2026 Eastern States Conference

Title: Evaluating Expired Waste Reduction Strategies for Controlled Substance Medications in the Hospital Pharmacy Setting

Authors: Allison Welsh, PharmD, MBA; Ashley Covert, PharmD, MBA, FACHE; Cecilia Costello, PharmD, MS; Lindsay Lutz, CPhT

Learning Objective: Evaluate the operational and financial impact of controlled substance repackaging and compounding practices to identify opportunities for cost reduction and workflow optimization.

Background: Controlled substance waste presents a significant challenge for health systems as it can lead to increased costs and potential risk of drug diversion. The American Society of Health System Pharmacists (ASHP) identifies minimizing controlled substance waste as a method to minimize opportunities for controlled substance diversion. In a 12-month lookback, Mary Hitchcock Memorial Hospital (MHMH) wasted approximately 13,000 units of controlled substances totaling over $90,000 (Wholesale Acquisition Cost). This cost does not include the time required to compound in house medications or repackage controlled substances into unit doses and syringes, which is believed to account for a significant cost that is not currently represented in the numbers.

Methods: A pre–post interventional study was conducted at MHMH to evaluate the cost and operational impact of controlled substance waste. Expired Schedule II through IV medication from in-house compounded, repackaged, and outsourced 503B products were evaluated for 3 month pre- and post-intervention phases. Interventions included PAR optimization, ADC removal, sourcing changes, compounding workflow adjustments, and formulary modifications. Primary outcomes included expired medication quantity and total waste cost (drug acquisition plus pharmacist/technician labor cost). Secondary outcomes included low-days and zero-days inventory events.

Results: Total expired controlled substance units decreased from the pre-intervention period to the post-intervention period, from 672 to 385 units respectively, representing a 42.7% reduction. Total waste costs decreased from $7,328 pre-intervention to $3,182 post-intervention with medication acquisition costs accounted for the majority of waste cost reduction (-$3,314). Labor-related waste costs also decreased $831, accounting for 21.8 hours of saved employee time. The largest reductions in waste cost were associated with converting compounded batch products to patient-specific preparation and PAR optimization interventions. Increased low- and zero-day inventory events were observed during the post-intervention period, though many were attributable to a single medication affected by manufacturing delays from a 503B outsourcing facility.

Conclusions: Targeted inventory optimization strategies substantially reduced expired controlled substance waste and associated costs in a hospital pharmacy setting. Ongoing refinement of PAR levels and sourcing strategies may further improve inventory efficiency while balancing stockout risk.

Self-Assessment Question:
Which of the following represents a potential unintended consequence of aggressive PAR level reduction interventions?
A. Increased medication acquisition cost
B. Increased zero-day (stock-out) inventory events
C. Increased controlled substance diversion risk
D. Increased expired medication waste