Emily Cox, Lawrence, has volunteered to join Heartland Community Health Center as its pharmacist in charge to oversee the center's involvement with the state's Unused Medication Repository program. Cox surveys some of the center's current medications in its storage area. by Mike Yoder

Since its inception in July 2009, the state’s Unused Medication Repository program has provided more than $6 million worth of unused drugs for free to Kansans who can’t afford them.

While it’s being touted by lawmakers and state health leaders as a successful program that’s kept drugs out of landfills and is helping low-income Kansans, it also may be putting some Kansans at risk of medical complications.

Lawrence pharmacist Jeff Sigler thinks some safety-net clinics may be misinterpreting the Kansas State Board of Pharmacy’s laws and regulations regarding the program.

He said the law requires an on-site pharmacist to affix a label to each medication that is dispensed to a patient. The label must include a doctor’s name, patient name, drug name and directions.

He thinks some clinics are dispensing drugs without all of the information or with information that’s not from a pharmacist. The other problem is some clinics may be dispensing the drugs as if they were samples.

“Samples are meant to be given for a short period of time, maybe a week to see if they can tolerate it. So, the chances of having a long-term medication error with samples is lower,” he said.

Program’s evolution

Krista Postai, CEO of the Community Health Center of Southeast Kansas, has been involved with the program since it began. She said the problem is that the program has changed since the Legislature passed the Utilization of Unused Medications Act in 2008.

It started as a program to allow nursing homes, mail-service pharmacies and medical care facilities to donate unused drugs to Federally Qualified Health Centers, indigent health care clinics and community mental health centers. To receive donations, clinics would deal directly with the donors and have pharmacists on site to oversee the dispensing of the medications.

Postai said the Pittsburg clinic ran into glitches. When the clinic received its first boxes of unused medications from nearby nursing homes, most of the drugs were outdated or not marked appropriately. It was a time-consuming process to sort them.

The clinic also began receiving large donations from mail-service pharmacies in bottles of 1,000 pills, which needed to be broken down into smaller supplies, and only a pharmacist can do that, which also is time-consuming.

Those involved with implementing the program also learned many areas of Kansas don’t have a safety-net clinic, so nursing homes didn’t have a place to donate unused drugs. Then, there were the clinics who received donations but couldn’t use them.

So, the Kansas Department of Health and Environment decided to provide about $140,000 in funding annually for the Community Health Center of Southeast Kansas, or CHC/SEK, to become a repository for the program. The money covers the salaries of a part-time pharmacist, a full-time coordinator and the costs for shipping.

The way it works is that the donors and recipients sign up to participate in the program through the Board of Pharmacy, and then can choose to participate in the repository. Through the repository, they can order drugs through an online system and then they are shipped to them.

But, clinics still need to have an on-site pharmacist to place the appropriate labels on the medications and oversee the program.

“We have to make sure that they have a pharmacist on that end so that the drugs are being reviewed and that they can attest to their safety as to where they’ve been stored and whether they’ve been tampered with,” said Debra Billingsley, executive secretary of the Kansas Board of Pharmacy. “It’s been problematic. A lot of the clinics have pharmacists who are there periodically but for them to actually go in and fill prescriptions every day, they almost need to be there full time, and that’s where we are having the difficulties.”

The Community Health Center of Southeast Kansas in Pittsburg serves about 22,000 people. It provides mental, dental and medical health services inside the building, along with a pharmacy. The center also serves as the repository for the state's unused medication program. by Kevin Anderson

Local impact

Lawrence’s Health Care Access was one of the first safety-net clinics to sign up to use the state’s unused medication program. The clinic distributed 700 medications worth about $60,830 to uninsured Douglas County residents, but then stopped using it last year after Sigler, which is the clinic’s pharmacist-in-charge, asked his pharmacy inspector to look into the regulations.

“A red flag went up,” he said. “I think for safety sake that once you start bypassing a pharmacist getting involved, I think that opens up some doors that we don’t want to open.”

Nikki White, executive director, said the clinic still provides medications through samples and patient assistance programs, where the labels are already affixed to the drugs when sent to the clinic. They also hand out as many low-cost prescriptions as possible, but sometimes patients can’t afford anything and that’s where the burden of not participating in the program hits the clinic’s bottom-line.

Lawrence’s Heartland Community Health Center recently found a volunteer pharmacist who will oversee its participation in the program.

Heartland CEO Jon Stewart said there has been confusion about the regulations, but the clinic will be adhering to the strictest State Board of Pharmacy rules.

“We are excited that we have someone now who is willing to wade in while the Legislature and the Board of Pharmacy kind of sort out what those requirements really need to be,” he said.

Changes coming?

Billingsley admits the regulations need to be updated.

“We are talking with Pittsburg to do it more like a mail-order situation so that the prescription flows from the clinic to Pittsburg. They fill the prescription and have a pharmacist do it there and then it goes to the patient. That’s what we are trying to get into place next,” Billinglsey said.

While there were talks last summer, there have been no changes. Billingsley and Postai say there have been more pressing issues and the system is working.

In 2011, 23 clinics used the program to hand out more than $1 million in unused medications.

Billingsley said if a clinic was found to be using the program inappropriately, it would be educated first, and if the problem continued it would be told that it can no longer participate.

“Each case is going to be viewed individually, and I guess it would be dependent upon exactly what they did that was incorrect,” she said.