Environmental Sustainability, Drug Repurposing, and Pricing. Pathways to align Value, Access, and Policy

Healthcare is one of the most polluting industries, contributing 4–5% of global greenhouse gas emissions—an environmental footprint that would rank as the fifth largest emitter worldwide (Lenzen et al., 2020). Drug repurposing, which identifies new indications for existing medicines, can help mitigate this impact by reducing the need for new compound discovery, an energy- and resource-intensive process. While further formulation steps remain necessary, repurposing offers opportunities for both environmental sustainability and improved patient access. Yet, current pricing regimes typically treat repurposed drugs as generics, and their value is undermined by complex health technology assessments, limited intellectual property protection, and insufficient regulatory incentives (Raji et al., 2025). This review aims to demonstrate how drug repurposing can minimize waste, reduce chemical synthesis, and highlight the need to align pricing and reimbursement models with broader societal and ecological value. Reported environmental benefits remain largely conceptual, with little empirical evidence such as lifecycle assessments or carbon footprint analyses (Raji et al., 2025). At the same time, pricing and reimbursement models fail to recognize the wider sustainability and societal contributions of repurposed drugs, limiting incentives for investment (Toumi & Rémuzat, 2017). Case studies illustrate pathways to sustainability and access: recycling of pharmaceutical blister packs (Perkola et al., 2024); redispensing unused anticancer medicines (Smale et al., 2024); population-level support for sustainable pharmaceutical practices (Alajärvi et al., 2022); open-source initiatives (Allarakhia, 2013); and the use of artemisinins as affordable anti-cancer therapies (Augustin et al., 2020). In conclusion, drug repurposing sits at the nexus of innovation, sustainability, and access. To fully realize its potential, coordinated reforms in pricing, regulation, and environmental policy are required.