Surviving Drug Shortages
The incidence of significant drug shortages has been gradually increasing since the early 1990s. Reasons for the drug shortages have included, but are not limited to, a lack of raw materials, manufacturing difficulties, voluntary recalls, and shutdowns of manufacturing plants by the Food and Drug Administration (FDA). Also, there have been more occurrences as pharmaceutical manufacturers discontinued drug product lines. Because of the shortages, pharmacies have faced an ongoing challenge to provide equivalent medications to patients without negatively affecting the quality of patient care. Despite these efforts, therapeutic options have not always existed. Therefore, hospital pharmacies have been forced to search for other buying options, therapeutic alternatives, or allocation strategies when limited supplies were available. The purpose of this article is to describe the survival strategies used by our hospital pharmacy in overcoming drug shortages. Strategy phases include shortage anticipation, assessment of shortage (management, clinical, and financial perspective), committee approvals, and education. Examples of therapeutic options will also be provided.
Drug Shortage Anticipation
The purchasing and inventory control manager and coordinator assess potential drug shortages on a daily basis, and routinely report potential problems to the director of pharmacy verbally and via electronic mail (email). Shortages are anticipated through periodic notices from the wholesalers, who outline the most recent drug shortages. In addition, recall notifications are also received directly from the manufacturers and wholesalers. In order to anticipate a drug shortage, sufficient quantities of drugs are ordered, based on wholesaler and/or manufacturer allocation. Unfortunately, it is frequently the case that there is no advance notice of the shortage. If a product is not available from the wholesaler, the purshasing and inventory control manager and/or coordinator attempt to order the medication directly from the pharmaceutical manufacturer and other sources specializing in backorder products. For immediate patient needs, a supply might be requested from other local hospitals. It is interesting to note that the FDA recently authorized the redistribution of influenza vaccines from one organization to another in an attempt to alleviate shortages for the 2001-2002 influenza season. However, our pharmacy does not support stockpiling of medications in response to an anticipated shortage. This practice can create an artificial shortage, which can drive an unnecessary supply shortage. cheap cialis canadian pharmacy