PRESCRIPTION “RECYCLING”

Location:
DRUGS- LAW AND LEGISLATION;

OLR Research Report


January 22, 2009		2009-R-0053
PRESCRIPTION “RECYCLING”

You asked if there are any requirements from state agencies that monitor hospitals or nursing homes to destroy unused portions of prescriptions of certain controlled substances and if any other states have considered or adopted anti-flushing legislation.

SUMMARY

At least 37 states have enacted laws creating prescription drug “recycling” or repository programs for unused medication, including Connecticut. Generally, these laws require the drugs not be expired, the participation by a state-licensed pharmacist or pharmacy in the verification and distribution process, and that each patient who is to receive a drug must have a valid prescription form. Controlled substances are usually excluded. Connecticut law specifically requires nursing homes and correctional facilities to return certain unused medications to vendor pharmacies.

CONNECTICUT LAW

Long-Term Care Facilities

In 2000, Connecticut passed one of the earliest laws nationwide establishing a drug “recycling” program. Under CGS § 17b-363a, long-term care facilities must return drug products dispensed to a patient and not used to the vendor pharmacy for repackaging and reimbursement. Qualifying drug products are:

1. prescription drug products that are not controlled substances,

2. sealed in individually packaged units,

3. returned to the vendor pharmacy within the recommended period of shelf life for the purpose of re-dispensing such drug products,

4. determined to be of acceptable integrity by a licensed pharmacist, and

5. oral and parenteral medication in single-dose sealed containers approved by the federal Food and Drug Administration (FDA), topical or inhalant drug products in units of use containers approved by the FDA, or parenteral medications in multiple-dose sealed containers approved by the FDA from which no doses have been withdrawn.

Drug products packaged in the manufacturer's unit-dose packages will be returned to the pharmacy for re-dispensing and reimbursement to DSS if reimbursement for use can occur before the expiration date.

Drug products repackaged in manufacturer's unit-dose or multiple-dose blister packs must be returned to the vendor pharmacy for re-dispensing and reimbursement to the DSS if (1) the date of repackage, the lot number, and the expiration date are indicated clearly; (2) it has been 90 days or less since the date of repackaging; and (3) a repackaging log is maintained by the pharmacy in advance of immediate needs.

Drug products dispensed in a bulk dispensing container may not be returned to the vendor pharmacy.

DSS reimburses the vendor pharmacy the reasonable cost of services incurred, as determined by the commissioner, and may establish procedures, if feasible, for reimbursement to non-Medicaid payers for drug products returned. Long-term care facilities failing to comply with the law are fined not more than $30,000 for each incidence.

Correctional Institutions

In 2001, the General Assembly passed P.A. 01-9, §§ 25-27, codified at CGS § 18-81q, which set conditions under which state correctional institutions must return specified unused drugs to vendor pharmacies for re-dispensing and reimbursement to DOC. DOC must establish procedures for returning the unused drug products to the pharmacies and must reimburse the vendor pharmacies for the reasonable cost incurred in operating the program, as determined by the DOC commissioner.

The act exempts retail pharmacies that supply limited amounts of non-controlled drugs or controlled substances for emergency use to the medical director of a state correctional institution. The act allows retail pharmacies to distribute certain controlled substances to a correctional institution's medical director for use as emergency stock. The law already allowed them to distribute these substances to chronic and convalescent nursing homes and rest homes.

DOC must establish procedures for the return of unused drug products to the pharmacy from which they were purchased.

Except for drugs dispensed in a bulk-dispensing container, which may not be returned, the act requires the return to vendor pharmacies, for repackaging and reimbursement of unused drug products that are:

1. prescription drugs that are not controlled substances,

2. sealed in individual packages,

3. returned to the vendor pharmacy within the recommended period of shelf life for re-dispensing,

4. determined to be of acceptable integrity by a licensed pharmacist, and

5. oral and parenteral (taken by injection) drugs in single-dose sealed containers approved by the FDA, topical or inhalant drugs in FDA-approved units-of-use containers, or parenteral drugs in FDA-approved multiple-dose sealed containers from which no doses have been withdrawn.

Drugs meeting these criteria must also meet specified packaging standards before they can be returned.

If drugs are packaged in the manufacturer's unit-dose packages, they must be returned to the vendor pharmacy if they can be re-dispensed for use before the expiration date stated on the package. If drugs are repackaged in the manufacturer's unit-dose or multiple-dose blister packs, they must be returned to the vendor pharmacy if (1) the repackaged drug clearly indicates the date of repackaging, lot number, and expiration date; (2) 90 days or less have elapsed from the date of repackaging; and (3) the pharmacy keeps a repackaging log for drugs that are repackaged before they are needed.

OTHER STATES

Similar legislation has passed in many other states regulating the “recycling” of prescription drug products. Most states allow the return of prescription drugs in single use or sealed packaging from state programs, nursing homes and other medical facilities. Some states include provisions for the financial terms of the donations or regulating resale. Virtually all laws include some restrictions designed to assure purity, safety and freshness of the products (http://ncsl.org/programs/health/rx-reuse.htm). OLR Report 2006-R-0045 details the California program.

Table 1: Prescription Drug “Recycling” Laws, by State


*State* *Bill #, Year*	*Description and History of Programs*
Arizona HB 2382 2006	What Rx: Accept only in original sealed & tamper-evident unit dose packaging. Rx Board will issue list of un-acceptable products.
	Who can donate: Person, manufacturer or health care institution.
	Who accepts: Pharmacy, hospital, nonprofit clinic that volunteers to participate.
	Donated to: Only state residents who meet eligibility standards set by Board.
	Restrictions: Expiration must be more than 6 months from donation date. Recipient must sign waiver form about the source and non-liability.
	Program Status: Final Regulations promulgated, effective 6/6/08.
Arkansas HB 1031	What Rx: Accepts drugs only in their original sealed and tamper-evident packaging.
2005	Who can donate: Nursing facility by the clinic pharmacy.
	Who accepts: Charitable clinic pharmacies.
	Donated to: Appropriately screened and qualified indigent patients who are not eligible for Medicaid but cannot afford private health insurance.
	Restrictions: The charitable clinic pharmacy cannot accept controlled substances. No product of which the integrity cannot be assured is accepted for re-dispensing.
	Program Status: Signed into law by governor as Act 132, 2/15/05.
California SB 798	What Rx: Drugs that are received and maintained in their unopened, tamper-evident packaging.
2005	Who can donate: Licensed health facilities, licensed pharmacies, and drug manufacturers that are legally authorized under federal law to manufacture and sell pharmaceutical drugs.
	Who accepts: Locations designated by local ordinances established by counties that elect to create such a repository and distribution program.
	Donated to: Persons in need of financial assistance to ensure access to necessary pharmaceutical therapies.
	Restrictions: Must be ensured that drugs received have not been in the possession of any individual member of the public.
	Program Status: Signed into law by governor as Chapter 444, 9/30/05
Colorado SB 07-231	What Rx: Unused cancer drugs or medical devices.
2007	Who can donate: Cancer patients and their families.
	Who accepts: Health care facilities, medical clinics or pharmacies that elect to participate in the program.
	Donated to: Eligible health care facilities, medical clinics or pharmacies for use under the program as well as eligible patients.
	Restrictions: Cancer drugs or medical devices needs to be prescribed by a practitioner, as defined in section 12-22-102 (27), C.R.S., for use by an eligible patient and is dispensed by a pharmacist.
	Program Status: The Act took effect 8/8/07.
Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
Connecticut	What Rx: Drug products.
HB 6002	Who can donate: Long-term care facilities.
2000	Who accepts: Vendor pharmacy or the Department of Social services for drug repackaging and reimbursement.
	Donated to: Eligible patients.
	Restrictions: Prescription drug products that are not controlled substances, sealed in individually packaged units, returned to the vendor pharmacy within the recommended period of shelf life for the purpose of re-dispensing such drug products, determined to be of acceptable integrity by a licensed pharmacist.
	Program Status: Signed by governor 6/21/00.
Florida SB 22A 2003	What Rx: Unused cancer drugs or supplies in its original, unopened, sealed and tamper-evident unit dose packaging.
HB 371 2006	Who can donate: A person, health care facility, hospital, pharmacy, drug manufacturer, medical device manufacturer or supplier, wholesaler of drugs or supplies, or any other entity may donate.
	Who accepts: A physician's office, pharmacy, hospital, hospice, or health care clinic that participates in the program.
	Donated to: Residents, except those Medicaid-eligible or under any other prescription drug program funded in whole or in part by the state are ineligible to participate.
	Restrictions: All drugs submitted to the program will be administered by a pharmacist to determine the drugs and supplies are not adulterated or misbranded. Additionally a cancer drug may not be accepted or dispensed under the program if such drug bears an expiration date that is less than six months after the date the drug was donated.
	Program Status: Fla. Stat. §409.908. The act took effect July 1, 2006.
Georgia HB 430	What Rx: Unused prescription drugs, but not those defined as controlled substances.
2006	Who can donate: Any person, including a drug manufacturer or any health care facility, may donate prescription drugs to the drug repository program.
	Who accepts: Any pharmacy, hospital, or nonprofit clinic that elects to participate in the drug repository program and meets criteria for participation in the program.
	Donated to: Medically indigent persons who are residents of Georgia.
	Restrictions: Only drugs in their original sealed and tamper-evident unit dose packaging may be accepted and dispensed. The packaging must be unopened, except that drugs packaged in single unit doses may be accepted and dispensed when the outside packaging is opened if the single unit dose packaging is undisturbed. Drugs donated by individuals must have an expiration date that is more than six months from the date the drug is donated.
	Program Status: The state-wide program required by this Code section was to be implemented no later than January 1, 2007.


Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
Hawaii HB 2005 2004	What Rx: Prescription drugs previously dispensed or distributed by a pharmacy for administration to patients in an institutional facility by personnel of the institutional facility may be returned to the pharmacist.
	Who can donate: Patients or personnel of an institutional facility with unused drugs.
	Who accepts: Institutional facilities or repositories of the state of Hawaii.
	Donated to: Pharmacists.
	Restrictions: The prescription drugs should be returned only to the original dispensing pharmacy. Also, prescription drugs from individual members of the public are not accepted for reuse.
	Program Status: This act should take effect on July 1, 2004, and will sunset on July 1, 2010.
Indiana	What Rx: Unused medications.
HB 1251 2004	Who can donate: Health facilities with unused drugs.
	Who accepts: Pharmacy or pharmacist who initially dispensed the medication.
	Donated to: Pharmacists, hospitals, health care facilities or practitioners.
	Restrictions: Requires the office of Medicaid policy and planning (office) to review the process of returning unused medication.
	Program Status: Statute Sec. 1 - 6 effective 07/01/04.
Iowa	What Rx: Prescription drugs and supplies.
HF 724 2005	Who can donate: Any person may donate prescription drugs and supplies.
	Who accepts: Medical facilities or pharmacies that elect to participate in the program and meet the requirements established by the department. Donated to: Drugs may be donated to individuals or may be distributed to another eligible medical facility or pharmacy for use.
	Restrictions: Must be inspected to assure the prescription drug or supplies have not been adulterated or misbranded. The drug must be in its original sealed and tamper-evident packaging.
	Program Status: The bill was approved and signed by the governor on May 3, 2005. NABP reports "rules in development establishing a Drug Donation Repository." As of 12/07.
	Dept. of Public Heath Regulations ARC 5563B (Chapter 109) Effective March 2007.


Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
Kansas HB 2578	What Rx: Unused medications; excludes controlled substances.
2008	Who can donate: Residents of adult care homes and donating entities that volunteer to participate in the program.
	Who accepts: A qualifying center or clinic in consultation with a pharmacist.
	Donated to: Medically indigent residents of Kansas.
	Restrictions: The medications must come from a controlled storage unit of a donating entity and be in its original packaging or tamper-evident packaging. Drugs purchased under Medicaid or SCHIP do not apply.
	Program Status: Signed into law by governor on March 20, 2008.
Kentucky SB 23	What Rx: Prescription "Legend" drugs or supplies needed to administer such drugs.
2005	Who can donate: Health facilities and pharmacies.
	Who accepts: Donations can be made on the premises of a health facility or pharmacy that elects to participate in the program and meets requirements specified by the cabinet by an administrative regulation promulgated by the cabinet.
	Donated to: Individuals who meet the eligibility criteria specified by an administrative regulation promulgated by the cabinet or eligible health facility or pharmacy for use under the program.
	Restrictions: The legend drug cannot be classified as a controlled substance. Upon inspection, the drug must be in its original, unopened, sealed, and tamper-evident unit dose packaging. In addition, the legend drug or supplies must be prescribed by a physician, advanced registered nurse practitioner, or physician assistant and dispensed by a pharmacist.
	Program Status: Signed into law by the governor on March 18, 2005.
Louisiana	What Rx: Prescription drugs.
HB 1402 2004	Who can donate: Any person, including a drug manufacturer, hospital, health care facility, or governmental entity.
	Who accepts: Charitable pharmacies.
	Donated to: Appropriately screened and qualified patients.
	Restrictions: Drugs must be in their original sealed and tamper-evident packaging. In addition, donor shall execute a form stating the donation of the drugs. The pharmacy should retain that form along with other acquisition records.
	Program Status: Signed into law as Act 811 of 2004; Program effective August 15, 2004.

SB 19 2006	What Rx: Unused portions of or surplus prescription drugs that are within the expiration date.
	Who can donate: A hospital, health care facility, or governmental entity enrolled in the Medicaid program.
Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
	Who accepts: Charitable pharmacies.
	Donated to: Medically indigent residents of Louisiana.
	Restrictions: Drugs must be in their original sealed and tamper-evident packaging. Pharmacists of the charitable pharmacies should determine if the drug is not adulterated or misbranded and is safe to dispense.
	Program Status: Signed into law by governor as Act 643 of 2006, 6/29/06.
Maine	What Rx: Unused prescription drugs.
HP 105 2005 HP 327/LD411 2007	Who can donate: Drug manufacturers, drug wholesale or terminal distributors, hospitals, health clinics, federally qualified health centers, Indian health centers and rural health centers and assisted living facilities licensed by the department.
	Who accepts: Pharmacies, hospitals, health clinics and federally qualified health centers, Indian health centers and rural health centers. Donated to: Qualified residents of Maine, which include family income below 350% of the federal non-farm income official poverty level and not receiving benefits from Mainecare.
	Restrictions: The program will only accept prescription drugs that are unopened and packaged in tamper-evident unit dose packages or that are unopened injectable, aerosol or topical medications.
	Program Status: Signed into law by governor as Chapter 20, 5/31/05.
	A 2007 law, Special Act Chapter 27, signed 6/27/07, provided $300,000 funding for the Maine Drug Enforcement Agency to establish a pilot program for return of unused prescription drugs by mail, consistent with the Maine Drug Return Implementation Group established by Public Law chapter 670 of 2003.
Maryland SB 1059	What Rx: Prescription drugs or medical supplies.
2006	Who can donate: Any person.
	Who accepts: Certain drop-off sites which meet specified criteria, a repository, the board and pharmacists.
	Donated to: A needy patient who is a resident of Maryland.
	Restrictions: The drugs must be packaged in tamper-evident unit dose packaging and unadulterated. The donor must sign a statement that indicates the donor is the owner of the drugs and are voluntarily offering them to the program.
	Program Status: Signed by governor as Chapter 287, 5/2/06.


Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
Massachusetts	What Rx: Unused medications.
Ch. 111, Section 25I	Who can donate: Residents or consultant pharmacist in a health care facility.
2004	Who accepts: Health care facilities.
	Donated to: Eligible residents of Massachusetts.
	Restrictions: The donated medication should be sealed in unopened, individually packaged units and within the recommended period of shelf life. Excluded are schedule I or II controlled substances as defined in MA ch.94C.
	Program Status: Signed by governor in 2004.
Minnesota	What Rx: Cancer drugs or supplies.
Statute 151.55 2007	Who can donate: A pharmacy, medical facility, drug manufacturer, or wholesale drug distributor, can donate if the donated drugs have not been previously dispensed. In addition, any individual over the age of 18 may donate.
	Who accepts: Pharmacies or medical facilities on the premises that volunteer to participate in the program. The medical facilities or pharmacies need to be licensed and in compliance with all applicable federal and state laws and administrative rules.
	Donated to: Any Minnesota resident who is diagnosed with cancer is eligible to receive drugs or supplies. The drugs will be distributed upon a priority base.
	Restrictions: Drugs must be in its original, unopened, tamper-evident unit dose packaging and not adulterated or misbranded. The donation must also be accompanied by a cancer drug repository donor form that is signed by the person making the donation or that person's authorized representative.
	Program Status: Statute effective 2007; SF 2941 expanded terms for a state repository and reuse of unused drugs program. (Signed into law as Chapter 327 of 2008, 5/15/08)
Mississippi	What Rx: Prescription drugs.
Miss. Code Ann. § 43-13-503 2004	Who can donate: The State Board of Pharmacy; the State Department of Health; the Division of Medicaid; any person, including a drug manufacturer, or health care facility or government entity.
	Who accepts: Any pharmacy, hospital, nonprofit clinic or health care professional.
	Donated to: Individuals who meet the eligibility standards or to other government entities and nonprofit private entities to be dispensed to individuals who meet the eligibility standards.
	Restrictions: Only drugs in their original sealed and tamper-evident packaging may be accepted and dispensed.
	Program Status: The drug repository program shall be fully implemented not later than July 1, 2005.


Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
Missouri HB 898	What Rx: Sealed and unopened prescription drugs.
SB 1160 2004	Who can donate: Any person or entity may donate prescription drugs.
	Who accepts: Any pharmacy, hospital, or non-profit clinic that elects to participate in the program.
	Donated to: Eligible Missouri residents.
	Restrictions: Prescription drugs must be in their original sealed and tamper-evident unit dose packaging. Prescription drugs donated by individuals should bear the manufacturer's lot number and an expiration date that is more than six months from the date the prescription drug is donated.
	Program Status: The act was effective 8/28/04.
HB 1687	What Rx: Prescription drugs.
2006	Who can donate: Any person, including but not limited to a prescription drug manufacturer or health care facility, may donate prescription drugs to the prescription drug repository program.
	Who accepts: Any pharmacy, hospital, or nonprofit clinic that elects to participate in the prescription drug repository program and meets the criteria for participation established by rule of the department pursuant to section 196.984.
	Donated to: People who are residents of Missouri and who meet the eligibility requirements of the program or to other governmental entities and nonprofit private entities to be dispensed to persons who meet the eligibility requirements of the program.
	Program Status: Approved by governor 07/12/2006.
Montana	What Rx: Unused prescription drugs.
SB 288	Who can donate: Long-term care facilities.
2001	Who accepts: Provisional community pharmacies.
	Donated to: Qualified patients for transfer free of charge or at a reduced charge to those individuals.
	Restrictions: Drugs defined as a dangerous drug or a drug designated as a precursor to a controlled substance cannot be accepted.
	Program Status: This act was effective 10/1/01; it was to be fully implemented by 1/1/05.
Nebraska	What Rx: Cancer drugs.
LB 756 2003 LB 1116	Who can donate: Any person or entity, including, but not limited to, a cancer drug manufacturer or health care facility.
2006	Who accepts: Any physician's office, pharmacy, hospital, or health clinic that elects to participate in the program and meets criteria established by the department for such participation.
	Donated to: Eligible Nebraska residents.
Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
	Restrictions: The drug needs to be in its original, unopened, sealed, and tamper-evident unit dose packaging, except that a cancer drug packaged in single unit doses may be accepted and dispensed if the outside packaging is opened but the single-unit-dose packaging is unopened.
	Program Status: The Act, RRS Neb. 71-2424 et seq., became operative on 9/15/03.
	In addition, LB 1116 of 2006 clarified the program, including eliminating a restriction on the number of doses that can be donated; allowing donation of injectible cancer drugs and requiring donation forms to include the name of the original patient. (Signed into law 3/13/06)
Nevada	What Rx: Prescription drugs.
SB 327 2003	Who can donate: A public or private mental health facility may return a prescription drug that is dispensed to a patient of the facility, but will not be used by that patient.
	Who accepts: A dispensing pharmacy.
	Donated to: The drug will be used to fill other prescriptions for patients in the pharmacy facility.
	Restrictions: The drug cannot be a schedule II drug specified in or pursuant to chapter 453 of NRS. The drug must be dispensed in a unit dose, in individually sealed doses or in a bottle that is sealed by the manufacturer of the drug.
	Program Status: The act becomes effective on July 1, 2003.
New Jersey	What Rx: Prescription drugs.
Title 24 2007	Who can donate: Unopened, unexpired prescription drugs dispensed to, but not used by, a patient within a licensed health care facility, may be reused at the facility in accordance with regulations issued by the State Board of Pharmacy.
	Restrictions: Must be unopened and unexpired.
	Program Status: This provision was not operational as of 12/2007 according to the National Association of Boards of Pharmacy.
New York	What Rx: Unused medication.
S 2803-e 2007	Who can donate: A resident or consultant pharmacist or his designee in a residential health care facility.
	Who accepts: The pharmacy from which the medication was purchased.
	Donated to: Eligible New York residents.
	Restrictions: The medication must be unopened in the original manufacturer's packaging and must be in tamper evident packaging.
	Program Status: The new law was referred to the NY Health Department on 1/9/08.


Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
North Dakota	What Rx: Legend drugs, devices, or supplies.
HB 1256	Who can donate: Any person or entity.
2007	Who accepts: Practitioners or pharmacies that meet the criteria established for participation in the program.
	Donated to: Eligible patients.
	Restrictions: A drug donated, prescribed, or dispensed under the program must be in the original, unopened, sealed, and tamper-evident unit dose packaging, except a drug packaged in single-unit doses may be accepted and dispensed if the outside packaging has been opened and the single-unit-dose package is unopened.
	Program Status: Signed into law by governor in April 2007.
Ohio	What Rx: Prescription drugs.
HB 221 2003	Who can donate: Any person, including a drug manufacturer or health care facility.
	Who accepts: Any pharmacy, hospital, or nonprofit clinic that has elected to participate in the program and meets certain eligibility requirements established in rules adopted by the Board.
	Donated to: Individuals with a prescription issued by a health care professional authorized to prescribe drugs.
	Restrictions: Drugs must be in their original sealed and tamper-evident unit dose packaging.
	Program Status: Signed by governor 1/6/03.
Oklahoma	What Rx: Unused prescription drugs.
HB 1297 2001 SB 1640 2006	Who can donate: Drugs may be transferred from residential care homes, nursing facilities, assisted living centers, public intermediate care facilities for people with mental retardation (ICF/MR) or pharmaceutical manufacturers.
	Who accepts: Any pharmacies operated by a county, pharmacy operated by a city-county health department or a pharmacy under contract with a city-county health department, a pharmacy operated by the Department of Mental Health and Substance Abuse Services or a charitable clinic for the purpose of distributing the unused prescription medications.
	Donated to: Oklahoma residents who are medically indigent.
	Restrictions: Prescription drugs defined as controlled substances will not be accepted.
	Program Status: This act became effective 11/1/06.


Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
Pennsylvania	What Rx: Unused cancer drugs
SB 638 2008	Who can donate: health care facility, health clinic, hospital, pharmacy or physician's office.
	Who accepts: Authorized participating pharmacies, designated by the Cancer Drug Repository Program of the State Board of Pharmacy.
	Donated to: Needy residents, as defined in "Income eligibility criteria and other standards and procedures for individuals participating in the program, determined by the Department of Public Welfare and the Pharmacy Board.
	Restrictions: Unit dose medication must be maintained by a health care facility, health clinic, hospital, pharmacy or physician's office rather than an individual patient, as "part of a closed drug delivery system." Expiration date must be at least six months in the future. A pharmacy "may charge a handling fee", to be determined by the Board of Pharmacy. Regulations to be drafted within 90 days of effective date.
	Program Status: signed into law by governor as Act No. 14 on 5/13/08; effective date 7/12/08.
Rhode Island	What Rx: Unused prescription medication.
HB 5107 2005	Who can donate: Nursing homes, assisted living centers and prescription drug manufacturers.
HB 5850 2007	Who accepts: Authorized participating pharmacies.
	Donated to: Medically indigent Rhode Island residents.
	Restrictions: The packaging of the medication should not be opened, except cancer drugs packaged in single-unit doses.
	Program Status: The program was scheduled to begin 1/1/06. In 2007 HB 5850 extended the implementation date to 4/1/07 and required notification to all nursing homes of the new program.
South Dakota	What Rx: Unused unit dose drugs.
HB 1165 2004	Who can donate: Patients in hospice programs, nursing facilities, or assisted living facilities.
	Who accepts: Hospice programs, nursing facilities, or assisted living facilities.
	Donated to: Eligible patients.
	Restrictions: The drugs are provided in the manufacturer's unit dose packaging or are repackaged by the pharmacy in a hermetically sealed single unit dose container.
	Program Status: Signed by governor 2/19/04.


Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
Tennessee HB 3560	What Rx: Unused prescription medications; controlled substances are excluded.
SB 3660 2006	Who can donate: Nursing homes or hospice services programs.
	Who accepts: Charitable clinic pharmacies.
	Donated to: Tennessee residents who are indigent.
	Restrictions: Drugs only in their original sealed and tamper-evident packaging should be accepted.
	Program Status: The act took effect 7/1/06.
Texas SB 1896	What Rx: Unused drugs; controlled substances are excluded.
2007	Who can donate: A pharmacist who practices in or serves as a consultant for a health care facility or a licensed health care professional responsible for administration of drugs in a penal institution.
	Who accepts: Pharmacies.
	Donated to: Eligible patients.
	Restrictions: Drugs must be sealed in unopened tamper-evident packaging and either individually packaged or packaged in unit-dose packaging.
	Program Status: Signed into law by governor 6/15/07.
Utah	What Rx: Unused drugs.
58-17b-503 2005	Who can donate: A pharmacist may accept back and redistribute any unused drug, or a part of it, after it has left the premises of the pharmacy.
	Who accepts: n/a
	Donated to: n/a
	Restrictions: The drug must have been prescribed to a patient in a nursing care facility, an ICFMR, or state prison facility, county jail, or state hospital; the drug must have been stored under the supervision of a licensed health care provider according to manufacturer recommendations; the drug should be in a unit pack or in the manufacturer's sealed container; the drug should have been returned to the original dispensing pharmacy; the drug should have initially dispensed by a licensed pharmacist or licensed pharmacy intern; and back and redistribution of the drug complies with Federal Food and Drug Administration and Drug Enforcement Administration regulations.
	Program Status: This law became effective on July 1, 2005.


Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
Vermont H.711 2005	What Rx: Any unsold or unused prescription drugs and medical supplies that the facility or distributor cannot sell or otherwise use.
	Who can donate: Any health care facility and wholesale drug distributor.
	Who accepts: Any participating pharmacy, hospital, or nonprofit clinic.
	Donated to: Vermont residents who meet the eligibility standards.
	Restrictions: Drugs or medical supplies must be in their original sealed and tamper-evident unit dose packaging to be accepted and dispensed, except for drugs packaged in single unit doses when the outside packaging is opened if the single unit dose packaging is undisturbed. The board of pharmacy shall allow donation of only those drugs bearing an expiration date that is less than six months beyond the date the drug is donated and shall allow drugs to be dispensed only when the expiration date is more than one month from the date of dispensing.
	Program Status: 01/24/2006.
Virginia	What Rx: Prescription drugs.
HB 154 2002 HB 1854	Who can donate: Hospitals are authorized to donate drugs that were originally dispensed to hospital patients, but have been returned.
2005	Who accepts: Pharmacies.
	Donated to: Indigent patients, without charge.
	Restrictions: The pharmacist-in-charge at the pharmacy shall be responsible for determining the suitability of the product for re-dispensing. A re-dispensed prescription shall not be assigned an expiration date beyond the expiration date or beyond-use date on the label from the first dispensing and no product shall be re-dispensed more than one time. No product shall be accepted for re-dispensing by the pharmacist where integrity cannot be assured.
	Program Status: H 154 signed 4/6/02. HB 1854 Signed by governor as Chapter 68, 3/24/05. Statute: Va. Code Ann. 54-3411.1
Wisconsin	What Rx: Prescription drugs.
SB 56	Who can donate: State prison pharmacies.
2003	Who accepts: State prison pharmacies.
	Donated to: Any patients in any state prison.
	Restrictions: The prescription drug should never have been in the possession of the patient to whom it was originally prescribed. The prescription drug is returned in its original container. A pharmacist determines that the prescription drug has not been adulterated or misbranded.
	Program Status: Approved by governor 8/20/03.

AB 854	What Rx: Cancer drugs or supplies.
2004	Who can donate: Any person or entity.
Table 1 Continued
*State* *Bill #, Year*	*Description and History of Programs*
	Who accepts: Medical facilities or pharmacies that elects to participate in the program and meets requirements specified by rule by the department.
	Donated to: Individuals who meets eligibility criteria or to another eligible medical facility or pharmacy for use under the program.
	Restrictions: The cancer drug or supplies needed to administer a cancer drug must be in its original, unopened, sealed, and tamper-evident unit dose packaging or, if packaged in single-unit doses, the single-unit-dose packaging must be unopened.
	Program Status: Enacted April 6, 2004.

AB 197 2005	What Rx: Expands Wisconsin's Rx recycling cancer drug repository to include prescription drugs and supplies for all other chronic diseases such as diabetes.
	Program Status: Signed into law by governor as Act 16, 7/5/05.
Wyoming	What Rx: Prescription drugs.
HB 194 2005	Who can donate: Any person or entity, including but not limited to a drug manufacturer, physician or health care facility.
	Who accepts: Any physician's office, a pharmacy or health care facility that elects to participate in the program and meets criteria established by the department.
	Donated to: Wyoming residents.
	Restrictions: Drugs shall be accepted or dispensed under the drug donation program only if they are in their original, unopened, sealed packaging or, if the outside packaging is opened, the contents are single unit doses that are individually contained in unopened, tamper evident packaging.
	Program Status: Signed by governor as Chapter 158, 3/2/05.

Source: National Conference of State Legislatures.

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