As cases of COVID-19 have surged, so has the demand for certain medications, such as the sedatives and painkillers given to people on ventilators. The result is drug shortages in hospitals, with some patients unable to get the drugs they need.
This problem isn’t new. Before the pandemic, nine out of 10 emergency room (ER) physicians reported routine shortages of sedatives, painkillers, and other drugs used in ERs and intensive care units. There are ongoing shortages of drugs used for heart disease, cancer, eye disease, and neurological problems. Some antibiotics and antifungals are hard to find. No medical specialty is safe from a drug shortage. Last year, there was a shortage of the shingles vaccine, Shingrix, as demand outpaced supply.
Since the year 2000, more than 2,000 drugs have been in short supply—an increasingly common problem that many medical experts are calling a crisis. And the crisis isn’t going away. Currently, there are more than 200 drug shortages in the United States, and each of those shortages typically lasts six to 12 months.
Here’s everything you need to know about drug shortages and how to work with your doctor to protect yourself if a drug you depend on goes missing.
The profit problem
It’s not easy to find out why a particular drug is in short supply because, by law, drug companies can keep every detail about manufacturing a trade secret. But the U.S. Food & Drug Administration (FDA) and other organizations have extensively analyzed the crisis, and several causes have become clear. The drugs most likely to have shortages are low-priced, generic, injectable or intravenous drugs because those have the lowest profit margins, and manufacturers are more likely to stop producing them. Examples include cefepime (maxipime), a broad-spectrum antibiotic, and propofol (Diprivan), a sedative.
Because of the low profit margins, typically only one or two manufacturers invest in producing the drug, with one manufacturer doing most of the production. If that primary manufacturer has any kind of problem, the supply is likely to suffer.
For example, two drug companies manufactured vincristine (Oncovin), a low-cost generic chemotherapeutic drug used in most children with cancer and in many adults. When one of the companies stopped producing the drug—for which there is no medically-proven substitute—a potential shortage caused anxiety in countless patients and their loved ones, as oncologists created and even implemented rationing plans. (The shortage was solved by the remaining company at the 11th hour.)
Supply problems can be caused by economics, a shortage of raw materials, a breakdown in machinery at the plant, a problem in distribution because of a natural disaster, or a regulatory issue that halts production of the drug.
Hospitals can worsen a developing shortage by ordering so much of the drug that it is no longer available to other hospitals. Less often, a hospital fails to order the drug far enough in advance to circumvent the shortage. This diverse pattern of ordering is why drug shortages aren’t uniform throughout the United States: One hospital can have sufficient supplies of a drug, while a hospital across town or in another state has a shortage.
The threats of a shortage
Shortages cause three main problems:
- Illness and death. If you don’t get the drug that works best for your illness, you may have to replace it with an inferior alternative. The FDA says that drug shortages have forced 47 percent of pharmacists to use less effective drugs in patient care. In some cases, there is no alternative, so the needed treatment is delayed or even denied. One survey showed that 56 percent of hospitals have delayed treatment because of drug shortages.
Shortages can even be deadly. A study published in the Journal of the American Medical Association found that a nationwide shortage of norepinephrine in 2011 increased the risk of death from septic shock by 15 percent.
- Medication errors. When a drug isn’t available, doctors and pharmacists have to scramble to make do with a replacement—a setup for preparation and prescribing errors that can cause side effects. The new drug might have a different dose—for instance, 0.5 milligrams (mg) per pill compared to 1 mg—which means the doctor and pharmacist have to make sure they’re prescribing and dispensing (and you’re taking) the right amount. Or perhaps the doctor has little or no clinical experience with the new drug and overlooks a potential side effect from a drug-drug interaction.
In the hospital, a nurse who is not familiar with the drug may dispense it incorrectly. These types of problems are not rare. Yearly, there are 1.25 million medication errors in the United States, and 6 percent are caused by shortages. That’s 75,000 medical errors per year or about 200 per day.
There are many practical ways to make sure that drug shortages don’t harm you or your pocketbook.
Find out if there’s a shortage. The best, most user-friendly source of information on drug shortages is supplied by University of Utah Health, which maintains a drug shortages list for the American Society of Hospital Pharmacists (ASHP). The alphabetized and searchable list is organized into several categories, including current drug shortages. You can find it by visiting https://pharmacyservices.utah.edu/drug-information/drug-shortages.php.
Talk to your doctor about alternative drugs. The ASHP list also provides a brief presentation of one or more substitutes for each drug that’s in short supply. Take a look at those substitutes and talk them over with your doctor to decide on the one that’s right for you.
The alternative might be a brand-name drug rather than a generic, deliver a different dose, or be eligible for refills every 30 days rather than every 90. You might pay more or feel scared and frustrated but, in most cases, there is no reason for your treatment to be interrupted.
Double-check your dose. If you switch drugs, double-check the dose with your doctor so you’re absolutely sure you’re not taking too much or too little.
Ask about potential side effects. New medications can carry new risks. Ask your doctor about possible side effects, and be on the lookout for them. If side effects occur, you may have to switch drugs again or change the dosage.
Make sure you’re still covered. Your insurance may not cover the new medication, or it might be on a different copayment tier. A study shows that prices for drugs in short supply increase as much as 14 percent. You may have to do some extra work to make sure it’s covered or covered at the same rate. You can ask the pharmacist to handle this with the insurance company. Oftentimes, if the insurance company is pointed to the ASHP website—which will confirm the shortage and the alternatives—it is likely to approve the new drug.
Be prepared for more shortages. Shortages are often rolling—if a drug is in short supply, its alternatives are also soon in short supply too. Understand that a drug shortage may force you to switch drugs more than once.