Redistribution of short-dated emergency medications as a cost avoidance and drug shortage management strategy

This study aimed to develop a process to reduce waste through redistribution of short-dated medications in emergency drug boxes and assess associated cost avoidance.

Short-dated medication items (defined as those expiring within 4 months) from more than 200 emergency drug boxes located throughout a large academic medical center were collected, sorted, and counted during two 3-month time periods. Medications expiring within 2 weeks were discarded. Remaining short-dated medications were redistributed to satellite pharmacies and the emergency department based on historical utilization patterns. The counts and costs of redistributed medications were collected and totaled. Results were compared between study periods to assess differences in numbers of drugs redistributed and the associated cost avoidance.

A total of 4,415 short-dated medication items were collected during the study periods. The medication items associated with the highest cost avoidance were epinephrine 1 mg/mL, 30-mL vial (cost avoidance of $25,764), phenylephrine 10 mg/mL, 1-mL vial (cost avoidance of $8,626), and naloxone 0.4 mg/mL, 1-mL vial (cost avoidance of $5,382). The estimated total annualized cost avoidance was $104,357 for the first period and $144,674 for the second period. Of the 16 unique medications stocked in emergency drug boxes, 12 were in short supply at the institution at the time of the project, and about 67% of the redistributed items were subject to national drug shortages.

A process that facilitates appropriate redistribution of short-dated emergency drug box medications can reduce medication waste and lead to substantial cost avoidance.