Sweeping drug shortages force health system pharmacists to adjust treatment, purchasing, survey finds

Drug shortages are rife across hospital and health system pharmacies and forcing most pharmacists to rely on alternatives that drive up costs and sometimes impede care, particularly when it comes to cancer care, according to new survey data of more than 1,100 provider pharmacy specialists.

The membership poll, fielded this summer by the American Society of Health-System Pharmacists (ASHP), found reports of drug shortages among 99% of respondents.

Two-thirds described the issue as “moderately impactful” while a third called it “critically impactful,” which was defined as the pharmacists needing to ration, delay or cancel treatments or procedures. Only three respondents said their organization wasn’t experiencing any drug shortages.

Chemotherapy drugs led the other specific product categories with 57% of respondents reporting that shortages of these drugs were having a “critical impact” on care. Corticosteroid and hormonal drugs (28%), oral liquids (22%), crash cart drugs (18%) and cardioplegia solutions (17%) followed in cited impacted severity.

To manage the shortages, the pharmacists frequently said they have been forced to tap a therapeutic alternative (97%), implement rationing criteria (85%) and convert to a different form or dosage (84%).

“Pharmacists in hospitals and health systems are working diligently with other clinicians to provide safe and effective care, despite ongoing drug shortages, by finding needed medications, identifying substitutes and managing changes to treatment plans when required,” ASHP CEO Paul Abramowitz said in a statement. “In some cases, there are no alternatives to the affected drugs, which puts patients at risk.”

At an operational management level, the respondents said they’ve circumvented the shortages by purchasing different vial sizes or concentrations (91%), shifting to a centralized or consolidated inventory (83%) and changing the products kept available in trays and carts (70%).

These tactics and the broader supply shortages take a toll on systems’ spending. Among the 353 survey respondents who said they are involved in their department’s annual budgeting, more than half estimated a 6% to 15% budget increase resulting from the shortages while about a fifth indicated a 16% increase or more. The spending increases were estimated to be greater for drug supply spending than labor, per the responses.

ASHP’s survey was conducted online from June 23 to July 14. The 1,123 responding members predominantly held pharmacist (93%) roles in a hospital or health system setting (88%), with the remaining respondents spread across pharmacy technician and pharmacy resident roles as well as ambulatory, outpatient, long-term care or other settings.

Spending increases on drug supply have been a constant across health system earnings reports from recent quarters. Additionally, the latest industry snapshot from consulting firm Kaufman Hall outlined a 7% year over year increase in hospitals’ daily drug expense, though drug spending per adjusted discharge had only increased 1% year over year.

Still, ASHP’s online tool detailing active drug shortages indicates 309 products currently in short supply, which the organization said is “the highest number in nearly a decade and close to the all-time recorded high of 320 shortages.”

The pharmacist group contends that these issues could be mitigated should policymakers take a hard look at the “quality and supply chain issues and larger healthcare marketplace trends that have placed intense economic pressure on the overall cost of generic drugs,” ASHP wrote in a recent policy paper.

In the short term, ASHP said Congress could ease the shortages by better enforcing previously passed legislation requiring drugmakers to develop risk plans and report issues to the Food and Drug Administration, increase healthcare providers' and pharmacies’ visibility into their supply chains and better incentivize new manufacturing of generic drugs.

In the longer term, ASHP encouraged Congress to instruct the Centers for Medicare & Medicaid Services to incentivize long-term purchasing contracts for drugs shown to be at risk of shortage, spread federal drug purchases to multiple manufacturers to encourage greater supply chain diversity and redundancy, and offer low- or no-cost financing for private sector organizations increasing their critical drug inventory.

“This issue requires quick action from Congress to address the underlying causes of shortages and ensure patients have the medications they need,” Abramowitz said.