Outrage: Drugs—and Dollars—Down the Drain

Every week two nurses, a pharmacist, a security officer and a housekeeper gather at the Hebrew Home at Riverdale in New York. For three hours they stand around to toss perfectly good pills down the toilet.

Why? The nursing home has no other choice but to dispose of the leftover drugs, says Daniel Reingold, president and CEO of the Hebrew Home. The medications remain from residents who have moved out or died before the month’s prescriptions were used. And there is simply no process in place to legally reallocate the drugs to other patients.

Between the value of the dumped drugs and the cost of five employees devoting their time to the project, a cool $250,000 is literally flushed away every year at the Hebrew Home, Reingold says. If every nursing home in the country disposes at a similar rate per resident, Reingold estimates that $435 million is wasted annually on prescription medication disposal in nursing homes.

“This is really outrageous,” he says of the weekly ritual and the absence of a viable drug redistribution program that could eliminate it. “It’s hard enough to get nurses by the bedside, and now we’re taking nurses to destroy medications. And more than the cost to the facility is the massive waste.”

But this wasn’t always the case. Just a few years ago many states allowed nursing homes to return certain unused, unexpired drugs to pharmacies. The facility would get a credit, and the drugs would go to someone who could use them. That system functioned because Medicaid, a state-administered program, picked up the tab for numerous medications in nursing homes and many states required that unused drugs purchased by Medicaid be returned to pharmacies for reuse.

That all changed with the launch of Medicare Part D in 2006, says Carla McSpadden, of the American Society of Consultant Pharmacists. Today, Medicare Part D—not Medicaid—foots the bill for most drugs found in nursing homes; what’s more, the program has no reuse requirement. That means pharmacies have no incentive to assist with redistributing the drugs. Even if they wanted to, no procedures exist to provide credits to nursing homes or to prevent double billing.

Still, in some situations leftover drugs can be reused—primarily if Medicaid or an individual is the purchaser and he or she lives in one of the 36 states with a reuse program. Those exceptions aside, nursing homes—and the rest of us who support Medicare with our tax dollars—are largely out of luck.

Michelle Diament, who writes frequently for the Bulletin’s In the News section, lives in Memphis, Tenn.