By: Peter Thøgersen, Health Policy Consultant, Pharmadanmark
Pharmacist Mia Lolk Lund is Head of Clinical Pharmacy at Sygehusapotek Fyn, Odense University Hospital, and one of the key contributors behind the DANROAD project, which makes it possible to re-dispense unused cancer medicine.
The solution has significant potential in terms of patient safety, sustainability and the efficient use of healthcare resources.
Each year, Sygehusapotek Fyn dispenses medicines free of charge worth many millions of Danish kroner, with expensive cancer medicines accounting for a relatively large share of the overall budget.
At the same time, these medicines have a high climate footprint, and supply shortages can have fatal consequences for patients.
For Mia Lolk Lund, it was therefore an obvious priority to work towards optimising workflows and reducing medicine waste within this category of medicines.
“We saw clear potential in developing a model that allows us to avoid effective medicines going to waste and unnecessarily burdening the climate.”
“Cancer medicines differ somewhat from other medicines we dispense free of charge, as we often see patients switch treatment due to side effects or lack of effect. As a result, it is not uncommon for patients to have unused medicines left over. Previously, these were simply sent for destruction, as legislation does not allow medicines to be re-dispensed once they have been issued to a patient,” Mia explains, and continues:
“However, we saw potential in working towards a model that allows us, in a safe and responsible manner, to prevent effective medicines from going to waste and unnecessarily impacting the climate. When a single pack can cost more than DKK 100,000, it really is a win-win situation.”
Pharmacist Mia Lolk Lund, Head of Clinical Pharmacy at Sygehusapotek Fyn, Odense University Hospital, and one of the key contributors behind DANROAD.
Patient safety is the top priority
A responsible model for re-dispensing medicines must ensure both that patients do not receive counterfeit medicines and that the quality of the medicine has not been compromised during the period when the pack has been outside the pharmacy’s custody.
The project has now developed such a model and obtained a dispensation to test it in practice.
“The most important thing for us is being able to guarantee the quality of the medicines we dispense to patients. I feel completely confident in the setup we are currently testing, which has been approved by the Danish Medicines Agency. Initially, we are focusing on tablet formulations that are stored at room temperature,” says Mia Lolk Lund.
In practice, each medicine pack is dispensed in a sealed bag with a temperature logger.
The patient must store the tablets in the sealed bag until they are needed, and if the medicine is not used, the patient must return the unopened bag to the outpatient clinic.
Staff from Sygehusapoteket then check that the bag and the pack are unopened, that the medicine has at least six months of remaining shelf life, and that it has been stored within the correct temperature range.
If all quality requirements are met, the pack can be re-dispensed to another patient.
A milestone reached
Patients have responded positively to the new initiative, and more than 100 patients have chosen to participate in the pilot project.
A major milestone was reached when the first patient returned an unused pack, says Mia Lolk Lund.
“As a healthcare professional, it is very satisfying to help ensure that medicines do not simply go to waste, but actually benefit patients.”
“I am truly pleased with the positive response from patients, and the fact that the first unused pack has now been returned and can be reused instead of being destroyed is, in my view, a major win for the climate, security of supply and the regions’ medicine budgets.”
“As a healthcare professional, it is very satisfying to help ensure that medicines do not simply go to waste, but benefit patients. At the same time, we are seeing patients become more climate-conscious and more aware of the importance of avoiding medicine waste.”
Part of a broader effort
The DANROAD project is part of the regions’ wider efforts to reduce the climate footprint associated with the use of medicines and is led by the Department of Pharmacology at Odense University Hospital.
You can read more on the department's website or in this article published in Pharma (in Danish).