Santa Clara County's Better Health Pharmacy and SIRUM pioneering free medicine redistribution

FOR IMMEDIATE RELEASE

SAN JOSE – Almost in passing, Santa Clara County Public Health Director Dr. Sara Cody announced at a meeting of the County’s Health and Hospitals Committee last week that the County’s Better Health Pharmacy (BHP) has distributed more than 31,000 free prescriptions, saving County residents more than $2,000,000.

In the past, when a nursing home patient in Santa Clara County was prescribed new medication, changed dosages or passed away, two licensed nurses had to oversee the drug disposal process: open the unused bottle, dump the contents in a bucket, stir in kitty litter and water, and call a hazardous waste company to pick it up for incineration.

Statewide, that added up to an estimated $100 million in drugs tossed annually, and, nationally, with two out of three prescriptions going unused, a significant environmental impact: medical waste incinerators are the largest source of the highly toxic pollutant, dioxin, and one in three water samples contain hormones widely used in pharmaceuticals.

Additionally, while that unused medication was a health safety hazard according to state law, it was a potential treasure to millions of people who couldn’t afford the drugs they needed to stay healthy and alive.

“Medication is the most cost-effective method of treating illness and improving health, yet one-fifth of adults don’t fill their prescriptions because of rising out-of-pocket costs,” says Santa Clara County Supervisor Joe Simitian, who has been pushing to safely recycle surplus drugs for more than a decade.

Thanks to two innovative programs, Santa Clara County health facilities have a greener, more cost-effective option for disposing of surplus drugs – and thousands of patients receive vitally needed free medication.

Better Health Pharmacy (BHP), California’s first and only surplus drug redistribution pharmacy, has distributed more than 31,000 free prescriptions since August 2015, saving County residents $2.3 million in drug costs, and decreasing the amount of unused medication going into the waste stream.

Last year, at Simitian’s urging, BHP doubled the amount of medication dispensed, and service hours have nearly tripled – from 16 to 42 hours a week – since the pharmacy opened its doors.
“We’ve got perfectly good unused medications on one side of town, and we’ve got folks desperately in need on the other side of town. It makes all the sense in the world to connect the two, and given its success, expand the program. It’s saving lives, and saving resources,” Simitian says.

Managed by volunteers, including pharmacists as well as pharmacy, college, and high school students, BHP is “the best-kept secret in the Valley,” says Narinder Singh, Director of Pharmacy at Santa Clara County. “Through this program, we are able to provide an incredible service to our community, reduce waste and protect our environment.”

Last month the Board of Supervisors formally commended BHP for its work and also commended Palo Alto-based SIRUM (Supporting Initiatives to Redistribute Unused Medicine), a vital partner in facilitating drug donation and distribution to BHP and beyond. SIRUM’s three founders, Stanford University graduate students, developed a “Match.com for medicine,” as well as logistics and record-keeping tools that allow health facilities, manufacturers and wholesalers to donate unused, unopened, unexpired medication to clinics and charitable pharmacies.

Through SIRUM, enough medicine for more than 300,000 prescriptions for patients in California, Colorado, Georgia, Iowa and Ohio has been donated, worth over $10 million.

Simitian became a champion of drug reuse while he was a state legislator. A group of Stanford medical students developed a “recycling” proposal and submitted it to Simitian’s “There Oughta Be a Law” contest. Simitian, then a state Senator, introduced “Recovery and Reuse of Unused Prescription Medicines” (SB798), which was adopted in 2005.

Santa Clara County was the first in the state to launch a surplus drug program, in 2008 at Santa Clara Valley Medical Center, serving County health facilities. Recognizing the need for direct consumer access, the Board of Supervisors funded the remodel of stand-alone space in San Jose, opening Better Health Pharmacy in August 2015.

“The average number of medications a nursing home patient is on is ten to twelve. That’s a lot of prescriptions that have the potential to go unused,” says Rebecca Turner, Nursing Facility Administrator at Lincoln Glen Manor in San Jose. “Everybody in the profession talked about what a waste it was.”

SIRUM called Turner for advice during its start up phase in 2008, and she was thrilled to help the organization navigate the state’s myriad drug regulations. Lincoln Glen Manor became SIRUM’s first donor.

“These individuals are so innovative, they’ve made it so convenient,” Turner says. “Originally SIRUM would give out lists of medications they needed, but it was too hard for us to sort. Now we just send everything to them in packaging they provide, and they deal with it, doing the bar coding, and the distribution.”

SIRUM charges donors a small administrative fee, based on a facility’s size. “It is definitely cheaper to donate rather than destroy meds,” says Turner, who’s an ardent program booster. “There used to be so much waste, and we want people to know that we’re not just taking care of our residents, but of the community as well.

“No other county is willing to go the extra mile to set up a program like this,” Turner adds. “I’m really proud of Santa Clara County in being innovative, and for the amount of medication they’ve donated to the community.”

“Better Health Pharmacy is a vital community resource,” agrees SIRUM Co-Founder Kiah Williams – even for residents with health insurance: “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 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.

Further, 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 2011 report from the Mayo Clinic. Conversely, when medicines are given to patients who otherwise couldn’t afford them, hospitalization rates decline as much as 42 percent, according to a study in Pharmacotherapy Journal.

Access to medication impacts health, as well as economic stability, Williams says, citing a study in which one-third of people with high drug costs reported cutting back on groceries. Medical bills are the number one reason for bankruptcy filing, according to a report by NerdWallet Health, a division of the price comparison website.

According to SIRUM, the average cost of a prescription is $45 (using online coupons and comparison shopping), but the range is vast: generic Lipitor (for high cholesterol), might cost $10 a month, but a course of enoxaparin to prevent and treat blood clots post-surgery is $150. And for a one-month supply of the anti-psychotic lurasidone? More than $1,200.

“Better Health Pharmacy really is a pioneer, one that we hope can become a national model,” Williams adds. “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.”

More information about the Better Health Pharmacy is available online at betterhealthrx.org.

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