Northwest Health Fall 2012

Medication Safety

Drug Shortages

Group Health pharmacy strategies help manage the medication supply.

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If you had a headache and discovered there was a national shortage of acetaminophen, your over-the-counter pain reliever of choice, you'd probably just reach for a substitute. There are several that are equally effective and readily available. The same isn't true if you have cancer and there's a shortage of a chemotherapy drug that can prolong your life.

There have been shortages of many drugs in recent years, says Walter Sidles, a purchasing manager for Group Health Pharmacy Services. In fact, the problem is so common that he identifies at least two to three items each week that are at risk of scarcity.

Why shortages happen. One simple cause is a temporary run on a drug, such as when people race to get a flu vaccine during an outbreak, says Sidles. Or there might be a shortage of raw materials or ingredients needed for the drug.

Other shortages are a result of a problem in manufacturing, such as a malfunction that shuts down a production line. Or the issue can stem from a Food and Drug Administration (FDA) plant inspection. For example, inspectors may discover a manufacturer has deviated from standard operating practice. When this happens, the FDA must confirm the drug isn't compromised before it's released on the market. Sidles says the FDA also has a backlog of inspections at manufacturing plants in foreign countries where some U.S. drugs are made.

Steps to protect drug availability. Whatever the reason, there's no question that drug shortages cause problems. Group Health works to protect our steady flow of medications through partnerships such as our alliance with Kaiser Permanente. "If there's a supply issue, they can help us leverage vendors to make sure we stay in supply," says Sidles.

When a drug is unavailable, Pharmacy Services uses several strategies to keep patients supplied. First, Group Health will stock up on items if they receive warning of a shortage. If the shortage becomes a serious issue, purchasers and pharmacists may stretch supply by limiting dispensing. For example, the pharmacist could temporarily restrict patients to a 30-day supply so there is enough for everyone until the drug is restocked. Sometimes changing a drug strength is an option. For instance, if there is a shortage of 10 milligram tablets, the pharmacy may change the prescription to two 5 milligram tablets. Or, a patient may be switched to a drug that is as good as or better than their current prescription.

Sidles says in many cases a solution can be found. "We work hard to make sure patients have what they need."

 

Recent Drug Shortage Why it Occured Group Health's Strategy
Midazolam, used for sedationManufacturing issuesWorked with a compounding pharmacy to source a new supply
Whooping cough vaccineRisk of shortage because usage doubledAnticipated problem and located enough supplies
Flu vaccineManufacturing failureDispensed vaccine only to at-risk groups
Doxorubicin Liposomal, chemotherapy drugManufacturer closedDrug rationed until FDA released alternative

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