1. National Summit on Preventing Pharmaceutical Waste October 19, 2010 University of the Sciences Philadelphia, Pennsylvania 1 October 19, 2010Prepared by the Product Stewardship Institute

2. Who is PSI? October 19, 2010Prepared by the Product Stewardship Institute2  Non-profit founded in 2000 Membership  46 States  170+ Local governments  55+ Corporate, Organizational, Academic Partners  Board of Directors: 7 states, 4 local agencies Multi-stakeholder product stewardship network

3. What is Product Stewardship? “Product Stewardship" is a principle that directs all those involved in the life cycle of a product to take shared responsibility for reducing the health and environmental impacts that result from the production, use, and end-of- life management of the product.

4. Pharmaceuticals Initiative National Dialogue Meeting #1 – June 2008 National Dialogue Meeting #2 – Dec 2008 – Suggestion for a summit on waste reduction – SR Workgroup at the time: organizations, pharmaceutical companies, EPA, state gov’t Workgroup focused on Controlled Substances Act change October 19, 2010Prepared by the Product Stewardship Institute4

5. “Source Reduction” Focus Qualitative research under Dr. Becker’s study – Florida Department of Environmental Protection Workgroup helped to develop agenda Partnership with WHEN on developing educational modules also under EPA Region 3 project October 19, 2010Prepared by the Product Stewardship Institute5

6. PSI’s Role Creating a forum & facilitating discussion Listening for potential action items, policy ideas Summarize what we hear at the meeting – Circulate for review Next steps? October 19, 2010Prepared by the Product Stewardship Institute6

7. Participants’ Role Ask questions Share information/perspectives Think outside the box Be specific – Multiple contexts represented October 19, 2010Prepared by the Product Stewardship Institute7

8. Agenda: 8 October 19, 2010Prepared by the Product Stewardship Institute TimeSessionPresenters 9:00 am Introductions and Welcome Andrew Peterson, PharmD, PhD University of the Sciences in Philadelphia 9:20 am Purpose of the Meeting  Introduction to PSI  Background on the issue  Focus and goals for the meeting  Sierra Fletcher, PSI  Joel Kreisberg, DC, MA Teleosis Institute 10:00 am BREAK 10:20 am Preventing Waste from Unused Prescriptions: Short-cycle dispensing, building co-pays & other options  Overview of the issue & stakeholder considerations  MaineCare initial prescription limitation policy  Discussion  Tracy McCutcheon, MHSA, MBA Centers for Medicare & Medicaid Services  TBD 12:00 pm LUNCH 1:15 pm Preventing Waste from Drug Samples  Overview of the issue and program experience  Discussion  Catherine Zimmer, MS, BSMT Zimmer Environmental Improvement, LLC 2:15 pm Preventing Waste: Different stakeholders’ perspectives  Research and potential policy options  Discussion  Julie Becker, PhD, MPH Women’s Health and Environmental Network 3:30 pm Next steps: Are there other strategies to discuss? Sierra Fletcher, PSI 4:00 pm Adjourn Sierra Fletcher, PSI

9. Goal Develop public and corporate policy recommendations to reduce the quantity of pharmaceuticals that are no longer wanted or needed in homes and healthcare facilities. We seek to build on information and policy ideas from around the country and from different perspectives. October 19, 2010Prepared by the Product Stewardship Institute9

10. Focus of this Meeting Preventing waste by reducing the quantity of drugs that are no longer wanted or needed in homes and healthcare facilities. October 19, 2010Prepared by the Product Stewardship Institute10 This meeting will not address issues associated with drug disposal including mail-back or other take-back programs, incineration, etc.

11. Challenge Complexity of the “ecosystem” Not “one-size-fits-all” Momentum is towards getting people their medicines as easily and cheaply as possible These are not reasons to avoid developing solutions October 19, 2010Prepared by the Product Stewardship Institute11

12. Thank you to our meeting sponsors: U.S. Environmental Protection Agency (Region 3) Purdue Pharma L.P. October 19, 2010Prepared by the Product Stewardship Institute12

13. Preventing Waste from Unused Prescriptions Overview of the issue & stakeholder considerations MaineCare initial prescription limitation policy Discussion October 19, 2010Prepared by the Product Stewardship Institute13

14. Questions What are the pros and cons of short-cycle dispensing? – Initial prescription limitations? Are there specific contexts in which this approach would be easier to implement? Voluntary? Mandated? What would need to happen for this to be widely adopted (if that’s what we want)? October 19, 2010Prepared by the Product Stewardship Institute14

15. Questions Should it apply to all medicines? – Only those with higher discontinuation rates? – Only those most likely to be abused? – To what extent does this depend on the context? What are the options for pro-rating co-pays? What would be the best possible scenario? Are there any next steps on this topic? – Other information? – Other stakeholders? October 19, 2010Prepared by the Product Stewardship Institute15

16. Thank you to our meeting sponsors: U.S. Environmental Protection Agency (Region 3) Purdue Pharma L.P. October 19, 2010Prepared by the Product Stewardship Institute16

17. Samples/Vouchers: Questions How can we minimize clinic sample waste? How can we encourage the use of vouchers in place of samples? What are the pros and cons? How/can this work in other contexts? Voluntary? Mandated? What would need to happen for this to be widely adopted (if that’s what we want)? October 19, 2010Prepared by the Product Stewardship Institute17

18. Thank you to our meeting sponsors: U.S. Environmental Protection Agency (Region 3) Purdue Pharma L.P. October 19, 2010Prepared by the Product Stewardship Institute18

19. One more time… What are the pros and cons? Are there specific contexts in which this approach would be easier to implement? Voluntary? Mandated? What would need to happen for this to be widely adopted (if that’s what we want)? October 19, 2010Prepared by the Product Stewardship Institute19

20. Next steps? Additional information? Strategies? People? Forums? October 19, 2010Prepared by the Product Stewardship Institute20