On January 20 through 22, a multi-institutional team, including graduate student Vanessa Martinez of our UMass Mechanical and Industrial Engineering (MIE) Department, presented a very creative, beneficial, and practical proposal for a new humanitarian company called Rx4All, a medication-recycling program which was chosen for one of four prizes from 33 competing projects in the Yale Healthcare Hackathon, held at the Yale Medical School in New Haven, Connecticut. The theme of the hackathon was “Re-engineering Patient Experience and Provider Engagement.”
“We are a non-profit organization seeking to redistribute unopened and unexpired medication to patients in the low-socioeconomic class living in the USA,” as the five-person Rx4All team explained.
The Rx4All team was made up of Martinez from UMass Amherst, Arshad Karin (Infosys), Pranjal Misra (Infosys), Isabel Castillo Piedra (Vassar College), and Joe Voves (R4 Technologies).
“I'm biased, but they had a very cool project,” concluded MIE Professor Jenna Marquard about Rx4All. Martinez is a member of Marquard’s research group.
According to an opinion article written by Peter B. Nichol and posted on CIO.com, “The problem this team solved was twofold: Many patients do not have access to medications, and drugs often expire at healthcare provider facilities, resulting in wasted medication. Rx4All was a program for recycling medications, redistributing providers' drugs nearing expiration instead of allowing these expensive drugs to go to waste.”
Nichol is the former head of information technology at Access Health CT and was responsible for IT at Connecticut’s health insurance exchange. Nichol rated RX4All as one of the “top three practical innovations from the Yale Healthcare Hackathon.”
The major feature of Rx4All is its humanitarian emphasis, as implied by the name of the company itself, shorthand for “prescriptions for all.” One of the ultimate goals of the proposed Rx4All is to expand its presence nationwide to help more than 40-million patients who are part of the 14.5 percent of Americans currently living below the poverty line. The proposed company would buy back sealed and unused medications and redistribute them at steeply discounted prices to low-income patients who might ordinarily go without their prescriptions because of the booming price of pharmaceuticals.
The Rx4All team reported that 31-million American families living below the poverty line choose not to take medications due to costs. As Nichol noted, Harvard Health found that 8 percent of adult Americans don’t take medicines because of the expense. What’s more, another 6 percent that do take them and have private insurance skip medications to save money.
Such nonadherence to prescriptions is significant when combined with the 10 percent of Americans on Medicaid and 14 percent with no insurance who are choosing not to fill prescriptions because they’re too costly.
“The standard patient strategy is to ask doctors for lower-cost medications, but even lower-cost drugs are sometimes not cheap enough to be affordable,” wrote Nichol. “Maybe if patients received even a small portion of their medication, they would see the value and fill prescriptions, often preventing more serious visits to their healthcare providers. Rarely are prescriptions written that are optional. Doctors write prescriptions to affect care outcomes.”
Nichol added that nonadherence to prescriptions is a huge issue beyond the health of patients. It causes a colossal loss of revenue. HealthPrize Technologies released a report estimating that global revenue loss has increased from $564 billion in 2012 to $637 billion in 2015. Nichol said that medical nonadherence accounted for U.S.-based revenue losses jumping from $188 billion in 2012 to $250 billion in 2015.
This mare’s nest of issues produces a vast waste. The Associated Press reported that more than 250 million pounds of pharmaceutical waste is generated annually by U.S. hospitals and long-term care facilities. This translates into $2 billion dollars wasted annually.
The vision of Rx4All is to operate as a nonprofit organization seeking to redistribute unopened and unexpired medications to patients in lower socioeconomic classes. The team developed a four-pronged approach: 1) Target nursing homes and hospitals with excess supply; 2) leverage reverse supply chains with existing distribution channels; 3) conduct free clinics; and 4) assist patients in the dissemination of near-expiration drugs to decrease disposal costs for providers.
As Nichol opined, “Rx4All was an insightful business model with practical uses targeting seasonal prescription drugs, addressing stock rotation, reducing shelf-life challenges, and utilizing generic launches to promote distribution.”
Even more importantly, Rx4All presented a business plan that can potentially save thousands of lives by recycling safe, medically necessary drugs to people who currently can’t afford them. (February 2017)