Medications in Single-Dose Vials and Implications of Discarded Injectable Drugs

Abstract

Every year, significant amounts of expensive injectable or infused drugs, distributed in single-dose vials, are discarded in the United States. This is due in part to the increasing number of drugs that are administered in variable doses based on a patient's weight or body surface area. Sharing medication from single-dose vials among patients is generally prohibited or severely restricted; accordingly, the unused drug amount will typically be discarded. Many of the weight-based drugs in single-dose vials are expensive and are paid for by federal health care programs (particularly Medicare Part B), private health plans, and patients who have cost-sharing obligations. This situation is further complicated in the United States by the way drugs are priced and the way clinicians and centers are reimbursed for the medications' purchase and administration. Prescription drug prices are significantly higher in the United States than in other industrialized countries, with prices averaging approximately 2.5-fold higher than prices in other nations. 1 In addition, in the United States, there is no national regulation of drug prices. 2

Trends in Medicare Part B Spending on Discarded Drugs, 2017-2020

“…The National Academies of Sciences, Engineering, and Medicine (NAM) 4,5 recommended discontinuing the JW modifier due to reporting inconsistency. However, the Infrastructure Investment and Jobs Act requires manufacturers to provide CMS rebates on spending on discarded drugs-as determined by JW modifier reporting.…”