensing costs by the drug manufacturer. Therefore “sample” drugs are dispensed only when greatest chance of being used rather than expiring on clinic shelves. Practice has the benefit of alerting the pharmacist that a patient has received the drug to help identify possible drug interactions. *For Medicare and Medicaid patients, however, vouchers may be considered an inducement to receive specific services and would be prohibited.

Discontinue use of samples Companies can provide vouchers instead of actual drug samples Patient can then take the voucher to the pharmacy to receive a small amount of the medication Pharmacy compensated for dispensing costs by the drug manufacturer. Therefore “sample” drugs are dispensed only when greatest chance of being used rather than expiring on clinic shelves. Practice has the benefit of alerting the pharmacist that a patient has received the drug to help identify possible drug interactions. *For Medicare and Medicaid patients, however, vouchers may be considered an inducement to receive specific services and would be prohibited.

Interested in Learning More? Contacts 28 Kate Hagemann Associate, Policy and Programs Product Stewardship Institute Catherine Zimmer, MS, BSMT Industry Leader, Environmental and Regulatory PSC Healthcare Services Julie Granillo Director of Outreach Dispensary of Hope Dan Simpson Chief Development Officer - Dispensary of Hope