Idaho offers incentive to spur resale of returned drugs

November 22, 2004

Drug restocking is the resale of previously sold medication that has been returned to a pharmacy or mail-order company unopened. The returns to pharmacies are by a long-term care or assisted living facility after a patient has died or had a prescription that has been discontinued.

That's what worries officials of the Idaho Board of Pharmacy. In September, the board published a Medicaid Information Release that detailed state Medicaid rules for the restocking of medications returned to pharmacies by assisted-living facilities. The state's rules, adopted in July, offer to pay $6 per Medicaid prescription worth $15 or more that a pharmacy restocks from a Medicaid-registered nursing home or assisted-living facility. "Our problem is with returns from the assisted-living facilities, where there is little or no medication oversight. We fought this measure very hard," said Jan Atkinson, the Idaho board's senior compliance officer, "and we're going to continue fighting it."

Restocking from nursing homes and hospitals has been allowed in Idaho since 2000, when the Food & Drug Administration reversed a 20-year-old policy prohibiting the practice. The FDA set specific restrictions: The dispensing pharmacy must be affiliated by contract with the nursing home; the pharmacy and R.Ph. must be licensed and in good standing; the dispensed medications must not have left the control of the nursing home after they were received from the pharmacy; and the storage, handling, and nursing home recordkeeping systems must be adequate to document the handling of the returned medications. In addition, special attention has to be given to storage conditions and only medications that have been dispensed in the original manufacturer's packaging can be returned. That year the Idaho board went a little further than the FDA in setting standards: the unused medications had to be returned with tamper-evident packaging intact and the pharmacy had to have a system in place to track restocking and reuse.

Part of the overall dilemma is that no single set of federal laws directly addresses the return of unused medications from either nursing homes or assisted-living facilities, Atkinson explained. Several state laws do give direction on how and when medications from nursing homes can be returned to pharmacies, as described above. But none of them addresses the return of medications from assisted-living facilities. "It's a situation with potential for significant safety problems," she warned.