COHOES — John McDonald will have to send more than $30,000 worth of unopened and expired mail-order prescription drugs and medical supplies off to Texas to be incinerated.

And it makes him sick to have to do it.

"Look at this waste. It's unbelievable," said McDonald, an owner of the family business, Marra's Pharmacy, who is also mayor of Cohoes. He had never seen anything like it in 25 years as a pharmacist.

Family members of a deceased man in his late-60s, a retired county worker who was not a Marra's customer, recently brought in dozens of bottles of pills, insulin, boxes of diabetic test strips and other supplies to treat diabetes, hypertension, kidney disease and allergies.

McDonald feared such medical waste may be a hidden epidemic, underscoring a lack of oversight that contributes to spiraling medical care costs, particularly from mail-order pharmaceutical companies that use automatic refill programs that are hard to cancel.

In the $30,000 case, the patient appeared to have little or no co-pay so there was no incentive to stop shipments of drugs he wasn't using. Moreover, the cost was being passed along to taxpayers for the patient, who was a public servant. In the patient's mind, the pile of drugs and medical supplies that piled up were thought to be "free."

"The solution to this kind of problem is complicated, but it's becoming more prevalent than we ever imagined," said McDonald, who learned of a woman who died in Cohoes a few months ago. She had thousands of dollars worth of unused mail-order diabetic test strips and medical supplies. A relative wanted to know what to do. Destroy it was the only option, McDonald said, since strict laws regulate such products.

As part of an earth-friendly environmental initiative, Marra's has taken in old and unused prescriptions as a public service for the past two years. It ships the material at Marra's expense, in special containers to a Texas company that destroys the items.

Typically, customers arrive with two or three old, partially-empty drug bottles at a time. But the outsized drop-off from family members of the deceased man – whose identity was withheld by McDonald due to privacy regulations — caused McDonald's seven staff pharmacists to gather around in wide-eyed amazement.

Nearly all of the dozens of bottles of pills and piles of boxes of medical supplies came from a large web-based mail-order company, informedRx.

"It's really disturbing and it indicates there's a lot of waste in the system," said Eileen Wood, vice president of pharmacy for Capital District Physicians' Health Plan, or CDPHP. The deceased man was not a CDPHP client.

"This is not the first time we've seen this and we're concerned," Wood said. "It's a big problem with pharmacy operations that do automatic shipping. Once they've got your prescription, they just keep shipping and shipping on auto-refill and you can't stop it. It's like a robot gone wild."

When they've tried to help customers stop automatically shipped drugs, McDonald said he and other pharmacists at Marra's have found it can be difficult to contact the mail-order companies to do so.

McDonald speculated that this is likely the scenario that led to the $30,000 pile of taxpayer-paid medical supplies that will be destroyed.

"Seeing all this waste was eye-opening and shocking," said Kathleen Bonner, an intern at Marra's who will graduate this spring from the Albany College of Pharmacy. She tallied the inventory, including 54 boxes of Flonase, a nasal spray for allergies, at more than $100 per box.

"It reminded me that there needs to be monitoring and personal intervention by a pharmacist," Bonner said. "This man needed care he wasn't getting. Obviously, he was non-compliant because none of the drugs had been opened."

McDonald and Bonner discussed, with an overtone of irony, that a pharmacist's mantra is to stamp out FWA: fraud, waste and abuse.

"This isn't fraud," McDonald said. "But it is waste and it's definitely abuse for taxpayers who paid for it."

pgrondahl@timesunion.com • 518-454-5623 • @PaulGrondahl