Intended for healthcare professionals


Overspending driven by oversized single dose vials of cancer drugs

BMJ 2016; 352 doi: (Published 01 March 2016) Cite this as: BMJ 2016;352:i788
  1. Peter B Bach, professor director1,
  2. Rena M Conti, associate professor2,
  3. Raymond J Muller, associate director of pharmacy services3,
  4. Geoffrey C Schnorr, project coordinator1,
  5. Leonard B Saltz, professor chair of pharmacy and therapeutics committee1 4
  1. 1Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, 485 Lexington Avenue, New York, NY 10017, USA
  2. 2Departments of Pediatrics Hematology/Oncology and Health Studies, University of Chicago, Chicago, IL, USA
  3. 3Research Pharmacy, Memorial Sloan Kettering Cancer Center, New York
  4. 4Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
  1. Correspondence to: P B Bach bachp{at}
  • Accepted 20 January 2016

Peter B Bach and colleagues call for an end to contradictory regulatory standards in the US that allow drug manufacturers to boost profits by producing single dose vials containing quantities that increase leftover drug

Even though reducing waste in healthcare is a top priority, analysts have missed the waste that can be created when expensive infused drugs are packaged containing quantities larger than the amount needed.1 2 This is particularly true for drugs for which dosage is based on a patient’s weight or body size and that come in single dose packages. These drugs must be either administered or discarded once open, and because patients’ body sizes are unlikely to match the amount of drug included in the vial, there is nearly always some left over. The leftover drug still has to be paid for, even when discarded, making it possible for drug companies to artificially increase the amount of drug they sell per treated patient by increasing the amount in each single dose vial relative to the typically required dose.

Increasing the amount of drug sold per treated patient also increases profits to doctors and hospitals in the United States. Under a system nicknamed “buy and bill,” doctors and hospitals buy single dose vials of drugs and then bill insurers or patients when they are used. The bill includes a percentage based mark-up which can vary widely, but even low percentages can equate to large amounts of money given that many of the drugs cost thousands of dollars per vial.

Although doctors and hospitals sometimes use leftover drug to treat a subsequent patient, thus reducing the amount of leftover drug for which they bill, this practice is very limited. Safety standards from the US Pharmacopeial Convention permit sharing only if leftover drug is used within six hours, and …

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