Fewer meds, clearer plans: How to reduce prescription drug waste without undermining patient care

Prescription drug waste is often discussed only as a problem for payers, pharmacy benefits, or policy makers. However, in the exam room, it can show up more casually, such as a patient who received a refill too early, has two similar prescriptions from different clinicians.

Those moments matter because prescription waste does more than increase spending. It can create confusion, undermine adherence, and force physicians and their staff to explain affordability issues created outside the clinical encounter.

Durable affordability gains don’t have to depend on a single policy mechanism. Physicians can help protect patients by reducing avoidable utilization and waste through clinically familiar steps, including addressing oversupply, identifying duplicative therapies, eliminating unnecessary medications and keeping conversations clear.

The need for medication stewardship is becoming more urgent as prescription affordability problems continue to shape clinical care. A KFF analysis found that in 2024, about one in six adults delayed or went without some form of care because of cost, including prescription drug rationing. For physicians, that affordability pressure often arises after a prescription has already reached the pharmacy counter, when patients delay refills, stretch doses, or call the practice to ask for a lower-cost alternative.

Integrating medication optimization into routine clinical decision-making can help physicians address these problems earlier. By identifying oversupply, duplication and unnecessary medications before they create cost or adherence issues, physicians can reduce waste without disrupting care.

Address oversupply before it becomes confusion

Oversupply often begins quietly: Refills are processed early, mail-order prescriptions arrive automatically or patients keep receiving a previous medication after their therapy has changed. In other cases, a 90-day supply may be filled before a patient knows whether the drug is tolerable or effective.

From an affordability standpoint, oversupply creates otherwise avoidable costs. Clinically, it can be even more concerning because excess medication creates room for misuse, duplicate use, or delayed recognition that a therapy has changed. A patient with three similar medication bottles at home may not remember which one was discontinued, and a family caregiver may assume every current bottle is still part of the plan.

Physicians can reduce this risk by asking a more specific medication question. “What are you taking?” is useful, but it often misses what's in the cabinet. A better prompt would be, “Which medications do you still have at home, even if you are not taking them every day?” That small change in wording gives patients permission to discuss accumulation and helps physicians and other clinicians spot refills that no longer align with the care plan.

Oversupply conversations should be carefully framed so patients don’t feel accused of poor adherence or wasteful behavior. Most oversupply issues stem from system design, including automatic refills, fragmented records, multiple prescribers, and cost-driven switching. The patient does not cause the resulting side effects, but is often left to manage them.

Look for duplication across transitions of care

Duplicative therapy often appears after a patient moves between care settings. A hospitalization, specialist referral, pharmacy substitution or insurance change can leave overlapping prescriptions in place, even when each clinician made a reasonable decision given the available information.

The Agency for Healthcare Research and Quality notes that duplicate therapy errors can lead to adverse drug events and that medication reconciliation helps create an accurate list of the patient’s medications across care settings. For patients with multiple chronic conditions or multiple prescribers, the reconciliation needs to go beyond the electronic health record medication list.

Two drugs may sit in the same therapeutic class but appear unrelated because they have different names, costs, refill histories or prescribing sources. Pharmacy claims may show overlap that isn’t clearly evident in the clinical record, making it easier for duplicative therapy to persist unnoticed.

Pharmacists, care managers and practice staff can also flag possible overlap after hospitalizations, specialist visits or insurance-driven switches. The physician’s role is to decide whether the overlap is clinically intentional. Some overlap is appropriate, but some add cost and risk without improving the patient’s care.

The conversation with the patient should stay focused on clinical fit. Rather than framing a change as a cost-cutting measure, physicians can explain that the goal is to make sure every medication still has a clear purpose in the care plan.

Deprescribe with clinical intent, not cost pressure

Polypharmacy is often described by the number of medications a patient takes, but the count alone doesn’t tell the full story. Patients with complex conditions may need multiple therapies, and reducing medications for the sake of a smaller list can create its own risks. The greater concern is medication use that’s unnecessary, outdated, poorly tolerated or no longer aligned with the patient’s goals.

JAMA has described polypharmacy as excessive or unnecessary medication use, noting that risk is higher among older adults and people with more than one prescribing physician. BMJ has also reported that polypharmacy in older adults is associated with adverse drug events, cognitive and functional impairment, higher health care costs, falls, hospitalization and mortality.

Patients may hear deprescribing as a sign that their care is being scaled back. Physicians can avoid that impression by explaining the clinical reason for each change and making clear that stopping a medication can be as intentional as starting one.

A useful way to frame the conversation is, “This medication made sense when it was started. Let’s make sure it still makes sense now.”

When a medication no longer improves outcomes, removing it can reduce side effects, simplify the regimen, lower costs and make the treatment plan easier for the patient to follow.

Move affordability discussions upstream

Patients are often told to shop for coupons, compare pharmacies or ask about cash-pay pricing after the prescription has already been written. Pharmacists frequently become the last line of defense when a patient reaches the counter and can’t afford the medication, but that support often arrives after the treatment plan has already been disrupted.

Physicians are in a stronger position when cost considerations are introduced before the prescription reaches the pharmacy. Better cost containment starts when prescribing decisions are supported by timely information about lower-cost options that still meet the patient’s clinical needs. That visibility helps preserve clinical intent while reducing avoidable spending before it reaches the patient.

Considering cost earlier doesn’t mean choosing the cheapest drug regardless of clinical fit. It means asking whether a lower-cost option can meet the same therapeutic goal, whether the prescribed drug is likely to be affordable, and whether cost will make it harder for the patient to start or continue therapy.

Patients expect affordability to be part of the prescribing conversation. When lower-cost options are clinically appropriate, many patients want physicians to help identify them before finances become a reason for delay, rationing or abandonment.

Providers shouldn’t have to serve as benefit managers, and patients shouldn’t have to navigate affordability barriers alone after leaving the office. The prescription needs to make sense clinically, financially, and practically for the patient’s daily life.

Keep the conversation clear

Clear medication conversations should answer the following:

1. What is this medication for?
2. What should I stop taking?
3. What should I do if the cost is too high?
4. Who should I call before changing how I take it?

These questions are especially useful for independent practices, where staff may not have the same administrative resources as large health systems. A few clear talking points can prevent confusion that later returns as phone calls, refill disputes, nonadherence or avoidable visits.

Prescription drug waste can’t be solved by physicians alone. Benefit design, pharmacy operations, drug pricing and policy decisions all influence whether patients can start and stay on therapy. Even so, physicians can reduce many waste patterns by keeping medication lists current, questioning unnecessary overlap and improving visibility into costs and utilization before affordability problems reach the pharmacy counter.

Patients judge the system by what happens when they try to fill and take a medication. They need the prescription to be available, affordable and realistic for their daily lives. More medications don’t improve all outcomes; physician oversight does.

Josh Canavan, Pharm.D., is the head of pharmacy at RazorMetrics, where he oversees the company’s Pharmacy and Therapeutics Committee, which is responsible for the management and updating of the company’s Intervention Codex, a system of therapeutic alternatives. With a doctor of pharmacy degree from the University of Georgia, he has more than two decades of experience in both retail and hospital pharmacy, as well as in health care technology. He played a key role in developing electronic health record systems for rural hospitals before joining RazorMetrics in 2019.