Drug Packaging: Does Size Matter?

In March 2016, Peter B. Bach, MD, and his colleagues at Sloan Kettering Cancer Center published a paper stating oversized packaging yields leftover drug waste and enables fraud. Glied and Bhaven, PhDs from NYU and Columbia, respectively, acknowledged the issues of waste and high drug prices in their May 11 Health Affairs blog, but suggest Bach’s solution is “unlikely to reduce the costs that matter to patients and payers.”

Bach et al. pointed out chemotherapy doses are proportionate to the size of the patient, while the vials they come in are one-size-fits-all, yielding waste for smaller patients.

Glied noted it’s wrong to assume production costs are proportional to package size and that raw materials alone dictate the cost of a drug. Drug manufacturers have high fixed costs associated with development and marketing that often dwarf the actual chemical costs. Furthermore, pharmaceutical companies can charge as much as the market can bear due to relative monopolies. Bach’s team estimated up to 33% of drugs go to waste. In 2016, that waste will amount to $1.8 billion in revenues from the top 20 cancer drugs alone.

Bach and his colleagues alleged that some physicians split contents of oversized vials among multiple patients and charge each for the full vial, while others space out doses in order to prescribe more vials per patient. Their solutions include different-sized vials related to dose, refunding leftover drugs, and implementing safe vial sharing practices. However, as Glied and Bhaven pointed out, requiring multiple vial sizes would decrease production efficiencies and therefore increase costs for manufacturers.

Editor’s note: An OncLive story, “Changing Drug Packaging Won’t Eliminate the Waste,” also served as a source for this report.