- A BMJ analysis of cancer drug packaging found overly large vial sizes lead to significant waste, costing over $2 billion a year in unused and leftover drugs. The study criticized the "buy and bill" practice used by hospitals and doctors in administering the drugs.
- The researchers examined the top 20 cancer drugs which are dosed by body size and packaged in single-dose vials—which account for approximately 93% of all sales of the drugs. They then calculated the amount of leftover drug from used vials and resulting value of the waste, net of hospital vial sharing.
- Regulations governing the use of drugs leftover from partially used vials are contradictory. On one hand, the Centers for Medicare and Medicaid encourage the practice, while the Centers for Disease Control and Prevention does not. Typically, there is only a six-hour window when leftover drugs can be safely used.
The researchers found varying percentages of leftover drugs across the 20 cancer drugs included in the study. At the high end, 37% of the drug Kyprolis was leftover due to mismatches between the dosing needs of the patient (based on weight) and the available vial sizes. Accounting for the estimated frequency of vial sharing, this percentage fell to 33%.
Other drugs' leftover percentages adjusted for vial sharing ranged from a low 1% (Treanda) to 27% (Velcade). The value in revenue from the wasted amounts of Velcade totaled over $300 million. Even if some of the drug is not used, government and insurer payers still foot the total cost.
Adding up the waste for all 20 drugs resulted in an estimated $1.8 billion spent on wasted drugs. The researchers estimated another $1 billion was overspent on mark-ups tied to the practice of "buy and bill," where hospitals and doctors purchase single vials and mark up the associated invoices.
The authors proposed creating a more efficient system by regulating manufacturing of cancer-drug vials so that size options contribute to lower waste. They also suggest a specific threshold for waste—in this case the example was 3%. Under that scenario, revenues from leftover drug would decrease from $1.8 billion to $400 million.
Another option would be to allow manufacturers to select vial sizes at will, but refund the cost of leftover drugs.