Unused medications result from medication order changes, from resident discharges, and mortality. Under appropriate circumstances, consultant pharmacists can reduce health care cost through the return and reuse of unused prescription medications. This statement addresses the legitimate return and reuse of medications in community base facilities when federal and state laws and regulations and facility policies and procedures are met. Reasonable mechanisms (for both the payer and the dispensing BHS Pharmacy) are in place for billing only the number of doses dispensed and crediting the number of doses returned that meet the Federal and State guidelines for returned drugs.
BHS supports the return and reuse of medications to the dispensing pharmacy to reduce the waste associated with unused medications in Community Based Facilities and to offer substantial cost savings to the health care system, provided specific drug product safeguards and appropriate guidelines are met.
BHS SUPPORTS THE RETURN AND REUSE OF MEDICATIONS TO THE DISPENSING PHARMACY ONLY IF THE FOLLOWING STATE BOARD OF PHARMACY GUIDELINES ARE MET:
- Consultant Pharmacist has made an on-site inspection of medication storage and deemed it to meet all guidelines set by State and Federal Laws and Regulations.
- Pharmacists shall not accept the return of a controlled substance.
- Drugs shall be in an unopened, tamper- evident container or blister card and all doses are intact.
- Drugs must be returned within 30 days of date dispensed. Anything older than 30 days will be destroyed. No credit given.
- The drugs or devices have remained at all times in control of a person trained and knowledgeable in the storage and administration of drugs in a long-term care facility or supervised living groups using the services of a consultant pharmacist. Drugs having left the facility either with the resident or a family member may only be returned for destruction. Credit will not be given.
- In the pharmacists' professional judgment, the unit dose package or full medication card meets the standards of the United States Pharmacopoeia for storage conditions including temperature, humidity, light sensitivity, chemical, and physical stability.
- Refrigerated items are not returnable. Credit will not be given.
- The drug or device has not been adulterated or misbranded.
- he drug has been stored in such a manner as to prevent contamination by a means that would affect the efficacy and toxicity of the drug. The drug labeling has not been altered or defaced, so that the identity of the drug, its potency, lot number, and expiration date are retrievable.
- If the drug is prepackaged, it shall not be mixed with drugs of different lot numbers and/or expiration dates unless the specific lot numbers are retrievable and the expiration dates accompany the drug.
Under the Controlled Substance Act, controlled substances may only be returned between Drug Enforcement Administration registrants. Because Community Based Care facilities are not DEA registrants, pharmacies may not accept controlled substances returned from such facilities. This statement uses the term "tamper-evident" instead of "unit dose" to convey that other types of packaging are acceptable for reuse as long as the tamper-evident seal is intact and the drug integrity is assured.