Drug shortages near record highs

MYRNA BROWN, HOST: It’s Thursday, the 20th of July, 2023.

Glad to have you along for today’s edition of The World and Everything in It. Good morning, I’m Myrna Brown

MARY REICHARD, HOST: And I’m Mary Reichard. First up: prescription drug shortages.

People across the United States are having trouble filling prescriptions for everything from cancer drugs to asthma and heart medications. It’s not unusual for some drugs to be challenging to find, but many of the drugs on the shortage list right now don’t have easy substitutes.

WORLD’s Mary Muncy reports.

MARY MUNCY, REPORTER: Karen Allen went to get her second chemo treatment for ovarian cancer two months ago.

She got all of her bloodwork done and then she and her husband went over everything with the nurse practitioner.

KAREN ALLEN: Then at the last minute, they're like, oh, by the way, we don't have any carboplatin.

Carboplatin is part of the two-drug regimen she was supposed to take six times.

ALLEN: So my husband and I just kind of looked—I mean, we didn't know what to say. I think we were both kind of just in shock.

She’s not the only one concerned.

The American Society of Health-System Pharmacists curates a running list of drug shortages in the U.S. Drugs are constantly moving on and off of it. Some are there for a few days, others for months or years.

MICHAEL GANIO: I’m Michael Ganio. I'm Senior Director of pharmacy practice and quality with the American Society of Health-System Pharmacists.

He says oncology drugs are likely the most critical on the list right now… but over the past year, they’ve seen shortages in ADHD medications, oral opioids, and antibiotics—some of them for children. He says even saline, a mix of sterile salt and water experienced a shortage over the last few years.

GANIO: We still need the basics, you know, and, and when you look at when I say basics, I really mean basics.

Ganio says the U.S. is at a ten-year high for active ongoing shortages, and it’s getting close to an all-time high.

GANIO: So as of the end of June, we were at 309 active shortages, the all-time high is 320.

Not every drug on the list will have a severe impact and there may be drugs that can be easily substituted for one that’s available.

GANIO: But when they are something that is very difficult to substitute, like these ADHD meds, or these oncology drugs, it's really, it can be devastating to a patient, you know, if your livelihood depends on your ability to function.

The shortage doesn’t mean there is none of the drugs, just that they can be harder to get and you might not have the dosage you need. It also means that doctors have to decide who gets what medication when. Most of the time, it’s a relatively simple process. Other times, it requires an ethics board.

The reasons for the shortage range from quality control problems, to supply chain issues…to harsh weather.

SOUND: [Tornado]

Just yesterday, a tornado severely damaged a Pfizer pharmaceutical plant in Rocky Mount, North Carolina. While there were no reported fatalities, the real damage is the cost in the facility’s capacity to produce important drugs. According to Pfizer’s website, the factory supplies 25% of the country’s injectable materials, including anesthesia.

Natural disasters like this compound existing problems with importing drugs from other countries where many companies can’t afford to meet the U.S.’s high quality standards.

RENA CONTI : My name is Rena Conti and I am Associate Professor at Questrom School of Business in Boston University.

Conti, a health economist, says companies need to be incentivized to produce high-quality products.

CONTI: And frankly, what that means is that U.S. payers should pay more to these manufacturers to make these products.

She says that payment could come in the form of policies created in Washington, or private consumers out of pocket, or additional payments to middlemen. Medical facilities could also create artificial demand by creating stockpiles of certain drugs.

CONTI: If prices rise, we will see both more investment in quality. And also potentially more suppliers willing to make these products and that will increase resilient supply over time.

Paying extra for a stable drug supply may also reduce costs in the long run. A report from 2019 shows that facilities spent an extra 360 million dollars a year on labor for managing drug shortages.

Here’s Ganio, who helps track pharmaceutical shortages.

GANIO: So there is a high cost to these drug shortages. And, you know, any sort of investment to mitigate them, should be looked at as potentially cost avoidance as well.

Conti says the biggest piece of advice she can give is that if a patient hears his drug is part of the shortage. He should talk to his doctor sooner rather than later.

By the time cancer patient Allen learned there was a shortage, she was already hooked up and ready to start her second treatment, so she went ahead and did it.

She’s not sure if skipping that dose of carboplatin had any effect, but she transferred to a private clinic that has a steadier supply of it.

So far, she hasn’t had to skip any more doses.

ALLEN: In our eyes, we figured well, the Lord, you know , it's out of our hands. So the Lord's—evidently I didn't need it or I wasn't supposed to have it because that’s really the only way we can look at it.

Reporting for WORLD, I’m Mary Muncy.

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