Medical students’ proposal could become state law

By Jenny Allen

After reviewing 129 submissions, local California State Senator Joe Simitian (D-11th District) announced on Mar. 31 five winners of the annual “There Oughta Be A Law” contest, including a team of five first-year Stanford medical students. The contest, spearheaded by Simitian, asked Californians to send in ideas that they want to see become state laws.

The Stanford team’s winning concept, according to a press release from Simitian’s office, was to establish a program that “would allow pharmacies to distribute previously sold, unexpired and unopened prescription drugs to patients, especially those with low income or severe disabilities.”

The Stanford team testified in front of a meeting of the state’s health legislative committee in Sacramento on April 27.

“This is a district full of smart, caring and engaged folks,” Simitian said. “And Stanford, of course, is a particularly forward-thinking community. When I read the med students’ proposal, it immediately impressed me as an innovative approach to the high cost of prescription medicines.”

Last fall, in a course entitled “Practice of Medicine,” the team, consisting of Emily Chang, Michael Mancuso, Josemaria Paterno, Joe Peraza and Shila Ravi, agreed to collaborate on the medication waste project idea that Paterno originally proposed.

“As someone who is soon to join a profession where cost, efficiency and access to care are defining issues of today’s health system, I would feel very comforted to know that some people who often have to choose between food and prescription drugs could be helped by this program,” Paterno said, adding that he had known of international medication redistribution programs that export unused HIV drugs from the United States.

“The logical extension of those international programs is that valuable, expensive, unused drugs are needed by patients here,” he said. “It makes sense to try to establish some sort of domestic program for American patients. In the United States, unused medication waste means hundreds of millions of dollars of potential savings and many potentially saved lives.”

Paterno emphasized that the medications given to the indigent and poor in the proposed program are not to be inferior, used or recycled.

“Although medication redistribution may seem like a risky idea, new technologies, packaging advances, proper protocols and safety inspections can make it reasonably safe or at least safer than no medicine at all for whole groups of people,” he said.

Since pharmacies can recover handling and inspection costs with a minimal handling fee for recipients when they redistribute the drugs, the cost of the program to the state should be close to nothing, Paterno said.

“The program is revenue-neutral and self-sustaining,” Paterno added. “Medicines would not have to be remanufactured, just verified. Many tablets or capsules already are packaged individually in tamper-proof wrappings with the name and date of expiration stamped on each one.”

After conducting preliminary research, Paterno said he recognized that “the only way to get this program done would be through establishing a state law to permit medication redistribution to provide liability protection for participating pharmacies.”

During winter quarter, the team of students worked with Simitian’s staff to plan a sustainable, efficient and safe program.

“We had to review issues such as the legal language, the distribution model and the formulary,” Paterno said.

Rei Onishi, a senior staff member in Simitian’s office, told Paterno that if the law gets through committee there’s a good chance it will pass.

“If passed, our proposal would show that even a small group of students can accomplish great strides for those in need,” Peraza said. “I hope it provides underserved populations with continued attention, support and representation.”

Chang said the proposed bill could be a practical way to combat what she sees as a disturbing injustice.

“With proper medications, education and management, the morbidity and mortality associated with diseases such as heart disease and diabetes could be alleviated or avoided,” she said. “However, the cost of prescription drugs is so prohibitively high that without insurance or a six-digit income, few can afford to pay for them over the course of months or years.”

Chang added that although the proposed bill is not a permanent solution to this problem, it would provide help to those who need it the most as soon as possible.

In developing the proposal, Paterno said the team also collaborated with relevant professionals across the nation, namely Linda Johnston, pharmacy director of Tulsa County, who has been advocating for drug redistribution in Oklahoma for six years, and Greg Prouty, pharmacy director for Stanford Hospital.

-Courtesy of the Stanford Daily, 4/05/05

Posted 4/28/05