Prescription drugs can be expensive, but a new study highlights part of the reason why. It turns out that about $1.8 billion in cancer drugs are thrown out each year in the United States, simply because of inefficient packaging.
The study comes from Peter Bach, director of the Memorial Sloan Kettering Cancer Center’s Center for Health Policy and Outcomes, and colleagues, who published their findings in the March 1st issue of the British Medical Journal. The researchers reviewed the top twenty most-used cancer drugs to see how much is used to treat patients and how much goes to waste.
Most cancer drugs are injectable medications as opposed to a pill. Instead of giving patients a set dose in pill form, the medical staff will administer the appropriate amount of medication from the vial. The problem is, once the required dose of medication is removed from the vial, the rest of the medication usually cannot be re-used. Safety standards limit how and where medical staff can use the leftover drugs on another patient, and it must be within six hours. In practice, this means that leftover medicine will simply be thrown away.
In the United States, drug manufacturers will offer their injectable medicine in vials of a certain size. This is usually more than enough to treat a given patient, let alone those that have a small body size and require a much lower dose. There is almost always leftover medicine that has to be disposed of, creating waste. Despite the fact that they only used part of the vial, the hospitals, insurance companies, and patients still have to pay for the full amount of drug. That can mean more profit for the pharmaceutical companies and more cost for the patient.
One example of a popular cancer drug with plenty of waste is Velcade (bortezomib). This particular drug was approved in 2003 to treat Myeloma, which is a blood cancer. Of the 3.5 milligram vial, medical staff will inject 2.2 milligrams into the typical patient, depending on their weight. This means that for the average patient, 1.3 milligrams of the drug will simply go to waste. Once the researchers crunched the numbers, based on the estimated sales of the drug for 2016, they realized that $308.7 million worth of the drug will likely be disposed of throughout the year in the U.S. alone. That money will come from patients who have to pay for the treatments out-of-pocket or insurance companies who might potentially raise their premiums to cover the cost of the drugs.
Another example of cancer drug overspending is Keytruda, which treats metastatic lung cancer and melanoma. Although the drug used to be available in a 50 milligram vial in the United States, it is now only available in a 100 milligram vial. Although the manufacturer Merck would have made $1 billion in revenue just from the wasted drug in the 50 milligram vial, by switching to a larger vial the company is poised to earn an extra billion. Although this means extra waste in the United States, it is not the same situation in the rest of the world. In Europe, for example, the 50 milligram vial of Keytruda is still available. In many countries, government regulations restrict drug costs and require particular packages, such as the 50 milligram vial. These same restrictions do not exist in the United States, allowing drug companies to charge the amount of money and provide the particular package sizes that they wish, increasing their profits.
The researchers believe that if the drug companies offered a greater variety of vial sizes for their cancer drugs, it could result in about three percent less waste as doctors choose the appropriate size for a particular patient. That is an estimated $400 million in waste instead of more than a billion.
The study authors also suggest that clarifying regulations around vial sharing could help reduce waste. Although the Centers for Medicare and and Medicade Services say it is fine to share vials, with certain restrictions, the Centers for Disease Control and Prevention (CDC) maintain that vial sharing is unsafe. With clearer regulations, medical staff could better judge when they could safely share vials between patients, reducing medication waste. In turn, this could help reduce costs for the patients.