Hospitals Adapting Amid Continued Drug Shortages

While new drug shortages impacting patient care have lessened, the supply chain remains vulnerable to drug shortage 'spikes', says an executive from the group purchasing organization, Premier.

Drug shortages remain widespread and hospitals spent nearly $700 million over three years to cover the additional costs of finding more expensive generic substitutes, according to a survey and analysis from the group purchasing organization, Premier.

"It's clear that this remains to be a very serious problem that continues to impact patient care and it creates major challenges for our healthcare system and other providers," Premier COO Mike Alkire said on a conference call with media last week.

The Premier survey of 124 "pharmacy experts" conducted in December 2013 and January 2014 found that 90% of respondents experience some sort of drug shortage within the last six months. Alkire says those results are similar to those found in a Premier survey conducted in 2010 at the height of the drug shortage crisis.

"Although recent reports show that new drug shortages have decreased, longer-standing, ongoing drug shortages remain an issue," he said.

"The supply chain is also vulnerable to shortage 'spikes' that significantly disrupt patient care and hospital operations. To remedy these types of shortages, including one currently affecting the supply of intravenous solutions, we need a 'SWAT team' mentality by all, including the FDA, the manufacturers, the distribution channel, the GPOs and the hospitals. FDA in particular plays a critical role given their role in approving the availability of additional drug supplies."

See Also: Drug Shortages Exacerbated by Supply Chain Woes

A Premier analysis found that U.S. hospitals spent nearly $230 million a year between 2011 and 2013 to pay for the additional costs of generic substitutes for shortage drugs.

"This is the estimated additional acquisition cost for hospitals for back-ordered products. The total economic impact is likely much higher since the figure excludes drugs purchased from off-contract distributors, more expensive purchases of therapeutic alternatives and indirect costs such as labor," Alkire says.

The survey found that the most often cited shortage drugs affecting patient safety and costs were:

• Electrolytes, intravenous (IV) fluids and parenteral nutrition solutions.
• Cardiovascular agents used to treat heart disease and other cardiac conditions, such as nitroglycerin IV solution.
• Surgical agents used for surgery preparation/anesthesia and sedation, such as propofol.

Fewer Shortages
The survey results suggest that the prevalence of shortages affecting patient care appears to be decreasing. Compared to 2010, Alkire says the number of respondents experiencing between one and five drug type shortages increased by 30%, but that those experiencing six or more drug type shortages decreased 26%.

In addition, 35% of respondents said they did not experience a shortage that could have delayed or cancelled care, a two-fold improvement from 2010. Respondents experiencing six or more occurrences decreased 46% from 2010.

"Part of the reason why shortages have lessened is because providers have become more skilled and capable of handling severe supply chain disruptions. They are implementing more effective programs to cope with shortages," Alkire says.

"Among the survey results 90% said that they've added back up inventories or adjusted par levels for critically important categories, 87% increased communication to internal stakeholders, and 83% implemented restrictions or rationing for short-supply drugs which obviously added to their overall costs of care," he said.