Medicaid reimbursement policies for financing long term care may contribute to the practice of medication waste. Long term care facilities are reimbursed only once a month by Medicaid for medications ordered from off-site pharmacies. Therefore, there are no financial incentives to order a smaller portion of a prescription until the resident can be reassessed for the appropriateness of the medication, dose, and route. These reimbursement policies have resulted in a practice of prescribing sufficient doses for a month, including newly prescribed medications. There is no current incentive for pharmacies to recycle unused medications.
Recycling is costly and labor intensive.
Medicare's payment policies are focused on purchasing appropriate care efficiently. The shift from cost-based to prospective payments create an incentive for providers to reduce cost, making the prudent and non wasteful use of all resources a high priority. In this prospective payment environment, evaluations of the quality of medication use will need to move beyond simple descriptions of prescribing patterns and begin to measure the adverse clinical and economic consequences of medication waste. Efforts to decrease and eliminate medication waste are critically important. The experience of Massachusetts could be an indication of potential national savings.