[Pharmwaste] Take back presentation - overprescribing

Tue Oct 28 11:06:40 EDT 2014

This is an area of weakness for me, but definitely one of my interests.  In preparing our manuscripts, there is so much focus on the need to expand disposal options and disposal awareness, but very little emphasis on addressing the underlying cause.  From the few that I've been able to talk to about this, it seems like Medicare/Medicaid may be a good place to start.  I'm told that when they initiate restrictions, the insurance companies generally follow suit.

When I think about who would have a vested interested in this, insurance companies come to mind (as well as Medicare/Medicaid).  They are paying for these meds that are not being used.  And then, I think about the regulatory side, which seems to be non-existent.  Who regulates auto-refills and mail order?  What entity determines who is eligible for auto-refills and what the requirements are? Why is there not a requirement that patients have to confirm that they are still using a medication and that they need more (or even that they are still alive!!!!) before a refill is sent?

At our last take back event, one participant brought in at least a one-year supply of unused diabetic supplies.  Insulin syringes, testing strips, alcohol pads, insulin.  They said they had been misdiagnosed.  Often when we ask people why they didn't stop these mail order meds, they tell us they called multiple times, but the meds just kept coming.  Where is the accountability?  Where are the checks and balances?

On the flip side, we need a huge public education campaign.  As a society, I believe we want the most bang for our buck, so if we're paying a co-pay, we want as many pills as insurance will allow.  Never mind that we may not need that many, that we may require a dose adjustment, or that the med may simply not work out.  When we purchase OTC meds, we look for a deal, "buy one get one free", a 100 count bottle will save us $0.03 per pill over a 25 count bottle.  We don't think about whether or not we will use all of the med before it expires.  From my med take back experience, I can see that this is particularly problematic when it comes to vitamins, herbals, and homeopathic products.  I upset some people when I say this, but we need to be pushing people to buy the smallest bottle, package, amount necessary when it comes to medications/supplements, etc.

Although this slogan is overused already, I'd like it for a public ed campaign - "Not in My House!" Use it to educate the public to keep all but the absolutely necessary meds out of their homes.  Unused, unneeded meds - Not in My House!  Unintentional medication-related poisoning of children - Not in My House!  Prescription Drug Abuse because I have unused meds sitting in my home - Not in My House!  You get the point....

So, do we have any experts on the med policy side?

Jeanie Jaramillo, PharmD
Managing Director, Texas Panhandle Poison Center
Asst. Professor, Texas Tech UHSC School of Pharmacy
1300 S. Coulter St., Suite 105
Amarillo, TX 79106
(office): (806)414-9299
(mobile): (806)376-0039

________________________________
From: Catherine Zimmer [zenllc at usfamily.net]
Sent: Tuesday, October 28, 2014 9:11 AM
To: Jaramillo, Jeanie; pharmwaste at lists.dep.state.fl.us
Subject: RE: [Pharmwaste] Take back presentation - overprescribing

Hi Jeanie and all,

Overprescribing is at the root of most consumer pharmaceutical waste.  In 2012, CMS attempted to address this somewhat with requiring rx providers to pro-rate co-pays for trial doses of new prescriptions, however they did not go so far as to address overprescribing by physicians and other providers.

So how do we get at the root of the problem?  I met with the MN Medical Ass’n a few years ago to try and address the practice.  It seems we need a concerted effort to educate MD about the costs of overprescribing—financial, social, environmental.  Best management practices for prescribing, put together by a pharmaceutical ass’n in collaboration with MD would be a good place to start.  I’d love to work on this.  Any suggestions?

Very truly yours,

Catherine Zimmer, MS, BSMT
Zimmer Environmental Improvement, LLC
St. Paul, MN
Ph:  651.645.7509
zenllc at usfamily.net<mailto:zenllc at usfamily.net>

From: pharmwaste-bounces at lists.dep.state.fl.us [mailto:pharmwaste-bounces at lists.dep.state.fl.us] On Behalf Of Jaramillo, Jeanie
Sent: Tuesday, October 28, 2014 2:50 AM
To: pharmwaste at lists.dep.state.fl.us
Subject: [Pharmwaste] Take back presentation - overprescribing

Hello All,

I gave a presentation last week at the National Association of State Controlled Substances Authorities Conference in Savannah.  I presented some of the data that our program has collected over the last 5 years specific to controls.  I am working on a manuscript with a group from Maine at current, but wanted to share with this group in case you are interested.  I believe the info in the charts within this PowerPoint are a strong indicator of the prevalence of over-prescribing; particularly of controlled substances.

Jeanie Jaramillo, PharmD
Managing Director, Texas Panhandle Poison Center
Asst. Professor, Texas Tech UHSC School of Pharmacy
1300 S. Coulter St., Suite 105
Amarillo, TX 79106
(office): (806)414-9299
(mobile): (806)376-0039

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