On the Job

Drug Disposal and Distribution

I sometimes receive questions that extend past the topic of medical assistants’ scope of practice but nevertheless concern issues many medical assistants may face. The following is one such situation that may serve as guidance for others in similar situations.

A handful of our patients in the infusion center [at which I work] have insurances that require their drugs come into our practice via specialty pharmacy, as opposed to our buying the drugs in quantity and storing in inventory. Twice in the past few months, we’ve had the situation arise where we have vials of very expensive infusion drugs no longer needed by the patient, but the pharmacy will not take them back or allow us to return them in any way. …

These drugs are very expensive, and the vials in question have never been in possession of the patient or general public. They have gone straight from the pharmacy to the office. We have other patients [who] struggle with their co-pays and deductibles. Are we able to use the remaining vials for the benefit of other patients? Or are we obligated to destroy [or] dispose of the medicine?

I responded as follows, with some information changed to maintain the correspondent’s privacy:

I understand the fact scenarios and your very good question. Are there any written terms of limitation of use of these infusion drugs? Specifically, does [the gastroenterology center at which you work] have a contractual relationship with the specialty pharmacies, and does [your workplace] have to agree—either explicitly or implicitly by virtue of taking possession of the infusion drugs—to not use the drugs for other patients? You indicate below that the specialty pharmacies do not permit [your workplace] to return the drugs. Are there any other conditions the pharmacies impose on [your workplace]?

If there are no such contractual (or quasi-contractual) limitations placed on [the center at which you work], and if the identity and dosage of the contents of the vials have virtually no likelihood of being incorrect, it is my legal opinion that the drugs may be used for other patients.

I hope this is helpful as a starting point. …  Please let me know how I can be of further assistance.