Recently, five departments including the National Health Commission, the State Administration for Market Regulation, the State Administration of Radio, Film and Television, the State Administration of Traditional Chinese Medicine, and the State Food and Drug Administration jointly issued the “Implementation Plan for Saving Pharmaceutical Resources and Curbing Drug Waste.” The “Plan” mainly puts forward specific work measures and requirements from the aspects of drug production, clinical use, drug circulation, publicity and guidance, waste drug management, organization and implementation, etc.
The statistics on drug waste are shocking. For example, a report 10 years ago pointed out that the waste caused by expired medicines in my country reaches 15,000 tons every year. In my country alone, the value of medicines wasted by households every year exceeds 10 billion yuan. After experiencing the COVID-19 epidemic and respiratory infectious diseases, more people have developed the habit of stockpiling medicines, which may lead to more waste of medicines.
Like resources such as medicine and food, any waste means loss. For example, the waste of medicines in the production and distribution links is a loss for related enterprises; the waste of medicines by families consumes the family’s financial resources. The waste of medical insurance drugs also wastes medical insurance funds. Our country is a resource-scarce country, and drug waste is a huge consumption of related raw materials.
The report of the 20th National Congress of the Communist Party of China proposed to implement a comprehensive conservation strategy and promote the conservation and intensive use of various resources. Medicines naturally need to be included in the comprehensive conservation strategy. The “Plan” issued by the five departments this time is not only to implement the requirements of the 20th National Congress of the Communist Party of China, but also to comply with the public will and public opinion. Due to the serious waste of medicines, there have been constant voices in recent years suggesting curbing this waste.
The “Plan” provides a “big prescription” to curb drug waste from all aspects, covering drug production, clinical use, drug circulation, publicity and guidance, waste drug management, organization and implementation, etc., forming a full-chain governance model. When each link exerts its efforts at the same time, it will bring about a superimposed governance effect, and the comprehensive saving effect can be expected.
The author believes that in order to maximize the curbing effect on drug waste, the key is to start with the word “big”. From a practical point of view, the phenomenon that causes a lot of drug waste is related to “bigness”. For example, some hospitals or doctors use “large prescriptions” when prescribing medicines, resulting in some medicines not being used up and causing waste due to expiration, which is regrettable.
Objectively speaking, “large prescriptions” are not entirely the fault of doctors. Some patients specifically ask doctors to prescribe more medicines in order to avoid multiple visits to the hospital. Some doctors write “big prescriptions” in order to get a commission from the drugs. In this regard, the “Plan” requires that appropriate dosages of medicines be prescribed according to the patient’s condition, and medicines shall not be prescribed for the purpose of simply increasing income or seeking personal gain.
Another example is the “big packaging” of some medicines. Some pharmaceutical companies use large packaging in order to sell more medicines. In addition, hospital pharmacies and pharmacies do not dismantle and sell medicines in large packages. Therefore, large-package medicines will flow directly to patients, resulting in waste if the patient’s recovery medicine is not used up. This “Plan” promotes appropriate packaging of drugs, and also proposes dismantling and distributing large-packaged drugs in outpatient and emergency departments.
Another example is the “big medicine box” in the home which also causes the waste of medicines. A research report a few years ago estimated that about 78.6% of households in my country have medicine kits. Now this ratio may be higher, especially for families with elderly people, children, and families who buy medicines and are reimbursed by medical insurance. There are more types and quantities of medicines in stock, and the medicine cabinets have become larger. Many medicines cannot be used up, resulting in waste.
The “Plan” of the five departments proposed to encourage family doctors to help contract residents in need organize their home medicine boxes, and also required that drug marketing and publicity should not mislead the public in purchasing and preparing medicines, which is expected to reduce household medicine reserves. In addition, appropriate restrictions should be placed on employees’ drug-buying behavior for medical insurance reimbursement, and a household drug recycling mechanism should be improved to reduce drug waste and related costs.
In other words, only by making the household medicine cabinet smaller or reducing the number of medicines stored in the household can the waste of medicines be significantly curbed. Simply put, curbing drug waste focuses on both supply and demand. As long as pharmaceutical companies, hospitals, pharmacies and other supply sides avoid drug waste, and consumers do not purchase and reserve excessive amounts of drugs, the phenomenon of drug waste can be significantly improved. In short, changing the various “big” aspects involving drugs into “small” should become an important starting point to curb the waste of drugs.