Throwing out a few bottles of expired prescriptions you come across in your medicine cabinet doesn’t seem that wasteful, right?
But for pharmacies and hospitals, the pile of expired drugs they’re required to toss out adds up to about $200,000 per hospital each year.
The total cost per year in hospitals across the United States is about $800 million.
When you count the costs of expired medications that are thrown away by pharmacies and consumers, at least $1 billion worth of drugs are being destroyed each year.
“There’s a lot of waste in any hospital system,” noted Dr. Robert Pedowitz, DO, medical director of the Family Practice of CentraState in New Jersey. “From multi-use bottles used once and packages that are never opened, there’s so much we waste on a daily basis based on the expiration date and not because we know that it’s definitely not still good.”
Still, from a safety standpoint, Pedowitz would rather err on the side of caution.
“I’d much rather waste money on things that do have adverse effects,” he told Healthline.
However, if the drugs that are past their expiration date are safe and effective to use, that could save hospitals, pharmacies, and consumers a lot of money during a time when prescription drug costs are skyrocketing.
“Any hospital or doctor would welcome the opportunity to explore and change the way we determine expiration dates,” Pedowitz said.
The myth of drug expiration dates
There are strict standards set in place by the U.S. Food and Drug Administration (FDA) to ensure drugs are stable and effective until their expiration dates.
“The expiration date is a target date for when things will start to deteriorate. After the end date, the medication may lose some of its potency and efficacy,” Pedowitz explained.
But the actual date of deterioration isn’t clear since the FDA doesn’t require testing for longer-term use.
“Many medications have much longer shelf lives than labeled,” a Mayo Clinic commentary stated.
A program co-created by the FDA backs up that claim.
In the 1980s, the Air Force, faced with a stockpile of expiring medication and hoping to save some of the expensive drugs, asked the FDA if some of the end dates could be extended. The FDA and Department of Defense answered with the Shelf Life Extension Program (SLEP).
The program selected drugs in the stockpile based on how expensive and in-demand they were, and analyzed them to see if the expiration dates could be safely extended.
Two-thirds of the 122 expired drugs tested by SLEP were still stable. The FDA extended their safe “end dates” by four years, on average.
A Department of Defense official told NPR and ProPublica that in 2016 it cost $3 million to run SLEP, “but it saved the department from replacing $2.1 billion in expired drugs.”
More recently, Lee Cantrell, who helps run the California Poison Control System, and Roy Gerona, a University of California San Francisco researcher, analyzed a box of prescriptions from the 1960s found in the back of a retail pharmacy.
Cantrell and Gerona said they were shocked to learn that nearly half a century later, 12 of the 14 compounds “were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations,” according to NPR and ProPublica.
However, even though they’ve been urged by the American Medical Association (AMA) to reexamine expiration dates, the FDA hasn’t pushed the initiative forward.
The pharmaceutical industry, which generated $8.7 billion in net income in 2016 solely by raising existing drug prices, doesn’t have any incentive to study whether their drugs are effective longer, the NPR report stated.
What expiration dates are costing Americans
A recent Consumer Reports survey found that a third of Americans taking medication were hit with an increase in prescription drug costs between March 2015 and March 2016, with most of them paying $63 more per refill.
Those costs aren’t expected to slow down, as prescription drug prices rose 8.8 percent in 2016, the fourth year in a row drug costs have gone up more than 8 percent.
There are also costs passed onto consumers as pharmacies try to avoid overstocking medications to minimize the amount of expired drugs they have to toss.
Often this understocking results in pharmacies only filling half or a third of a patient’s prescription, called a partial fill.
“Apparently in some pharmacies, partial fills have become a practice,” Carolyn Ma, PharmD, dean of the University of Hawaii at Hilo’s College of Pharmacy, told Healthline.
Ma said that if a patient is trying out a new drug, it can make sense to do a partial fill. If the drug doesn’t work for them, then filling the entire prescription creates more unused drugs.
But pharmacies are also driven by the high cost of drugs to only stock the minimum amount of expensive drugs, since they have to routinely toss out thousands of dollars of soon-to-expire drugs.
“In essence, it’s money sitting on the shelf,” Ma pointed out.
This practice creates confusion for patients. It also costs them to return to the pharmacy more frequently to fill the total prescription.
Pedowitz has noticed that mail order pharmacies are contributing to the growing amount of expired medications sitting in consumers’ medicine cabinets.
Because mail order pharmacies send medications continuously, when a patient’s dosage goes down, for example, they end up getting more medicine than they can possibly take before the expiration date.
Meanwhile, they’ve already paid for the medicine and will be more tempted to take expired pills in the future.
Should you take expired drugs?
“Not a day that goes by that patients don’t bring in expired medications,” Pedowitz said.
When patients ask if they can still take the expired drugs, Pedowitz has a standard answer and a realistic answer.
The standard answer: Doctors have to adhere to certain policies per FDA guidelines and their medical licenses, which includes directing patients to throw out old drugs.
“The reality is that many medications may have a shelf life that is three or six months, or more, longer than their expiration date,” Pedowitz said. “As a general rule of thumb, I think you’re good 30 days past the regulation date.”
It’s not likely you’ll get sick from taking expired medication, but it might give you a false sense of security.
“It’s not necessarily that taking a medicine past its expiration date is harmful. It’s just not as effective. You’re potentially undertreating yourself,” Ma explained.
Studies have shown that cost is the biggest barrier for patients trying to take their medication as prescribed.
“To maintain compliance, many people are using old medications,” since they can’t afford to throw out medicine and pay for a refill, Pedowitz said.
But with serious or chronic diseases, not getting the full dosage could create long-term health problems.
For drugs that aren’t for a serious illness, you may be able to take expired medication safely and semi-effectively past the expiration date.
Just avoid using injectable, powder inhalers, and nitroglycerin tablets past their end date. Pedowitz explained that they break down a bit faster and are more vulnerable to things like bacteria growth.
Hospitals and pharmacies, governed by strict rules unlike your personal medicine cabinet, will continue tossing out over a billion dollars in expiring drugs every year.
“We know the expiring drugs might be safe and effective, but we just don’t know the specifics of it until we study them,” Pedowitz said.
He believes further testing of expiration dates is a good move for consumers and the healthcare industry.
“We’re talking about escalating costs of healthcare in the U.S., and throwing out expired medication is an area we can potentially save a lot of money in,” he said.