John Rothsheim Nerd Wallet
Drug shortages are a real reality, and many Americans know the inconvenience of having to wait to fill a prescription. But in recent years, the shortage has become more serious, surprising observers and making headlines.
The number of prescription drug shortages rose to 323 in the first quarter of 2024, the highest in a decade, but it’s not just about the numbers. Patients and their healthcare providers are also facing even more severe shortages, some with potentially life-altering consequences.
Hospital crash carts, used to provide emergency treatment to patients in serious conditions such as cardiac arrest, are running low on pre-measured packages of drugs such as epinephrine, forcing clinicians to remove them from vials. Extra time must be spent measuring doses, increasing the chance of medication errors.
If first-line chemotherapy is not available, some cancer patients must take other drugs with far worse side effects.
Shortages can affect everyone involved in healthcare in any setting. According to the April 2024 report, “Drug shortages impact patients, families, caregivers, pharmacists, hospitals, nursing homes, hospices, and other individuals and entities across the health care system.” white paper From the U.S. Department of Health and Human Services.
To make matters worse, the past 12 months have seen drug shortages with no substitutes, said Erin Fox, senior pharmacy director at the University of Utah Health. As an example, Fox cited the drug oxytocin, which is prescribed by obstetricians to induce labor and stop a mother’s bleeding after delivery.
Which medicines are in short supply?
As of April 2024, hundreds of prescription drugs are difficult or impossible to obtain. These include quinapril, which is primarily used to treat high blood pressure. Injectable acyclovir, an antiviral drug. and propofol for general anesthesia.
Check the availability of prescription drugs with U.S. Food and Drug Administration search results. FDA Drug Shortage Database or American Society of Health-System Pharmacists ASHP Drug Shortage List. Click on a drug name to view details about that specific shortage.
The impact of the shortage on patients and their health care providers could be severe. Scott Matsuda, a member of the patient and family advisory committee of the nonprofit Patient Access Network (PAN) Foundation, said he works with cancer patients who “suddenly find themselves without chemotherapy drugs.” We have cooperated. Sometimes, he added, patients report that their cancer symptoms return soon after they stop receiving first-line chemotherapy.
No medical facilities, including hospital operating rooms, have been spared. Dr. Jesse Ehrenfeld, an anesthesiologist and president of the American Medical Association, sometimes has to use second-line drugs to induce anesthesia. These drugs can have additional side effects, such as lasting longer than necessary, he said.
“Complex workarounds can also introduce errors,” Ehrenfeld said. “And some of our colleagues have had to delay or cancel care because of the shortage.”
Why are there so many medicines in short supply?
What’s causing the shortages? About 12% of them are due to manufacturing problems, like when a tornado hit the Pfizer factory in North Carolina, according to a drug company report compiled by ASHP. . Another 14% shortfall occurs when demand suddenly exceeds supply. That happens, for example, when demand for the antiviral drug Tamiflu surges during flu season. and 12% are due to business decisions, such as when a drug company decides it can make a bigger profit by producing a different drug.
However, the largest category cited by manufacturers as a reason for stock shortages was “unknown/not provided” at 60%. Ehrenfeld says. “It’s called flying blind. In most cases, we don’t actually know the cause, so it’s difficult to identify sustainable solutions.”
What is being done to solve this multifaceted problem?
Drug shortages are a difficult problem because their causes are so diverse. Stakeholders have been searching for solutions for decades, but shortages persist across health care.
As a start, ASHP recommended that Congress give the FDA the authority to impose “significant fines” on drug companies that fail to report manufacturing or supply chain problems. Failure to report is rampant in the industry.
“We believe that by requiring FDA to increase transparency in manufacturing and distribution, we can understand the causes and alleviate the challenges,” Ehrenfeld said.
To improve the profitability of generic drugs, pharmacist groups are also recommending that the FDA waive some fees for manufacturers who bring these low-cost drugs to market quickly.
Some observers are hopeful that momentum is building for impactful action. “I’ve been working on drug shortage issues since 2001, and now we’re seeing the most attention I’ve ever seen from Congress and other agencies,” said Fox, who testified on the issue at a Senate committee hearing. “I’m collecting them,” he says.
How can drug shortages be avoided?
The bottom line for healthcare consumers is that systemic problems with prescription drug supply are likely to persist. If you don’t have the medicine you need, taking these steps will increase your chances of getting it sooner.
- Follow your insurance company’s instructions to refill your prescription as soon as possible. Ordering your prescription in advance gives you more options to get your prescription refilled before it runs out.
- Contact your prescriber. Let them know that your prescription is not at the pharmacy or that your prescription will be delayed. Ask for suggestions about other ways to obtain the drug, generic or brand-name equivalents, or alternatives that might work for you.
- If a generic drug is not available, ask your insurance company to cover the brand name version. If your insurance company is reluctant to pay for a more expensive brand-name drug, ask your prescriber to do it for you.
- Build a long-term working relationship with your pharmacist.
- If a pharmacist knows you’re a regular customer, they’re more likely to rush to find a supplier that carries your medications.
- Try other pharmacies. Drugs in short supply are often unevenly distributed among pharmacies. Please call to see if another retailer in your area has it in stock. If your insurance company has an option to mail your prescriptions, consider giving it a try.
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John Rossheim writes for NerdWallet. Email: [email protected].
