Better Health Pharmacy: pioneering free medicine re-distribution

Thanks to Santa Clara County’s innovative prescription medication redistribution program, thousands of County residents receive essential medications for free – and local health facilities have a green, cost-effective option for disposing of unused drugs. 

Better Health Pharmacy (BHP), California’s first and only surplus drug pharmacy, has distributed more than 27,500 free prescriptions in Santa Clara County since it launched in 2015, saving the County $2.1 million in drug costs, and decreasing the amount of unused medication going into the waste stream. 

“We’ve got perfectly good unused medications on one side of town, and folks desperately in need on the other side of town. It made all the sense in the world to connect the two,” said Santa Clara County Supervisor, Joe Simitian, who has been at the forefront of efforts to safely recycle surplus drugs for more than a decade. “It’s saving lives, and saving resources.”

In the past, when a nursing home patient in Santa Clara County was prescribed new medication, changed dosages or died, licensed nurses opened the unused bottles, dumped the contents in a bucket, stirred in kitty litter and water, and called a hazardous waste company to pick it up for incineration.

Statewide that added up to an estimated $100 million in drugs tossed annually from nursing facilities, as well as pharmaceutical manufacturers and wholesalers. Additionally, processing unused medication caused significant environmental harm: medical waste incinerators are the country’s largest source of the highly toxic pollutant dioxin, and one in three water samples contain hormones widely used in pharmaceuticals.

Located in San Jose, and managed by County staff with the assistance of volunteers – including pharmacists, as well as pharmacy, college, and high school students – “BHP provides an incredible service to our community, reduces waste, and protects our environment,” said Simitian, who, in 2018, successfully pushed to triple the County pharmacy’s service hours and double the amount of medication re-distributed.

Simitian became a champion of unused drug redistribution while he was a state legislator, after a group of Stanford medical students submitted a “drug recycling” proposal to his annual “There Oughta Be a Law” contest. At that time, state law categorized unused prescription medication as a health safety hazard, instead of a potential treasure to people who couldn’t afford the drugs they needed. 

“Medication is the most cost-effective method of treating illness and improving health, yet about ten percent of adults skip their prescriptions because of rising costs. That’s 4 million people going without the medications they need in California alone,” Simitian said.

As a State Senator, Simitian introduced “Recovery and Reuse of Unused Prescription Medicines” (SB798), which was adopted in 2005. In 2012, Senator Simitian passed “Prescription Drug Recycling Programs” (SB1329), which made it easier for counties to opt into the program, and expanded the supplier list. (State law continues to prohibit donations from individuals.)

Santa Clara County launched its surplus drug program in 2008 at the Public Health Department’s pharmacy. Recognizing the need for direct consumer access, the County opened BHP as a stand-alone pharmacy in August 2015. In response to increased demand, Simitian led a successful effort to expand pharmacy staffing and hours in 2016.

Because BHP relies on donations of unopened, unexpired drugs, mostly from local nursing homes, its supply can vary. While California’s law does not allow reuse of “controlled substances” like narcotic painkillers or stimulants, BHP’s searchable online inventory includes dozens of medications to treat asthma, diabetes, high cholesterol, stroke risk, mental health, infections, and more. 

Even for those with health insurance, “Better Health Pharmacy is a vital community resource,” said Kiah Williams, co-founder of Palo Alto-based SIRUM (Supporting Initiatives to Redistribute Unused Medicine), a key partner in facilitating drug donation and distribution to BHP and beyond. “Of the people who skip their prescription drugs, half have insurance, but struggle with high co-pays or deductibles.”

Patients with a co-pay of $50, for example, are four times more likely to abandon a prescription at the pharmacy than patients with a $10 copay, according to research by CVS Pharmacy, in partnership with Harvard University and Brigham and Women’s Hospital.

Access to medication has serious health impacts: patients who have heart disease and cut back on medication are 50 percent more likely to have a stroke or heart attack, according to a report by the Mayo Clinic. Conversely, when medicines are given to patients who otherwise couldn’t afford them, hospitalization rates decline as much as 42 percent, showed a study in Pharmacotherapy Journal.

Better Health Pharmacy is a “pioneer,” said Williams – one that she and her colleagues hope will become a national model: “It starts with the comprehensive health care provided at the County level. Santa Clara County owns the hospital, the trauma center for the region, and also has a set of outpatient clinics. It makes sense to provide medication on the front end to avoid emergency room visits and hospitalizations. It’s about prevention.”

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