Explore our ACCC 2020 Impact Report, the Oncology Issues, Vol.36 N.5, and our video podcast, CANCER BUZZ TV.



Home / ACCCBuzz Blog / Full Story

UNC Combats Rising Drug Prices by Reducing Expensive Waste

Lindsey Amerine, PharmD, BCPS

September 5, 2018
Vials in a Box on Pharmacy Counter

The University of North Carolina (UNC), North Carolina Cancer Hospital was the first program in the nation to adopt a closed-system transfer device that has saved $39 million in drug expense annually by reducing waste. This 2018 ACCC Innovator Award recipient will describe the process behind drug vial optimization at the ACCC 35th National Oncology Conference in October. In this guest blog post, Lindsey Amerine, PharmD, BCPS, provides a preview.

Total medication costs in hospitals and clinics have increased by 49% ($65.7 billion to $98.2 billion) from 2011 to 2016.1,2 Oncology and infusion agents, including antineoplastics and biologics, are the largest drivers in this price increase. Drug waste from the use of single-dose vials (SDV) for oncology and infusion agents is estimated to cost $1.8 billion annually.3

In October 2011, UNC’s Department of Pharmacy implemented a drug vial optimization program, the first of its kind in the United States. Drug vial optimization is the extension of a drug vial’s sterility through the use of a closed-system transfer device—PhaSeal™—up to the chemical stability of the drug or a maximum of 7 days, whichever is earlier. The process has led to significant financial, safety, and clinical outcomes.

Through drug vial optimization, our organization has decreased drug waste by 94% from 2011 to 2016, saving UNC millions of dollars in drug expenses annually. The drug waste reduction program has also decreased the number of closed-system transfer devices (PhaSeal vial protectors) needed due to fewer vials being opened, thus requiring fewer vial protectors.

Patient Safety Implications
During implementation of the drug vial optimization program, patient safety was a top priority, and it continues to be our top priority while maintaining the program. The measurement of central line–associated bloodstream infections (CLABSI) is an indirect marker for patient safety. It is a sensitive measure that can be impacted by many activities (e.g., handwashing), so the goal for our program was not to experience a CLABSI rate increase after implementation; instead, our CLABSI rate decreased following drug vial optimization implementation.

We will be presenting details on our drug vial optimization program at the ACCC 35th National Oncology Conference, October 17-19, 2018, in Phoenix, Arizona.

Guest blogger Lindsey Amerine, PharmD, MS, BCPS, is the associate director of pharmacy for Infusion Services, Investigational Drug Services, Medication Assistance Program, Revenue Integrity, and WakeBrook Hospital at the University of North Carolina Medical Center. An article on the drug vial optimization program will be published in Oncology Issues in coming months.


  1. Hoffman JM, Li E, Doloresco F, et al. Projecting future drug expenditures – 2012. Am J Health Syst Pharm. 2012;69:405-21.
  2. Schumock GT, Li EC, Wiest MD, et al. National trends in prescription drug expenditures and projections for 2017. Am J Health Syst Pharm. 2017;74:e339-59.
  3. Bach PB, Conti RM, Muller RJ, et al. Overspending driven by oversized single dose vials of cancer drugs. BMJ. 2016;352:i788.


We welcome you to share our blog content. We want to connect people with the information they need. We just ask that you link back to the original post and refrain from editing the text. Any questions? Email Barbara Gabriel.

To receive a weekly digest of ACCCBuzz blog posts each Friday, please sign up in the box to the left.


More Blog Posts

ACCC on Twitter