Ask the care expert ... about unused medications

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Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

I am getting mixed information from experienced staff members as to what has been passed along by our pharmacy company about discharging patients with their controlled and scheduled medications. No one can give me a definite answer whether this is legal or not. Can you help?

The issue may relate to billing, in addition to managing unused controlled substance medications. While discharging with medications promotes an improved transition of care and minimizes the risk of return to the hospital, often facilities ask that the pharmacy split-bill the medications.

The facility pays for the medications used in the nursing facility during the Part A stay. The balance of the resident's personal inventory may be billed to Medicare Part D, a different third-party payer or the responsible party. This saves the administrator the total cost of medications that would otherwise be unused and destroyed. 

The facility census should indicate the correct discharge date to the pharmacy to assure the Part D plan will cover the medications.

Additionally, according to the Drug Enforcement Administration, unused, unwanted controlled substances must be destroyed by the end user. That's why they are not returned to the pharmacy for destruction.

Sending a resident home with his or her controlled substances relieves the facility of their disposal and the cost of the remaining unused doses, while minimizing diversion in the facility. 

Your pharmacy should assist you with policies and procedures for implementing these changes. The pharmacy and therapeutics committee, which meets at least quarterly, also works out the details of such policies. This is the committee that would decide the who, what, when and where about the items listed at your facility.