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VCVSHealth <br />Ms. Hondo <br />March 20, 2019 <br />Page 2 <br />container itself is not a hazardous waste. Accordingly, it is only the weight of residue in the <br />container that needs to be counted toward generator status; the weight of the container does not <br />need to be counted toward generator status." In accordance with this EPA memorandum, CVS <br />N <br />ounts only the weight of warfarin residue toward a facility's generator status. <br />Federal Hazardous Waste Pharmaceuticals Rule. On February 22, 20195 EPA's final <br />Management Standards for Hazardous Waste Pharmaceuticals and Amendment to the P075 <br />Listing for Nicotine ("Pharm Rule") was published in the Federal Register (84 Fed. Reg. 5816). <br />The Pharm Rule codifies EPA's position regarding containers that once held acute and non-acute <br />hazardous waste. With respect to dispensing bottles, vials, or ampules (not to exceed 1 liter or <br />1,000 pills) or unit -dose containers, the new 40 CFR 266.507 (effective at the federal level on <br />August 21, 2019) indicates that these containers are "considered empty and the residues are not <br />regulated as hazardous waste provided the pharmaceuticals have been removed from the stock <br />bottle, dispensing bottle, vial, ampule, or the unit -dose container using the practices commonly <br />employed to remove materials from that type of container." 40 CFR 266.507. Based on this <br />provision, containers that previously held acute hazardous pharmaceuticals no longer require <br />triple rinsing to be considered "RCRA empty." Also based on this provision, since containers <br />are considered empty and the residues also do not have to be regulated as hazardous waste, <br />neither the residue nor the container counts toward a facility's generator status at the federal <br />level. We highlight several important considerations from the Pharm Rule preamble: <br />1. EPA reviewed data and confirmed that very little residue remains in containers after the <br />pharmaceuticals have been removed. EPA then concluded that the containers (and the <br />residue) do not require management as hazardous waste. Specifically, in the Pharm <br />Rule, EPA references back to several studies that EPA discussed in the preamble to the <br />proposed rule. Based on the studies, although some residues remain in containers, EPA <br />concluded that the residues are minimal and that these containers are effectively empty <br />once the pharmaceuticals have been dispensed. EPA ultimately determined that residue <br />data for single -unit dose containers/packaging and dispensing bottles, vials and ampules <br />that once held p -listed pharmaceuticals (warfarin) can be considered effectively "RCRA <br />empty." Given the size of the containers and "nominal quantities of residues involved," <br />EPA proposed (and ultimately finalized) to allow the residues in these containers to be <br />managed as non -hazardous waste pharmaceuticals, so long as the pharmaceutical product <br />has been fully dispensed. The specific studies — two from stakeholders; one from <br />Riverside County, California; and one from EPA's Office of Research and Development <br />— and EPA's conclusions regarding these studies are discussed at 80 Federal Register <br />58051 through 58054 of the proposed Pharmaceuticals Rule. These pages are attached. <br />2. EPA emphasizes that allowing empty containers to be managed as non -hazardous waste <br />without first triple rinsing the containers will decrease sewering of warfarin residues. <br />EPA notes that in healthcare settings, if containers are triple rinsed, the rinsate will likely <br />be poured down the drain, which is not good environmental practice. "[EPA] think[s] it <br />C� pharmacy / Care <br />mark /minute clinic /specialty <br />36482763v1 <br />