Connecting Low-Income Patients to High-Quality Medicine

Nearly 25% of American adults cannot afford the medication they need. SIRUM prescribes a solution.

Two years ago, Tara Leeds* stopped taking her medication. After 40 years of taking prescription drugs to treat her bipolar disorder, she grew tired of their side effects and convinced herself she no longer needed them. She was wrong.

Tara’s mental state quickly spiraled into disarray—she lost her job and was soon living in a motel. She knew she had to start taking medication again, but even with insurance the drugs were too expensive. Her family estranged and health issues compounding, it became clear that Tara would likely succumb to the fate of so many others: abandoned by society and left homeless in the streets by a mental disorder dragging her life into irreparable chaos.

Meanwhile, less than an hour’s drive from Tara’s motel, long-term care facility Lincoln Glen was spending over $1,000 a year to destroy leftover drugs—untouched, unused medication, including exactly what Tara desperately needed to treat her bipolar disorder.

The profound inefficiency highlighted by this scenario is what drives SIRUM, a five-person nonprofit, to correct a long-ignored, wasteful, and incredibly expensive hole in the American healthcare system. SIRUM connects facilities that throw away unused medications with the patients who need them most.

SIRUM is having a big impact considering their size. The five-person team works out of a cramped single-room office in Palo Alto.

“This is happening all over the U.S.,” explains George Wang, one of three cofounders of SIRUM. “There is a patient right now that needs some life-saving medication, and across town someone is probably throwing that same medication away. That’s unconscionable to me.”

SIRUM’s Solution

Today, instead of rounding up unused meds and destroying them, Lincoln Glen’s director of nursing Deane Kirchner simply scans a bar code on the unused medications, entering them into an online database. At the end of each month she prints out a shipping label and packages the leftover drugs. The medication is sent not to an incinerator but to a nearby safety-net pharmacy, where Tara and other patients unable to afford expensive medication fill prescriptions for free.

Unused medication is ordinarily to be destroyed, often by incineration. In California alone, long-term care facilities destroy approximately $100 million worth of medication annually. Instead, Lincoln Glen’s Director of Nursing Deane Kirchner prepares drugs for donation.

In the U.S., the healthcare industry destroys approximately $5 billion worth of medication per year. At the same time, nearly one in four American adults do not take medication prescribed to them because they cannot afford it. Some safety-net clinics spend significant budget to cover medication costs their indigent patients cannot afford — an expensive but preferred alternative to patients landing in an emergency room when health issues have escalated to extremes.

Healthcare professionals like those at Lincoln Glen have long lamented the system's inefficiency, but legislation has either been unclear or blatantly prohibitive of drug donation. It was not until 2011 that donating medicine became efficient and scalable, when SIRUM parsed the legislation and created a system that made donating easier than disposal.

“We want to expand to a national program,” says cofounder Kiah Williams. “We are in four states now and there are 40 states with laws [that permit drug donation]. We want to be in all 40 states.”

As of March 2016, SIRUM had secured drug donations totaling $5.6 million, redirecting them to people who might otherwise go untreated or sacrifice necessities like food or heating in order to buy them.

“How much money you have should not determine the access you get to healthcare,” Williams says.

When Drugs Go Unused

Unaffordable healthcare has complex consequences. When treating patients with little to no health coverage, doctors often face a dismal conundrum: prescribe the patient the cost-prohibitive drugs they need, or prescribe something affordable that’s far from the best treatment available. SIRUM hopes to create a world in which doctors can confidently prescribe the best treatment to all patients, regardless of income or insurance.

Unused medications also affect more than just the patients who need them. Considering the entire lifecycle of medicine production, each pound of new active ingredient that is produced generates hundreds of pounds of waste, meaning SIRUM has prevented hundreds of thousands of pounds of waste from being needlessly created. Many states also lack proper disposal protocols, resulting in trace amounts of drugs making their way into water supplies. A recent study across 25 states found that 70% of waterways used for drinking were contaminated with pharmaceuticals.

Drugs are discarded for a variety of reasons: stocked-up medication is left behind when patients die or leave facilities, or when treatments are changed or reduced. SIRUM accepts this leftover medication from more than 200 diverse donors including nursing homes and pharmacies. At the receiving end, a variety of free or reduced-cost clinics and pharmacies stock and distribute the drugs to those in need.

The beauty of SIRUM’s method is that much of this redistribution process is automated through an online platform. There is no need for large storage warehouses or hordes of volunteers—obstacles that have hindered other drug-donation programs from scaling in the past. Instead, SIRUM’s platform automatically determines where the greatest need is and suggests a list of recipient partners from which the donating facility can choose. Once they make that choice, medications go directly from that facility to the recipient.

This unprecedented efficiency keeps SIRUM’s operating costs low; the bulk of their expenses are associated with recruiting and training donor and recipient organizations. SIRUM hopes to become financially sustainable in the long-term by charging recipient organizations a small fraction of what they would ordinarily pay for new drugs.

The Free Pharmacy

SIRUM’s latest endeavor is supplying medication to Better Health Pharmacy, a free pharmacy in Santa Clara County in northern California. Officially opened on February 16, it’s the first entirely free pharmacy in the state. Now, rather than deliberating whether a patient can afford the medicine they need, area doctors can consult an open medication directory online showing everything in stock at Better Health Pharmacy and prescribe their patients accordingly.

On the day of its grand opening, county officials praised the pharmacy while SIRUM cofounders Wang and Adam Kircher waited around nervously, helping the pharmacy staff where they could and anticipating the arrival of patients. The pharmacy is somewhat concealed in a bulky county medical building, and there was talk that word might not yet have reached the public.

Pharmacists, volunteers, and county officials have worked hard to create Better Health Pharmacy, a free pharmacy in Santa Clara County, CA, that is stocked entirely with donated medication supplied by SIRUM. 

Less than a week later, a line of patients spills out of the pharmacy and into the hallway. Word had spread. Still, many patients, after years of dodging exorbitant healthcare costs and weary of fine print, seem to be in disbelief. To most, the pamphlets spreading across town appear too good to be true: “All you need is a prescription from your doctor,” the brochures say. “No proof of citizenship, residency, or income is required.”

During Tara’s first visit to the pharmacy, she sits anxiously in the waiting room, folding her worn prescription in her hands. In the hallway, her sister, who drove her to the pharmacy, explains, “She still thinks it’s going to mess with her insurance or that there’s some sort of catch.”

“People like her think that they aren’t valuable,” she continues, “that they aren’t worth taking care of because no one ever really bothered to take care of them.”

One of the first patients at Better Health Pharmacy fills out his prescription. 

When it’s Tara’s turn to approach the counter, the pharmacists do not ask about her insurance, and they are not concerned with her income or employment situation. They just ask for her prescription and a few minutes later Tara walks out, medication in hand.

*Patient names have been changed.

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