"Trial" prescriptions to reduce drug wastage: results from Canadian programs and a community demonstration project

To determine the acceptability of a program to avoid drug wastage through "trial" prescriptions.

Cross-sectional survey, followed by a 9-month demonstration project.

Consultants to trial prescription programs operated by 2 public- and 3 private-sector drug plans in Canada were surveyed. All of the trial prescription programs were voluntary. The demonstration project involved 215 English-speaking adults who filled a "new" prescription for an angiotensin-converting enzyme inhibitor, beta-blocker, or calcium channel blocker (CCB) in 1 of 16 Peterborough, Ontario pharmacies. Patients received a 7-day supply of medication and a reminder card on which the dispensing pharmacist recorded the mutually agreed date and time the patient would be contacted to assess the results of the "trial." Patients who tolerated the medication received the balance of their original prescription.

Most patients (86%) who were offered trials in the demonstration project accepted them, and most (82%) who accepted them found them helpful. The proportion of patients who received the balance varied by program, ranging from 47.1% to 86.6%. The dollar value of the wastage avoided through trial prescriptions varied by drug class. This was driven largely by differences in the unit cost of the medications, but also to a lesser extent by larger prescriptions for CCBs.

Trial prescriptions were acceptable to patients and, if focused on specific medications, could reduce the direct cost of drug wastage. More work is needed to define the conditions under which trial prescription programs are feasible for pharmacists and drug plans.