Are pharmaceutical shortages part of the new health care norm?
Doctors and pharmacists in Florida aren't strangers to diminished inventories. Here's a closer look at the current shortage and how the state is managing.
National drug shortages continue as Florida health care experts navigate what some expect to be the new normal of pharmacy.
The Food and Drug Administration lists over 120 pharmaceuticals that are in short supply, ranging from chemotherapy drugs to breathing medication. A recent Senate report found drug shortages increased by 30% from 2021 to 2022. The American Society of Health System Pharmacists drug shortages list has over 233 such entries.
However, doctors and pharmacists aren't strangers to diminished drug inventories, said Dave Lacknauth, an executive board member of the Florida Society of Health-System Pharmacists.
"Within the health care industry, dealing with pharmaceutical shortages has been a norm," said Lacknauth, who is also an executive director of pharmaceutical services at Broward Health.
Why is there a shortage?
Earlier this year, Akorn Pharmaceuticals filed for bankruptcy, which triggered a recall of over 70 products. The move created a shortage of critical medicines like albuterol, a breathing medication. Akorn was one of only two domestic manufacturers.
However, shortages have been part of the health care over the past decade. In 2010, the FDA reported 178 drugs in short supply; that continued through 2011 and involved cancer drugs, anesthetics for surgery, drugs for emergency medicine and electrolytes for intravenous feeding.
A report by the House of Representatives found that shortages occur for several economic reasons including a "race to the bottom" price point mentality for generic drugs, creating low or no profit margins for manufacturers. This creates a hesitancy to invest in advanced manufacturing or to expand the generics business in the U.S., the report stated. Additionally, the it found U.S. generic drug manufacturing facilities were operating at 51% capacity because expanding production wasn't economical.
How hospitals manage
Because the drug supply chain has peaks and valleys, hospitals and pharmaceutical companies have arranged a system to avoid panic buying, stocking up and depleting supplies further, said Lacknauth.
"Our pharmacies in our health systems have worked to ensure procurement of those even through shortages," he said. "We usually get allocations, and the allocations we get are usually based on our usage. And that’s kept us above water.”
Meaning hospitals will continue to receive the same amounts of medication from pharmacies they’ve previously requested. If the supply is too low to honor the previous requests, the hospital will pivot to another drug that will cover the same treatment
Lacknauth says believes the shortage could affect Florida more than other states due to its large aging population and demand for medication.
"I do believe we're more vulnerable to drug shortages. I think we're a retiree state, and we get a lot of folks to come down for retirement, and therefore I do believe that that impacts higher volume for us in Florida," he said.
In Central Florida, both Orlando Health and Nemours Children's Health declined to comment on what strategies they were implementing. AdventHealth sent a statement to WMFE regarding shortages.
“The AdventHealth pharmacy team has a proactive approach to managing medication inventory and shortages. Medication inventories are currently sufficient to meet all patient care needs,” it said.
When asked for details on its "proactive approach," the hospital network did not respond.
The new norm
Several organizations have expressed concern regarding the shortage, including the American Cancer Society, which said that some drugs are unique in cancer treatments.
“A number of the drugs included in the shortage don’t have an effective alternative. As first-line treatments for a number of cancers, including triple-negative breast cancer, ovarian cancer and leukemia often experienced by pediatric cancer patients, the shortage could lead to delays in treatment that could result in worse outcomes," the society stated.
That being the case, Lacknauth said, on a scale of one to 10, he’s not worried.
“I think we're at a four or five. I think we're feeling it, we're seeing it, and it's impacting us. But we've been able to pull in medications through allocation to take care of our patients,” he said.
While shortages are nothing new, the House study found that shortages are lasting longer, in some cases more than eight years. Lacknauth believes that's the new reality health care workers should come to expect.
"I don't think it's something that will go away. I think a lot of health care systems have been accustomed to it. When you are in this industry, you have to understand how to manage that shortage situation to ensure that you do have treatment for patients in our community."
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