Sample Post 5

Co-authors: Michell Zulu, PharmD; Kelli Brignac

Key Takeaways:

1. The Blue Cross Blue Shield of North Carolina (BCNC) RemediChain Pilot Program demonstrated substantial growth in the number and value of reclaimed and redistributed medications. This increase highlights the program’s effectiveness in both reducing medication waste and improving access to essential cancer treatments.
2. The collaboration with Blue Cross Blue Shield of North Carolina and the implementation of targeted marketing strategies significantly boosted public awareness and participation. These efforts were crucial in driving engagement from health care providers, patients and the community, thereby enhancing the program’s reach and impact.
3. The success of the RemediChain Pilot Program in North Carolina underscores its potential for broader implementation. A nationwide reclamation and reuse program could expand access to life-saving medications, reduce health disparities, and generate significant cost savings – a compelling case for scaling the program across other states.

Introduction

Prescription drug repository programs have emerged as both a promising solution to the growing issue of medication waste and a viable opportunity to improve access to essential treatments for underserved populations.

As of September 2023, 44 states, Washington D.C., and Guam have established laws supporting these programs, with 28 states having operational initiatives in place1. However, despite their potential, prescription reclamation programs face significant legal, compliance, funding and awareness challenges that hinder their full impact.

Nationwide, more than $100 billion worth of medication is destroyed each year and 20% of filled prescriptions are thrown away; while 32 million Americans report being unable to afford their medication. The problem is especially pronounced among patients with cancer, whose treatments may change frequently and whose medications can cost up to $45,000 for a 30-day supply. The RemediChain platform, launched by Good Shepherd Health in 2019, aims to tackle those dual challenges – both of which have grave consequences for the environment, the economy and the health care system as a whole. At its core, the platform encourages community members to donate their unused medications to cancer patients in need. This approach promotes a sense of community responsibility and reduces the environmental impact of medication waste.

On January 6, 2023, Blue Cross and Blue Shield of North Carolina (BCNC) partnered with Good Shepherd Health to launch a RemediChain pilot program focused on improving medication affordability and reducing waste. The pilot’s objectives were to:

1. Assess the impact of BCNC’s marketing efforts on the platform’s overall performance;
2. Quantify the number and value of donated medications provided to North Carolina residents; and
3. Analyze the operational costs of running the program.

Methods

We employed the RE-AIM framework to guide the program’s implementation and evaluation according to five key outcomes: Reach, Effectiveness, Adoption, Implementation, and Maintenance.

The pilot program focused on reclaiming unused, unexpired oral chemotherapies from individual patients and health care providers and matching those donations with cancer patients in need. In the simple process, donors detailed their potential donation in an online form and sent eligible medication to RemediChain using a provided shipping label. Pharmacists inspected the donated medication, and once approved, added it to RemediChain’s inventory. Donated medication was either redistributed to eligible cancer patients in need or properly incinerated upon expiration. Note: To avoid losing medication to expiration, RemediChain pharmacists dispense medication based on its remaining shelf life, with those nearing expiration sent out before those with significant time left.

To streamline the donation process, ensure medication safety, and optimize the matching of donated medications with recipients, the program leveraged advanced technology. These included secure data management systems, automated inventory tracking, and algorithms to efficiently match medications based on patient needs, medication availability, and each patient’s resident state donation and reuse laws.

To increase participation, BCNC implemented a comprehensive 12-month marketing campaign. The campaign included provider news articles; email blasts; blog posts; co-branded postcards and flyers; informational letters mailed to providers; and three live one-hour RemediChain presentations to large teams of providers and other stakeholders.

Results

The RemediChain pilot program demonstrated significant success in terms of medication reclamation, matching, and cost savings. But it also provided insights into the insurance status of donation recipients.

Among 703 patients who were matched with donated medications from 2020-2023:

• 12% were uninsured
• 30% reported their insurance didn’t cover their necessary chemotherapy
• 58% reported that while their insurance provided prescription coverage, they could not afford the co-pay or coinsurance

Reach: The RemediChain Pilot Program successfully engaged a diverse population of both donors and recipients, with a significant increase in participation following Blue Cross NC’s marketing efforts. During the pilot, RemediChain collected prescription donations from 38 states and provided medication to vulnerable patients in 18 states. In North Carolina, specifically, the number of patients matched increased more than 12 times, from 7 to 97.

Effectiveness: With the help of Blue Cross NC, the program demonstrated substantial improvements in medication access and cost savings. Program-wide, compared to the 2022 baseline:

• The number of reclaimed medications increased from 1108 to 1660 (+50%).
• The total value of reclaimed medication increased from $9,793,178 to $18,206,603 (+85%).
• The number of matched medications increased from 227 to 429 (+89%).
• The total value of matched medications increased from $2,602,245 to $4,326,211 (+66%).

The average value of each reclaimed medication was $10,967, and the average value of each matched medication was $10,084. In North Carolina, compared to the 2022 baseline, 128 donations were received versus 97, the number of matched medications increased from 7 to 97, and the total value of medications matched to North Carolina residents in 2023 increased to $1,127,384 from a 2022 baseline of $63,028. The average value of each medication reclaimed from North Carolina was $11,731, and the average value of each medication matched to North Carolina residents was $11,622.

Adoption: Blue Cross NC’s comprehensive marketing campaign – including provider news articles; email blasts; blog posts; co-branded postcards and flyers; information letters mailed to providers; and live presentations – resulted in increased adoption by health care providers and community members, as evidenced by the across-the-board increases seen during the pilot program.

Implementation: The program’s workflow and technology, including a user-friendly online platform and automated inventory tracking, ensured the safe and efficient donation, inspection, storage, and redistribution of reclaimed oral chemotherapies.

Maintenance: The program demonstrated long-term benefits in both medication access and cost savings. However, the increased number of expired medications in 2023 – the first year of significant inventory expiration in our program’s four-year history – highlights the need for additional long-term strategies to optimize medication utilization and minimize waste.

Key Results:

1. The numbers of both donations and matches increased by 50% year-over-year for the entire platform, not just North Carolina.
2. In North Carolina, donations increased by more than 32%, while matches increased by more than 1400%. North Carolina residents received $1,127,384 worth of reclaimed chemotherapy.
3. The potential for nationwide replication with Blue Cross Blue Shield and other associations is substantial, offering opportunities to expand access to life-saving cancer medications; reduce health disparities; improve patient outcomes; and contribute to a significant reduction in prescription drug waste

Discussion

Several key factors contributed to the success of the RemediChain Pilot Program.

1. The program’s focus on reclaiming oral chemotherapies addressed a critical need for expensive and often inaccessible medications.
2. The partnership with BCNC and their extensive marketing efforts significantly increased public awareness and participation. The targeted outreach to health care providers, patients and the community through various channels both effectively communicated the program’s value and drove engagement.
3. The program’s use of advanced technology streamlined the donation process, ensured medication safety, and optimized the matching of donated medications with recipients, enabling efficient scaling and handling of increased donation and match volumes.

The potential for nationwide replication of the RemediChain program in partnership with Blue Cross Blue Shield and other associations is substantial. Such a program would greatly expand access to life-saving cancer medications for underserved populations, reduce health disparities, improve patient outcomes, and contribute to a significant reduction in prescription drug waste. Additionally, the cost savings achieved through medication redistribution could be reinvested into other critical areas of cancer care and support services.

The data on recipient insurance status highlights the crucial role of prescription drug repository programs in addressing the needs of underinsured and uninsured populations. Even among those with insurance, a significant number faced barriers to accessing necessary cancer treatments, underscoring the importance of programs like RemediChain in bridging these gaps. Future research should consider incorporating data from multiple prescription drug repository programs, expanding the geographic scope to include a more diverse range of regions, and collecting qualitative data to provide a more nuanced understanding of the program’s impact. Longitudinal studies could help evaluate the long-term effects of the program and the evolution of medication reclamation and redistribution processes over time.

Conclusion

The RemediChain Pilot Program, in partnership with Blue Cross NC, has demonstrated the feasibility and impact of a prescription drug repository program focused on oral chemotherapies for cancer treatment. The program’s success in reclaiming, matching, and safely disposing of medications, coupled with its cost-effectiveness and operational efficiency, presents a compelling model for nationwide replication.

By likewise leveraging the reach and resources of Blue Cross Blue Shield associations across the country, the potential to improve access to cancer medications, reduce prescription drug waste, and drive cost savings could be transformative. Good Shepherd Health’s innovative approach, technological infrastructure, and strong partnerships provide a solid foundation for scaling and sustaining this vital effort to improve both cancer care and health equity.

Still, the limitations of this retrospective analysis highlight the need for further research to address the long-term impact of prescription drug repository programs. Future studies should adopt multi-site, longitudinal, and mixed methods approaches to provide a more comprehensive understanding of the challenges and opportunities associated with medication donation and redistribution.

In conclusion, the RemediChain Platform serves as a promising model for addressing the critical issues of medication waste and access in the United States. By building upon the lessons learned from this pilot and investing in further research and collaboration, stakeholders can work toward developing sustainable and scalable solutions that improve the lives of patients, reduce health care costs, and promote a more equitable and efficient health care system.

References

1. Oncologic drug repository programs in the United States: a review and comparison
   Health Affairs Scholar, Volume 2, Issue 3, March 2024, qxae031, https://doi.org/10.1093/haschl/qxae031