Congress has failed to make progress on drug pricing reform, but a group of lawmakers are pushing for something they hope will be more agreeable: finding solutions to reduce drug waste, and so costs to consumers.
Following a recent ProPublica investigation that found drug companies package many single-use liquid medicines such as eye drops in large containers that lead to waste, a bipartisan group of senators are introducing legislation on the issue. Their bill, the Reducing Drug Waste Act of 2017, would direct the FDA and Centers for Medicare & Medicaid Services to come up with a plan to address the problem.
Last month, ProPublica published a report that detailed how millions of dollars in cancer medications and eye drops are wasted each year because of oversized packaging. For eye drops, patients often spill or apply for too much medicine due to oversized packaging and then wipe away the excess, the report said.
"This is a colossal and completely preventable waste of taxpayer dollars, and it means American patients and hard-working families are paying for medication that gets tossed in the trash,” Sen. Dick Durbin, D-Ill., said in a statement accompanying the legislative announcement. “Instead of allowing the pharmaceutical industry to profit at our expense, it’s time we put an end to this wasteful spending.”
Sen. Chuck Grassley, R-Iowa, added that it's "commonsense legislation" to address part of the waste problem.
Responding to the ProPublica piece, a Novartis representative told the publication that large drops give patients a margin to ensure they're getting enough medicine; other drugmakers didn't comment for the report.
The waste issue in pharma has made plenty of headlines before, and it remains to be seen how much traction the new bill can get. Earlier this year, authors in the Journal of the National Cancer Institute wrote that a new flat dose for Merck's Keytruda in first-line non-small cell lung cancer, regardless of patient weight, could lead to hundreds of millions in additional healthcare spending.
They concluded that the 200-mg dose could lead to $825 million in waste, while two experts in an accompanying editorial placed the figure above $1 billion. The medication was previously available in 50-mg and 100-mg vials. Besides creating waste, the editorial authors wrote that the high flat dose could incentivize practitioners to use Keytruda over other potentially cheaper options.
Merck responded by saying its dosing change reflected uncertainty up front and accumulated data as trials progressed. Further, the company maintains that "fixed dosing helps to eliminate wastage," and that its flat dose will "make reimbursement consistent across patients."
Before that paper, Peter Bach, M.D., director of the Center for Health Policy and Outcomes at the Memorial Sloan Kettering Cancer Center, published a 2016 report with colleagues that concluded large cancer vials lead to $3 billion in waste per year. According to the study, drugmakers supply cancer drugs in vials that are too large for most patients. Nurses use the amount each patient needs and toss the rest due to safety regulations.
"Drug companies are quietly making billions forcing little old ladies to buy enough medicine to treat football players, and regulators have completely missed it," Bach told the New York Times. "If we're ever going to start saving money in healthcare, this is an obvious place to cut."
Brian P. McDonough, MD, FAAFPPeer
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