Wendy Gwinner's work brings her in contact with people still reeling from a cancer diagnosis. The oncology social worker says she's seen nearly 100 patients since April who couldn't afford the drugs needed to treat their disease.
Gwinner hopes a new law that establishes a way for unused, unopened cancer drugs to be donated to participating pharmacies and dispensed to qualifying patients will change that.
The Montana Board of Pharmacy began developing rules to implement the law at a meeting earlier this month.
"It would be my hope that they feel the urgency in this," said Gwinner, who works at Bozeman Deaconess Cancer Center.
Since April, the clinic has seen 97 patients "that we had to get assistance so that they could afford the medications that would save their lives," Gwinner said. Cancer drugs are some of the most expensive ones on the market, said the bill's sponsor, Rep. J.P. Pomnichowski of Bozeman.
Gwinner also works with Medicaid patients whose cancer diagnosis "sends them into the doughnut hole" — a gap in coverage between Medicaid's initial coverage limit and the point at which its catastrophic coverage kicks in — during which patients must cover all their medical costs.
"Then the decision becomes, 'Do I spend every last penny that I saved for my retirement to treat my cancer or do I not treat my cancer?'" Gwinner said. "I never want to hear that."
So Gwinner works with pharmaceutical companies and foundations to seek money to help people get the drugs they need.
On the other side of the issue are people who have been prescribed three months of a drug, say an anti-nausea medication, but it quits helping after six weeks. Someone else could benefit from the drug, but it's illegal to give it to anyone else.
"Patients who develop a resistance, patients who pass away, there are drugs and there are patients who need them," Pomnichowski said. "This is really an attempt to make drugs available that otherwise would be tossed. Perfectly good medication is being thrown away when people who need it can't have it."
40 states have cancer drug repository
The cancer drug repository would be the middleman, allowing pharmacies or other health care facilities to accept, store and dispense or administer donated drugs and supplies.
Montana is one of about 40 states that have or are developing a cancer drug repository.
Nebraska has 77 participants in its program, said Marla Augustine, spokeswoman for the state's Department of Health and Human Services. But she said the agency doesn't "have a way of knowing how much it's used."
"Our impression is that it's not used a great deal, but again, we don't have a good way of monitoring that," Augustine said.
Montana's draft Board of Pharmacy rules limit which drugs can be donated, requires that they be in tamper-evident packaging, that records be kept and stipulates that the drugs cannot be resold.
"This is a very controlled process," Pomnichowski said. "This is not someone handing off their medication to another patient. Knowledgeable people are handling the drugs."
Christopher Harris, an attorney representing GlaxoSmithKline, testified during a state House committee hearing that the company "enthusiastically supports this.
"This is an extremely well drafted piece of legislation and has all the safeguards to protect against abuse," Harris said during the mid-February hearing.
Ron Klein, executive director of the Board of Pharmacy, said he expects a public hearing will be held later this year to discuss the proposed rules and that when the board meets in January, it will review public comment received at the hearing and in writing.
He said the rules could be ready to implement as soon as the latter part of January.
It's unclear how many people would participate.
"I think it will serve some market, but how big it will be I don't know," said Bill Burton, a Helena pharmacist and president of the Board of Pharmacy. "I just know there's an awful lot of big-dollar items wasted in nursing homes when people die. I think it will serve the public well."
Gwinner said the key is for people to know the cancer repository exists.
"A huge component of this will be in the implementation," she said. "Everybody has to know about it. It won't work unless we have the donations and patients know to ask for help."