The struggle to keep soaring medical costs in check is feeding an increase in state programs that collect unused prescription drugs to give away to the uninsured and poor.
Some states allow donations of sealed drugs from individuals, while others only accept pharmaceuticals from institutions, such as doctor's offices or assisted-living homes. Drugs are typically vetted by pharmacists to cross-check safety, then distributed by hospitals, pharmacies or charitable clinics.
The type of drugs donated run the gamut and include antibiotics, antipsychotics, blood thinners and antidepressants.
At least 33 states have laws to allow or study drug recycling programs, according to the National Conference of State Legislatures. Most state programs are just a few years old or still in the test stages, but officials envision huge gains.
In Iowa, David Fries, CEO of the Iowa Prescription Drug Corporation, said the program has the potential to double or triple in the near future. Officials in Tulsa, Okla. also see plenty of room for growth.
"There are millions of dollars of unused meds out there that have not been captured," said Linda Johnston, director of social services for Tulsa County.
Regulations to ensure safety vary from state to state, but the basic concept is the same.
"These are medications that would've otherwise been destroyed," said Roxanne Homar, Wyoming's state pharmacist.
A pilot program in Cheyenne, Wyo., last year netted $81,000 in donated drugs to fill 557 prescriptions. State officials say that's just a small slice of the vast reserves of drugs that go to waste each year. The program is now working to get $180,000 in drugs it has online so it can be accessed by other programs in the state.
Drug recycling programs pay for themselves "by just working with one patient and saving them and keeping them out of the hospital over the long term," Iowa's Fries said.
Ensuring that a diabetic doesn't miss her medication, for example, might stave off "eye problems, foot problems, all kinds of medical conditions," he said.
It's still too early to measure the impact of drug recycling in offsetting the costs of emergency room and other hospital care for the uninsured. But when medical conditions go untreated, the financial toll is clear.
A study by the Commonwealth Fund in 2006 found 59 percent of uninsured people with chronic conditions either skipped a dose of their medicine or went without it because it was too expensive. One-third of that group visited an emergency room or stayed in a hospital overnight or did both, compared to 15 percent of their insured counterparts.
The costs to treat uninsured patients in Wyoming alone are staggering. Every year, hospitals there provide about $120 million in uncompensated care, according to Susie Scott, executive director for the Wyoming Health Care Commission.
There are between 80,000 to 90,000 uninsured in Wyoming, and their options for medical care are "generally limited to emergency room situations," Scott said.
In Iowa, hospitals in 2005 provided $465 million in uncompensated care, according to the state's hospital association.
Meanwhile, between March and December of last year, Iowa's drug recycling program collected 319,000 dosage units worth an estimated $292,000.
In the face of such enormous costs, saving a few dollars by using recycled drugs may seem futile. But the savings that could be achieved would add up over time.
In Louisiana last year, one charitable pharmacy in Baton Rouge filled over 38,000 presecriptions worth $2 million, the vast majority of which were donated medications. Officials say they don't track how many people the state's recycled drug program has helped statewide.
"In health care reform, it's got to be a cumulative effect of a lot of different efforts. It seems like throwing a 10-foot rope down a 40-foot hole, but we have to begin somewhere," Scott said.
Officials in Oklahoma's Tulsa County agree; they've worked with charities since 2004 in a program to fill the prescriptions of county residents.
"We do know that the cost of not providing medications has a large ripple effect and impact on our community whether it's going to the emergency room, whether it's going to a nursing home early, dying early, missing school. If we don't get medicines to people who need them for their mental illnesses, they become homeless, they end up in jail," said Johnson.
Still, some states are having trouble getting their drug recycling programs off the ground.
In Florida, for example, a program created two years ago to get cancer drugs to the uninsured has languished. Only three of the 300 hospitals eligible to participate have signed up, taking in a total of seven drug donations. Critics say the program has lacked publicity.
And since drug recycling programs rely on donations, they're not seen as long-term solutions. But when successful, officials say they can help plug gaps in medication for those who live paycheck to paycheck.