Background

Over the last few years, drug shortages have become more common in the United States. According to data from the University of Utah Drug Information Service, there were 309 active, ongoing drug shortages at the end of the second quarter of 2023 — the highest number of shortages in almost 10 years and close to the all-time high of 320 shortages in 2014.

Some of the drugs currently in short supply include antibiotics, children's medications, and several cancer treatments. In a recent survey from the Society of Gynecologic Oncology, doctors in 35 states have reported little to no supply of crucial chemotherapy drugs, even at teaching hospitals and large cancer centers.

"This is, in my opinion, a public health emergency," said Amanda Fader, a professor at the Johns Hopkins School of Medicine and president-elect of the Society of Gynecologic Oncology, "because of the breadth of the individuals it affects and the number of chemotherapy agents that are in shortage right now."

In May, the Biden administration assembled a team to identify long-term solutions to these drug shortages, including developing tools to predict future drug shortages, creating quality scores for drug manufacturing facilities, and more. FDA has also been working with certain overseas drugs manufacturers to import some chemotherapy drugs in short supply.

How ongoing drug shortages are impacting hospitals

Between June 23 and July 14, the American Society of Health-System Pharmacists (ASHP) surveyed 1,123 of its members to learn about the severity and impact of ongoing drug shortages. Of the participants, 93% were pharmacists, and 88% worked in a hospital or health system.

Overall, more than 99% of respondents said they were experiencing drug shortages. In addition, 32% of respondents said the current drug shortages had a "critical" impact on patient care while 63% said they had a "moderate" impact.

When asked about the severity of shortages of specific drugs, 57% said shortages of antineoplastic (chemotherapy) drugs had a critical impact, leading to delays in care and rationing of treatments. Shortages of most other drugs, such as corticosteroid and hormonal drugs and oral liquid drugs (lidocaine, ibuprofen, etc.), had a more moderate impact on patient care. 

To manage the current drug shortages, most respondents said they switched to alternative medications (97%), implemented rationing criteria (85%), or converted some medications to different dosage forms (84%).

Operationally, many respondents purchased different sizes or concentrations of certain drugs (91%), centralized or consolidated their inventory (83%), or changed the products in their trays/carts (70%).

According to ASHP, "[m]anaging drug shortages is a labor-intensive process" and "can divert time and resources away from clinical care." Among respondents who were involved in their department's annual budget process, most said they believed managing drug shortages would lead to between a 5% and 15% increase in their annual drug or labor expenses.

To address the current shortages, ASHP has recommended several policy solutions, including penalties for drug manufacturers without risk strategies and diversifying the broader manufacturing supply chain.

According to Mike Ganio, senior director of pharmacy practice and quality at ASHP, strategies to combat drug shortages need to more proactive, which will require greater investment into drug manufacturing quality.

In the survey, 87% of respondents who were involved in purchasing decisions said manufacturer and product quality were very important, and 59% said they would preferably purchase drugs from a manufacturer that had achieved a certain predetermined quality standard.

In addition, 85% of respondents who participated in drug budgeting said they were willing to spend more on drug products from manufacturers that achieved quality recognition. In general, most respondents said they were willing to spend between 5% and 10% more for these products.

"If purchasers had more information to support those manufacturers that have better quality investments, better quality systems in place, more resiliency in their system — then I think we would be able to start to address some of these core root causes and problems," Ganio said. (Alltucker, USA Today, 8/10; McPhillips, CNN, 8/10; ASHP survey, accessed 8/11)

The COVID-19 pandemic revealed the vulnerability and inflexibility of the health care supply chain. Now, leaders face the challenge of rebuilding the supply chain in such a sustainable way that it will not “break” during the next crisis – but without adding unnecessary cost into the system. Explore our toolkit with insight on the future healthcare supply chain, including case studies from high-performing providers and suppliers.