Why are doctors rationing cancer drugs?

Drug shortages in the United States reached a 10-year high in the first quarter of 2023, according to the American Society of Health-System Pharmacists. Limited supply of critical cancer treatments has forced oncologists to ration or deny life-saving medications. While blame for the current shortage lies with production pauses at major drug manufacturing facilities, experts say the shortages are a long-term problem.

Which cancer drugs are in short supply? A May NBC analysis of U.S. Food and Drug Administration data reported inadequate supply of 14 cancer drugs nationwide. Most concerning are shortages of the generic chemotherapy drugs carboplatin and cisplatin. Commonly used to treat a wide variety of cancers—including lung, breast, bladder, ovarian, prostate, and head and neck cancers—these drugs can often eradicate the disease completely.

How badly are patients being affected? A National Comprehen­sive Cancer Network survey conducted in May reported that 93 percent of cancer centers were experiencing carboplatin shortages, while 70 percent were short of cisplatin. All centers surveyed were still able to fully treat patients who needed cisplatin, but only two-thirds of c­enters were able to maintain carboplatin patients’ required dosage. When faced with limited supply of a drug, doctors can typically use an alternative one. But cisplatin is often substituted for carboplatin and vice versa, making the scarcity of both particularly challenging.

What’s causing the shortages? Most cancer drugs low in stock are older generics with expired patents. Once a drug’s patent expires, profit margins become razor-thin. If a generic manufacturer encounters production problems or goes out of business, other suppliers of the drug may struggle to meet demand. An Intas Pharmaceuticals manufacturing plant in India stopped production of certain drugs late last year after an FDA inspection found quality and safety problems. The plant produced over half the U.S. cisplatin and ­carboplatin supply.

Any solutions? Some observers say the government should loosen Medicare and Medicaid price ­control policies that financially ­disincentivize generic drug manufacturers. Others have called for more supply-chain transparency from pharmaceutical companies to allow healthcare providers to get ahead of production failures.

What are regulators and lawmakers doing? The FDA said in June it would temporarily allow imports of a non-FDA-approved version of ­cisplatin made in China. It will also allow Intas to ship needed drugs to the U.S., subject to third-party testing. Sens. Gary Peters, D-Mich., and Joni Ernst, R-Iowa, recently introduced legislation that would require federal agencies to evaluate supply chain vulnerabilities and decrease U.S. reliance on foreign countries for key pharmaceuticals.