By Deborah Cho
I would highly recommend reading the Stanford Social Innovation Review’s recent article An Rx for Surplus Meds featuring the Dispensary of Hope, a brilliant model of providing prescription medications to those who need but can’t afford them.
In a nutshell, the Dispensary of Hope, a not-for-profit enterprise, collects unused medication samples from participating physicians and pharmacies across the country and redistributes those medications to safety-net health centers. Those health centers can then prescribe these much-needed medications to patients who are unable to obtain them otherwise. Since many of those medications would likely sit on shelves until they had to be discarded if they were not donated, this is beneficial to both the physician practices that no longer have to worry about proper drug sample disposal and also to safety-net health centers and their patients.
More specifically, participating physician practices and pharmacies simply fill with medications the boxes that are shipped to them by the organization and then ship the box back to the organization’s headquarters. The organization’s staff and volunteers there do all the legwork necessary to properly inventory the drugs so that they can be distributed. This way, time and effort required on the parts of these physician and pharmacy groups is minimal (not to say that their contribution is minimal – the Stanford article states that $14 million of sample donations were expected for 2013). The organization thus provides a missing link, acting as an intermediary between the donors and the recipients to keep the supply constant and regular.
Though I would be the first to admit that this seems to be a very effective model, I wonder if there is a way to reach even more free clinics and help even more patients. This particular organization requires safety-net health centers to pay a $7,500 subscription fee each year to receive the samples. Though these centers receive medications worth much more than the cost of subscription fee, there are undoubtedly many smaller clinics that would not be able to afford to pay such a hefty fee and that also would not require such a large volume of drug samples.
These clinics are just as valuable to the medically underserved population, even if they are reaching a smaller group of the population in smaller buildings. And there are probably physicians and pharmacies with small cabinets bursting with drug samples set to expire within a few months that would be more than happy to hand those samples over. (As a side note, there should be better regulations on how large drug sample packaging can be relative to the actual drug itself. A box the size of a DVD case for one pill seems unreasonable and probably wastes a lot of shipping costs for organizations like Dispensary of Hope.)
According to the Prescription Drug Marketing Act and the regulations on the charitable donation of drug samples, only a licensed practitioner or another charitable institution, which must also have a licensed practitioner or pharmacist who can examine the samples, can deliver and receive the samples. This language seems to require either no intermediary at all or a costly intermediary, like the organization described above, in these sample transfers.
The idea that drug samples could and should be donated to places like free clinics was discussed several times in my former life as a medical student. It was understood, however, that it would take more than just goodwill on the parts of busy physicians and pharmacists to ally with places like free clinics to carry out the actual transfer of unused samples from a private office to a free clinic. But in this era of extreme social networking, I can’t help but hope that there is still a way to connect private offices and free clinics without requiring a $7,500 fee. Maybe we can make an app for that.