(058) Development of an Oral Oncology Drug Repository Program at a Tertiary Academic Medical Center

Poster Abstract:

Background:
A recent study analyzing data from 35 clinical trials, including 22 oral anticancer drugs, found the mean cost of waste associated with dose reduction/discontinuation of oral anticancer medications to be $4,290 per patient.1 Not only is this waste costly to patients and healthcare systems, but high costs of cancer medications pose accessibility barriers for patients, particularly those that are under- or uninsured. This can lead to delays in initiation of potentially lifesaving therapy.

Although avenues such as patient assistance programs (PAPs) and grants exist, there are limitations. PAPs have restrictive eligibility criteria and evaluation may be a lengthy process, delaying initiation of treatment. Grants are not available for all diagnoses and provide a finite amount of financial aid. In these situations, a drug repository program, which allows for re-dispensing of unused medications, may provide a bridge while pursuing long-term financial aid solutions.

The first enacted legislation allowing for use of donated prescription drugs was in Georgia, in 1997. Since then, over half of the United States have legislation allowing for drug repositories; however, this is often underutilized.2 In Maryland, legislation for drug repository programs has been in place since 2007.

Objectives:
The primary objective of this project is to establish an oral oncology drug repository program with the goal of increasing access to critical oncologic medications in situations requiring a bridge to a more sustainable solution. A second aim is to initiate efforts to lobby the Maryland legislature to allow repository programs to accept medications not in their original sealed and tamper-evident unit-dose packaging.

Methods:
The framework of our program was modeled after published reports of successful programs in other states.3 The first phase of this project involved identification of oral oncolytics to include in the initial stages of the program through collection of dispensing data. The second phase will establish operational logistics of the drug repository program. This will involve defining eligibility requirements to receive re-dispensed drug, as well as development of processes for identifying prospective patient candidates and standardized safe drug collection and disposal. Additionally, we will establish pharmacy resources and workflows to allow for the provision of this service. Opportunities to partner with outside organizations that collect and re-dispense medications will be explored as a means to reduce waste of low volume medications.

Results:
In progress.

Discussion/conclusions:
In progress.

References (must also be included in final poster): 1. Lam M, Olivier T, Haslam A, Tuia J, Prasad V. Cost of drug wastage from dose modification and discontinuation of oral anticancer drugs. JAMA Oncol. Published online July 20, 2023. doi:10.1001/jamaoncol.2023.2306.
2. American Society of Clinical Oncology Position Statement on Drug Repository Programs. American Society of Clinical Oncology. October 21, 2022. Accessed August 28, 2023. https://old-prod.asco.org/sites/new-www.asco.org/files/content-files/advocacy-and-policy/documents/2022-Drug-Repository-Statement.pdf.
3. Stanz L, Ulbrich T, Yucebay F, Kennerly-Shah J. Development and implementation of an oral oncology drug repository program. JCO Oncol Pract. 2021;17(3):e426-e432. doi:10.1200/OP.20.00513