{"entity":{"id":"idea-cost-vial-sharing-dose-rounding","kind":"idea","name":"Share vials and round doses to stop throwing away expensive drug","aka":[],"tldr":"Weight-based doses rarely match vial sizes, so the leftover is discarded and still billed; closed-system vial sharing and rounding doses to the nearest vial within 10% eliminate most of that waste.","summary":"Medicare pays for discarded drug under the JW modifier and, since 2023, requires refunds from manufacturers for waste above 10% under the Infrastructure Investment and Jobs Act. Pharmacies can avoid the waste in the first place: closed-system transfer devices extend the in-use stability of single-dose vials so one vial serves several patients, and dose banding (rounding to the nearest vial size within a defined tolerance) is standard in the NHS. Both are cheap and can be implemented by a hospital pharmacy in months.","asOf":"2026-09-10","links":[{"label":"CMS: Discarded drug refunds (JW and JZ modifiers) (page moved; nearest live section)","url":"https://www.cms.gov/medicare/payment/part-b-drugs/"}],"tags":[],"related":[],"cancers":[],"sections":["chemotherapy","immunotherapy"],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-drug-pricing","b-dose-optimisation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Dose rounding and vial sharing will reduce discarded drug for the ten highest-spend Part B oncology drugs by more than 70% in participating centres.","rationale":"The NHS national dose-banding tables and multiple US single-centre studies report six- and seven-figure annual savings per institution.","test":"Pharmacy-level before-and-after audits of JW-modifier billing and drug spend, with a registry of any stability or safety issues.","maturity":"being-tested-at-scale","actor":"clinic","cost":"small","horizonYears":1},"route":"/ideas/idea-cost-vial-sharing-dose-rounding/","neighbours":{"section":[{"id":"chemotherapy","kind":"section","name":"Chemotherapy","route":"/fronts/chemotherapy/"},{"id":"immunotherapy","kind":"section","name":"Immunotherapy","route":"/fronts/immunotherapy/"}],"bottleneck":[{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"},{"id":"b-dose-optimisation","kind":"bottleneck","name":"Wrong doses","route":"/bottlenecks/b-dose-optimisation/"}]}}