Survey: 99% of Hospital Pharmacists Experiencing Drug Shortages

There were 309 ongoing drug shortages at the end of the second quarter of 2023, which is near the all-time high of 320 shortages.

Drug shortages are near a 10-year high, according to the American Society of Health-System Pharmacists (ASHP).

Drug shortages can have an impact on patient care, including drug rationing, delays in care, and cancellation of treatment. Drug shortages also affect pharmacy costs in terms of labor expenses and drug purchasing costs.

Based on quarterly drug shortage statistics from the University of Utah Drug Information Service, there were 309 ongoing drug shortages at the end of the second quarter of 2023. This figure is near the all-time high of 320 shortages.

ASHP has released the findings of a new survey on drug shortages. The survey, which was conducted from June 23 to July 14, features data collected from more than 1,000 ASHP members.

The survey includes several key findings.

• More than 99% of survey respondents said they were experiencing drug shortages
   
• 32% of survey respondents said their drug shortages were critically impactful, which means they are having drug rationing, delays in care, or canceling of treatments or procedures
   
• 57% of survey respondents said they had critically impactful shortages of chemotherapy drugs
   
• 73% of survey respondents said that drug shortages had caused increases in their drug budgets by 6% to 20%
   
• 87% of survey respondents who were involved in purchasing decisions said manufacturer and product quality were very important
   
• 59% of survey respondents who were involved in purchasing decisions said they would prefer to buy products from manufacturers who meet a predefined quality standard
   
• Survey respondents who reported using clinical management strategies to address drug shortages said they had taken the following actions: changed to therapeutic alternatives (97%), implemented rationing criteria (85%), converted to different dosage forms (84%), changed order sets or protocols (75%), and delayed or canceled treatments or procedures (42%)

Drug shortages are reaching a historical high, Michael Ganio, PharmD, MS, senior director of pharmacy practice and quality at ASHP, told HealthLeaders. "We are at a high point for the number of active, ongoing shortages since 2014. The shortages have been steadily increasing. What is different is that if you look at the number of newly reported shortages from 2012 to this year, there is a slight downward trend in the number of new shortages each year. However, this can be deceiving. When you look at the number of active shortages, the number keeps increasing. What that tells us is that shortages are not resolving as quickly as they are happening."

Active shortages are concerning, he said. "Some of the drug shortages we have been following have been ongoing for five to 10 years. Regarding the current trend, while the number of new shortages may not look like an impressive number, the number of active shortages is nearing an all-time high."

Impact of drug shortages

The costs of managing drug shortages are significant, Ganio said. "We know from a 2019 report that was conducted by one of the group purchasing organizations that there was an estimated $359 million in annual healthcare labor expenses in managing drug shortages. The new survey results do not give an actual dollar amount, but we wanted to get percentages of how much more pharmacies are spending on personnel and their drug budgets. What we found was that there is between a 5% to 20% increase in baseline spending for personnel and drug budgets."

Clinical management strategies can be effective in responding to drug shortages, he said. "Often, we can manage a drug shortage within the pharmacy department, so there is no impact on patients. We can buy drugs from alternative suppliers. We can buy different package sizes or concentrations, then repackage the drugs and make sure whoever is administering the drug is aware that it looks different, and it is going to be a different amount that will be administered. Those strategies result in the patient receiving the exact same drug."

However, sometimes clinical management strategies have a negative impact on patients, Ganio said. "When we look at certain classes of drugs such as chemotherapy drugs, the survey found there is almost 60% rationing drugs, delaying treatment, or canceling treatment. That is not sustainable. We cannot and should not accept that as a fact of life for our patients."

Substituting drugs has a downside, he said. "When we treat a patient, we have a drug of choice. There is a first line of treatment for a reason. It is either optimally effective, has fewer side effects, or there is some sort of cost benefit to the treatment. When that treatment is not available, and we have to go to a second-line treatment, we are compromising one or more of the benefits of first-line treatment or you are introducing risk for a medication error."

The drug shortage forecast for the rest of 2023 and into 2024 is uncertain, but Ganio is pessimistic. "The reality is that there are multiple factors that contribute to shortages. A good case in point is the tornado that damaged a Pfizer facility in North Carolina. We are still waiting to see the impact from that event. Pfizer has released some information about what we might expect, but so far there is no definitive measure of how impactful that event will be. However, if we follow the current trends, I expect things will get worse before they get better."

Related: Drug Shortages Endanger Patients, Hike Costs