Thomas Buckley stood under the blinding stage lights at Central Connecticut State University and brought a microphone to his mouth. Between cheers from the boisterous crowd, the professor laid out his ambitious plan for helping poor people get access to costly prescription drugs.
“Every year in the United States, $5 billion worth of perfectly good medicines are wasted. Thrown away!” he said, his pitch rising. “Despite the fact that the medicine has not expired and can still be used by those in need.”
Buckley told the throng of 1,500 supporters gathered in CCSU’s auditorium on that October day that 38 states have enacted laws allowing health officials to collect and redistribute unused prescription drugs. The medication is put through rigorous quality checks and then directed to people who could not otherwise afford it.
“But wait, ladies and gentlemen,” he said. “Connecticut is not one of those states.”
The crowd unleashed a chorus of boos.
“In Connecticut alone,” Buckley continued, “we have over $50 million of wasted, needlessly discarded medicine in our nursing homes, correctional facilities and other institutions.” He paused before adding: “GHIAA is going to change that!”
The room rang with applause.
Buckley, who teaches pharmacy at the University of Connecticut, is a member of the newly formed Greater Hartford Interfaith Action Alliance, or GHIAA, a group of faith leaders and community organizers that devised a series of proposals for legislative reform. Its ambitious agenda, unveiled at GHIAA’s inaugural forum at Central, includes anti-racism training in schools, a push to expunge the criminal records of ex-offenders and plans to join national efforts tackling gun violence.
In the hot-button arena of health care, the group’s leaders are focused on a widespread issue – access to necessary-but-expensive prescription medication. Their plan seems like a no-brainer: Scoop up millions of dollars in wasted, unexpired drugs from the state’s nursing homes and prisons and re-route them to charity pharmacies that serve uninsured and underinsured residents.
There’s only one problem: Someone else already thought of it. But instead of turning the medications over to people who need them, the state pockets the money.
A little-known, 20-year-old law mandates that the unused drugs go back to vendor pharmacies, which reimburse the state. The program is saving Connecticut more than a million dollars each year, according to figures from the Department of Social Services, one of the agencies overseeing it.
The law, adopted in 2000, requires nursing home operators to send their unopened, unexpired prescription drugs – often ordered in bulk quantities – back to pharmacies for a credit. The recycled medication can then be repackaged for distribution. Similar legislation was passed for correctional facilities a year later.
But despite the program’s savings, officials across multiple state departments and Connecticut’s nursing home industry were unaware it even existed, and little is known about its current operations.
The head of the state’s nursing home association needed a week to confirm that long-term care facilities were still participating in the initiative, and could offer no details about how much medication was being recycled each year. An official overseeing drug control in the consumer protection department was unsure about the program’s status. And DSS would not provide access to the employee managing the endeavor.
No one – not the Department of Energy and Environmental Protection, the Department of Social Services, the correction department nor the Department of Consumer Protection – could say how much, if any, unexpired medication was being tossed out by the state or its nursing homes on an annual basis.
After weeks of inquiry, even the people closest to the program could offer little insight about its progress or standing.
An obscure program
Every year, nursing homes and other long-term care facilities across the country throw away tons of potentially reusable drugs. The unexpired medication – often dispensed in large quantities, a month’s worth at a time – is tossed after a patient dies, leaves or stops taking it.
The drugs are wide ranging: Capsules for diabetes, syringes of blood thinners, high-priced pills for dementia and seizures.
A 2017 ProPublica investigation found that some states were discarding millions in unused medication each year. While no one tracks that waste on the national level, estimates show it’s significant.
Colorado officials told ProPublica that their state’s 220 long-term care facilities were throwing away a whopping 17.5 tons of potentially reusable drugs every year, with a price tag of about $10 million. The Environmental Protection Agency estimated in 2015 that about 740 tons of drugs are wasted by nursing homes each year.
Researchers at the University of Chicago have said that about $2 billion worth of unused medication is squandered each year at care facilities in the United States.
Connecticut was one of the earliest states to try to blunt that problem. In 2000, the General Assembly passed a bill requiring nursing homes to send their unopened, unexpired prescription drugs back to vendor pharmacies for credit. Then-Gov. John G. Rowland signed it into law that June.
Under the statute, drugs that are packaged in unit-dose or multiple-dose blister packs – cards with rows of pills in sealed bubbles – must be returned to the pharmacies. Nursing homes that do not comply may be fined up to $30,000 for each violation.
Controlled substances are not included in the program, nor are drugs packaged in bulk dispensing containers. The consumer protection department was charged with adopting regulations for the repackaging and labeling of the drugs, and care facilities were tasked with creating protocols for the return of the medication.
A nearly identical law for the state’s prison system was approved during a 2001 special session.
In the early years, the program generated substantial savings. A report by Connecticut’s Office of Legislative Research shows the nursing home portion saved the state $4 million in 2005, $3.4 million in 2006, and $2.2 million in 2007.
By 2009, though, the figure had plummeted to $696,179. No one could point to an exact cause, but some state officials suggested that with the advent of Medicare Part D, certain drugs became more affordable, so it was cheaper to purchase new medication than to recycle it. It was unclear if the program ever temporarily ceased operation, or if the volume of drugs being reused simply dwindled.
Data provided by DSS show the savings ramped back up in recent years – to $2.3 million in 2015; $2.7 million in 2016; $2.9 million in 2017; $4.3 million in 2018; and $3.2 million so far in 2019. The totals are divided between the state and federal government – Medicaid is a joint program – so the state is holding onto $1 million to $2 million annually.
The savings are achieved through claim adjustments, said David Dearborn, a spokesman for the agency. Medicaid purchases the drugs through claims made by pharmacies. When the unused medication is returned, the claims are reversed.
Dearborn said officials at DSS had several theories for why the savings swelled in recent years. Medications are more expensive and more prevalent, and people are living longer with chronic illness.
“For example,” he said, “NPH insulin used to be inexpensive. Today, the only way to get NPH is by buying it in a delivery system (a pen or auto-injector, a wearable pump, or a pump that is tied to a computer that assesses blood sugar) … that costs significantly more than the old medication with the separate syringes.”
Drug recycling in the state’s prisons also yielded early success. Connecticut saved $1.1 million in 2008, the program’s first year; $1.2 million in 2009; and $1.4 million in 2010, according to the Office of Legislative Research. But sometime over the last decade, those savings tapered off.
Officials at UConn Health, which oversaw inmate care under a now-severed contract with the correction department, said the addition of Pyxis machines, cabinet-like structures that allow drugs to be dispensed in smaller quantities, cut down on bulk orders, eventually eliminating excess medication – and the need to recycle. UConn Health was not able to say when the machines replaced the larger shipments entirely, or how long the program stopped operating.
DOC resumed management of inmate care last year, and in October signed a new pharmacy contract that brought back the bulk shipments. Karen Martucci, a spokeswoman for the department, confirmed that DOC is again participating in the drug recycling program.
In both the long-term care facilities and the prisons, it was unclear if all of the unexpired medications were being returned to vendor pharmacies. A handful of nursing home operators and pharmacists contacted by The CT Mirror did not return calls seeking comment.
“On the fundamental question of ‘Is there a program functioning?’ I can say yes, there is,” said Matthew Barrett, president of the Connecticut Association of Health Care Facilities. “But what I can’t say is the full extent of what the volume is, or what the level of participation is across all 213 nursing homes.”
Asked for records of fines levied on care facilities that don’t comply, Dearborn said DSS was unaware of any penalties imposed on the nursing homes during the last two decades. He did not answer questions about whether the department had ever conducted enforcement checks or what kind of monitoring was being done.
To collect penalties, the law gives the social services commissioner permission to offset payments due to those facilities. Fines received by DSS must be deposited in the state’s general fund and credited to the Medicaid account.
“We’re not aware of documentation of any fines levied for possible noncompliance,” Dearborn wrote in an email to the CT Mirror.
A new strategy
Since learning about the status of Connecticut’s drug recycling efforts, Buckley, the pharmacy professor at UConn, is exploring other ways of funneling unused medication to charity dispensaries.
There already is one pharmacy in Bridgeport, backed by St. Vincent’s Medical Center, that distributes unexpired drugs to patients without insurance or with paltry coverage. Buckley and his colleagues at GHIAA want to open another in the capital city or its suburbs. They are in talks with a local health organization to fund the project.
Hope Dispensary, the Bridgeport pharmacy, gets medication shipped in from a national nonprofit in Tennessee. Hope pays a modest flat fee and can order pharmaceuticals for a range of ailments, including high blood pressure, diabetes, cardiac problems and asthma.
But leaders of the Bridgeport operation would like to see a drug reclamation program that steers unused medications from within Connecticut to charity dispensaries here.
“A lot of medication goes to waste and it’s stuff that I could definitely use,” said Angela Faulhaber, the pharmacy manager at Hope. The Bridgeport facility served 4,000 of the state’s most vulnerable people last year. Its formulary has about 70 different drugs, mostly generics.
Once a charity pharmacy is up and running in the Hartford area, Buckley said he’ll explore whether there are any unused drugs in the state’s nursing homes or other facilities that are going to waste. Leaders of several long-term care centers have told Buckley there still is unexpired medicine being tossed out.
He’ll also look at the possibility of a law change to allow bulk quantities of recycled drugs to be shipped in from other states, a process he said is currently forbidden.
“We’re not running away from this drug reclamation issue because we still think we have a big medication waste problem in Connecticut,” he said. The $50 million figure he cited at CCSU was his estimate of Connecticut’s share of the nation’s drug disposal.
Legislators said they are open to a law change. Prescription drug efforts are expected to be a centerpiece of health reform at the Capitol next year, and some lawmakers said they would entertain a proposal to reuse unexpired medication or to allow bulk shipments.
“That does sound like an interesting solution,” said Sean Scanlon, a co-chairman of the Insurance and Real Estate Committee. “I’m open to talking to them about it.”
For now, Buckley is refining his legislative pitch and firming up details on the new charity pharmacy. He’ll proceed with the dispensary even if the law change takes years.
“There’s a wide gap in who’s got access to care and who doesn’t,” he said. “Hartford and Bridgeport are two shining lights of where health disparities are. So that’s where our focus is.”
Editor’s note: This story was amended on Dec. 16 to more accurately reflect the circumstances under which a DSS employee was not available for an interview. The employee was not given the opportunity by the agency to speak to the CT Mirror.