Leftover Pills Are Saving Lives: The Promise of Prescription Drug 'Recycling'
Mary Janine Bolchazy knew something was wrong in late 2019 while addressing her Christmas cards at home in California.
“I realized that my handwriting was atrocious,” she says. “I couldn’t really form the letters, and I was a Catholic school principal, so you know, we were taught by nuns...cursive writing.”
After finding a brain lesion, doctors diagnosed Bolchazy, 77, with primary central nervous system lymphoma. The regimen of intravenous chemotherapy that followed took a toll on her kidneys, so her physician switched her to a daily oral chemotherapy pill.
The drug was easier to handle, butthe retail price sent her head spinning—about $500 a pill, or $15,000 monthly.
“And I said, ‘Oh my God, lord have mercy on us,’” Bolchazy says.
Even with her Medicare Advantage insurance plan expected to cover most of it, the thousands in out-of-pocket costs were still too much. So a helpful nurse connected her to Good Shepherd, a nonprofit pharmacy across the country in Memphis.
The organization has created a program called RemediChain to get people like Bolchazy their chemo medication for free.
Thanks—in large part—goes to other cancer patients.
Good Shepherd’s current $3.5 million inventory of anti-cancer pills comes completely from individuals and cancer clinics across the country. It's made up of their unused tablets and capsules that otherwise would have sat in a medicine cabinet, been tossed in the trash, incinerated or flushed down the toilet (which is harmful to the environment).
“[These are] meds that have been dispensed to patients, that they never opened, that are unexpired, in the original packaging,” says Good Shepherd’s founder Philip Baker. “Literally, in pristine condition.”
After inspecting the donations, Baker says, “we can re-dispense them to people who would not otherwise be able to afford their chemotherapy.”
Prescription drug waste is widespread in the U.S.—estimated to be in the billions of dollars—although no entity officially tracks it. And, Baker says, it’s a common problem in cancer treatment. One small study at a cancer center in Iowa found that 41 percent of about 90 patients looked at didn’t use all their medication.
“A lot of times people pass away, and they’re on these meds, and the family members are left with them,” he says.
Or often, doctors will change prescriptions to improve treatment outcomes. Some drugs stop working, or have adverse side effects. Patients then find themselves with a surplus of pills.
Rosemary, who asked to be identified by her first name only to protect her medical privacy, had her breast cancer medication dosage changed twice. So, she donated $27,000 of unopened prescriptions, already paid for by insurance, to RemediChain. The program covers the cost of shipping.
“I’m a big recycler, and I compost and recycle everything,” she says from her home in South Carolina. “Medicine, as expensive as it is, it’s certainly something that should be recycled and get put into the hands of somebody who needs it.”
Financial barriers to these specialty drugs are significant, especially as their retail prices continue to rise, says Stacie Dusetzina, an associate professor in health policy at the Vanderbilt University School of Medicine. She adds that the average monthly cost of an orally administered chemotherapy is $14,000.
Even with insurance, co-pays can sometimes be $2,000 or more. Research shows that about half of patients facing that amount of cost-sharing don’t even pick up their first course of pills from the pharmacy.
“This is for cancer treatments that we know save people’s lives,” Dusetzina says. “If you take them you can live a normal life span, and if you don’t, you can die from your cancer quickly.”
Jeff Davis manages RemediChain, which he says is often a last resort for patients who can’t get other forms of financial assistance through pharmaceutical companies or foundations.
“A side worry is if they’re successful, and their treatment works and they overcome the illness, then they’re going to be bankrupt because of medical bills,” he says.
But there are some limits to what the organization can do. For one, reliance on donations means some medicines aren’t always available. Then, there’s red tape, says Baker.
“What’s worse is if you have a med for somebody, but you can’t send it because their state law doesn’t allow it,” he says.
At least 38 states authorize unused medication "recycling" as of 2018, but regulations vary in terms of who is eligible to give and receive the meds. Nationwide, there’s no lack of all kinds of prescription drugs to be reclaimed, anti-waste advocates say, ranging from cholesterol-lowering ones to antidepressants.
Some states like Iowa and Wyoming even have their own central drug reclamation repositories, collecting unused meds from places like nursing homes and dispensing them to the uninsured or underinsured.
Kiah Williams, co-founder of a California-based surplus medication redistribution group called SIRUM, says a goal is to raise awareness and normalize drug donating.
“When we look at how we build our programs and how we think about what works and what doesn’t work in redistribution is how do we make it as easy to recycle this medicine as it would be to throw it away,” she says.
Organizations like hers and Baker’s are addressing a health crisis born of a financial one; roughly one in five adults reported in a 2019 poll an inability to pay for at least one prescription.
“That is an everyday injustice that many people are facing that they can’t afford basic medications,” Williams says.
Baker is also trying to ensure pills that can’t be reclaimed are disposed of properly. He asks individuals to text #FlipYourScrip to (833) 999-1003 when cleaning out their medicine cabinets. If his team determines a prescription can’t be reused, they’ll send a link with the location of a close-by official “take-back box" to discard it. As incentive, they offer a $5 gift card for following through.
And of course, if it’s an inspection-approved oral chemotherapy, it could become a lifeline for those like Bolchazy. RemediChain has given her eight months of prescription fills so far.
“I can jump out of bed and say, ‘Hey thank God for another day of living and loving,’” she says. “That pill keeps me alive.”