Drug Waste in Cancer Care: Why Real-Time Medication Management Matters

Drug Waste in Cancer Care: Why Real-Time Medication Management Matters
An NCODA Response to the WSJ Investigation

A recent story published in the Wall Street Journal investigated patterns of excessive prescription refills via national mail-order pharmacies. Within the article, (linked here/subscription required) the reporters research identified up to $3 billon in drugs that were filled before required refill dates resulting in an overabundance of medications sitting in patients’ hands that might not have been needed.

While the Wall Street Journal investigation focused broadly on excess dispensing across Medicare, the implications are even more urgent in oncology, where a single unnecessary prescription can represent tens of thousands of dollars in waste and pose serious safety risks for patients whose treatment regimens change rapidly and frequently.

The Journal analysis is based on Medicare prescription records accessed under a research agreement with the federal government. The records include details of each individual prescription for more than 50 million Medicare recipients between 2021 and 2023, but don’t identify individuals.

The overfilling of prescriptions poses an issue related to cost but also creates an unfortunate added risk for patients, particularly elderly patients who may be managing several concurrent medications. Excess medication increases the likelihood of confusion, missed doses, or taking the wrong dose altogether – risks that are amplified in complex disease states such as cancer, where therapies often change rapidly based on patient response, side effects, or disease progression.

Medically Integrated Pharmacy: The Standard of Care for Reducing Cost and Waste

NCODA (Network for Collaborative Oncology Development & Advancement) has long taken a stance on reducing unnecessary cost and waste within the healthcare system, while simultaneously prioritizing patient safety and quality of care. Nowhere is this balance more critical than in oncology, where medications are both life-sustaining and among the most expensive therapies in healthcare. When prescriptions are filled without real-time insight, a medically integrated approach, into a patient’s current clinical status, treatment plan, or tolerability, waste is not just a financial concern but a clinical one.

This is where the Medically Integrated Pharmacy (MIP) model represents a fundamentally different and more appropriate approach to care. Unlike traditional or mail-order pharmacy models that operate separately from the clinical team, MIPs are embedded directly within the oncology practice. Pharmacists function as active members of the care team, collaborating closely with physicians, nurses, and other clinicians to ensure medications are prescribed, dispensed, and adjusted based on up-to-date clinical information.

Through their direct integration within the oncology care team, MIPs are uniquely positioned to manage therapy changes in near real time, preventing high-cost medications from being dispensed when they are no longer clinically appropriate.  Automatic refills do not occur in MIP practices, eliminating one of the primary drivers of unnecessary drug waster. Medications are dispensed only after confirmation that the patient will be continuing therapy and updates can be paused or stopped immediately when a dose is modified, a therapy is held, or a treatment plan changes. This real-time oversight dramatically reduces the likelihood of patients receiving medications they no longer need, saving millions of dollars in avoidable drug waste. This team-based, patient-centered approach not only minimizes needless costs, but also supports adherence, reduces abandonment, and improves overall outcomes for cancer patients navigating complex treatment regimens.

The MIP model should not be viewed as an alternative approach, but rather as a best practice and emerging standard of care for oncology patients. The Wall Street Journal investigation highlights the consequences of disconnected pharmacy practices, it underscores the need for care models that prioritize coordination, accountability, and real-time decision-making. Medically Integrated Pharmacy does exactly that—protecting patients, reducing unnecessary waste, and ensuring that every prescription aligns with the most current plan of care.

This level of coordination enables MIPs to proactively prevent unnecessary refills and stop medications that are no longer needed, avoiding the automatic and uncoordinated dispensing practices that often contribute to excess supply in more disconnected pharmacy models. The MIP model has also been shown to reduce medication abandonment and minimize potential waste, while supporting better adherence and patient outcomes.

In Oncology, Waste Isn’t Abstract—It’s Measured in Patient Risk and Six-Figure Price Tags

In addition to advancing the MIP model, NCODA provides members with practical tools to measure and demonstrate the impact of integrated care. Through the NCODA Cost Avoidance & Waste Tracker, oncology practices can submit real-world data to quantify cost savings and waste reduction. The tool defines waste as drugs that have been processed or prescriptions filled, and then, for any reason, the patient does not use the drug. Cost avoidance is any intervention made before the drug is dispensed that prevents waste.

Since the tool’s introduction, participating practices reported more than $36 million in costs avoided and over $11 million in medication waste prevented based on approximately 3,400 patient prescriptions, representing an average of nearly $14,000 per patient in avoided cost and waste. Given the high cost and clinical value of oncology therapies, these figures highlight the significant opportunity to reduce waste when pharmacy care is fully aligned with the clinical team. NCODA identified the need to track cost avoidance and waste in order to have real-life data to communicate the impact MIPs can have on cost and patient safety. Since 2016, we have worked with oncology practices across the United States to create the Cost Avoidance Waste Tracker in a way that would track meaningful impact of the MIP model in supporting efficient and effective oncology care. 

What Can Be Done to Address Pharmacy Waste?

Improving outcomes and reducing unnecessary costs starts with rethinking how prescriptions are managed across the continuum of care, particularly in complex disease states like cancer.

Michael Reff, RPH, MBA, Executive Director of NCODA believes that there are many ways that pharmacies can help reduce the distribution of excess medications. “It is deeply concerning when patients receive medications they no longer need. Whether due to a dose change, a treatment hold, or a shift in their care plan. This is not only just a waste issue, but more importantly a patient safety issue. Cancer care demands constant coordination and accountability, and when pharmacy decisions are disconnected from real-time care, patients are put at risk. The Medically Integrated Pharmacy model reflects how cancer care should be delivered. Every patient deserves a coordinated, team-based approach that ensures the right medication, at the right dose, at the right time, aligned with their care at every step.”

According to the Wall Street Journal analysis, mail-order pharmacies filled just nine percent of Medicare prescriptions in the three-year period examined but accounted for 37 percent of the excess dispensing. Jonas Congelli, RPH, Associate Executive Director at NCODA added, “the common practice by some mail order pharmacies of encouraging 90-day refills and then sending refills early can certainly contribute to the over-filling that was seen in the article. In the oncology space we face different challenges with oral oncolytics, but it is important to stay on top of dose changes and any adjustments every step of the way. In my prior role, I’d often have patients bring in tens of thousands of dollars in unopened medications dispensed by mail order pharmacies, just asking what to do with them when they weren’t needed.” 

As policymakers, payers, and healthcare leaders seek solutions to rising drug costs and medication waste, the findings highlighted in the Wall Street Journal reinforce a critical lesson: disconnected pharmacy models are not designed for complex, high-risk care. For cancer patients, Medically Integrated Pharmacy practice should be the standard, not the exception. By aligning pharmacy care directly with clinical decision-making, the MIP model protects patients, reduces unnecessary waste, and ensures that every prescription reflects the most current and appropriate course of treatment.