The latest healthcare supply shortages, which include amoxicillin, albuterol, and children’s acetaminophen, stem from a failure to account for demand, and from a lack of healthcare supply-chain transparency, an expert told MDLinx.
If the US healthcare system is to move past these shortages, it will require enhanced collaboration among all supply-chain stakeholders, including healthcare professionals on the front lines.
Clinicians can familiarize themselves with best practices to ameliorate the current shortages, and to prevent future shortages.
The healthcare supply-chain history, starting in 2020 and concluding in the present, can be summarized with a single word: disruption.
First, there was the PPE shortage. Then came a surge in demand for ventilators and support medications. Later, IV contrast stocks dwindled, followed by a lack of basics like acetaminophen for children, albuterol, and amoxicillin.
Are supply shortages the new normal? And if so, what can healthcare professionals do to ameliorate the problem? MDLinx turned to a pharmacy supply-chain expert for insights.
How we got here
Mittal Sutaria, PharmD, is the senior vice president of contract and program services in pharmacy at Vizient, a healthcare performance improvement company. Vizient is also a driving partner behind the End Drug Shortages Alliance, a partnership of health systems, supply-chain leaders, and industry stakeholders.
According to Sutaria, the current shortages were actually 20 years in the making. Throughout the prior two decades, pharmacists have mitigated these shortages by ordering strategically. Largely, Sutaria said, these shortages were confined to the generic injectables space.
COVID put a stop to that, spiking demand for certain drugs and devices in a way that no one could have anticipated. The system was rattled by unforeseen shortages of oral formulations and inhalations.
But social distancing also had some second-order effects, one of which was a change in drug-manufacturing orders.
Utilization rates for drugs like amoxicillin, albuterol, and children’s acetaminophen dipped from 2019 to 2021 because people were staying home, and the rate of typical seasonal ailments dropped off.
When retailers made projections for 2022 and 2023, they stuck to the trend and anticipated they would need less.
As Sutaria explained, “A lot of manufacturer production depends on what commitments they have and what they’re forecasting not just 6 months down the line, but really a year to three years down the line.”
Long-term ordering gives manufacturers time to acquire supplies and deliver the product as scheduled. But projections based on COVID-related conditions, Sutaria elaborated, did not account for a spike in seasonal infections like influenza and RSV, and the subsequent spike in demand for treatments, that followed the end of social distancing.
Why this keeps happening
According to Sutaria, the current predicament boils down to a lack of transparency.
"There is so little transparency in the world of pharmaceutical supply chain, as in, Where is the raw material coming from? What is the reason for this drug shortage?"
— Mittal Sutaria, PharmD
Sutaria said she couldn’t pinpoint the reason why there is a drug shortage today, because of the lack of transparency.
What makes a bad situation worse, Sutaria explained, is that one of the chief mitigation strategies that healthcare systems have turned to is stockpiling alternative products. That spikes demand drastically compared with historical usage.
Adding insult to injury is that the 2023 cold and flu season so far has been comparable to previous ones, in terms of the number of infections.
“There might be a slight spike, but it’s not tremendously more,” she said. “It’s not like we haven’t seen this type of flu season before. But combine that with potential challenges of amoxicillin that might have entered the market, and anticipatory purchasing, and now your demand has skyrocketed and you don’t have sufficient supply. Then it trickles down.”
The other transparency problem, Sutaria said, is that the supply chain itself is largely opaque.
Purchasers do not know how much capacity manufacturers have, or if they can respond to market demand by switching or ramping up production.
“All of these details need to be more transparent so that the industry can understand, what is the true capacity of the marketplace?” Sutaria explained. “Then, in reverse, you also need to understand what is the true demand.”
Finally, Sutaria said that redundancy is also an issue. In certain situations, a single supplier may be manufacturing on contract for three others. Purchasers, such as care networks, may think there are three suppliers, but there’s actually just one.
Moving beyond the shortages
Sutaria said that solving this problem will require collaboration between suppliers, distributors, group purchasing organizations, and providers. This is integral to the mission of the End Drug Shortages Alliance. There are also steps that healthcare professionals can take on the front lines of care to help.
Sutaria said that progress starts with healthcare institutions’ managing shortages proactively.
Letting pharmacists who manage hospital formularies order as much as they can is not a sustainable solution.
Instead, healthcare institutions can prioritize patients differently and order drug quantities that are consistent with past needs.
As an individual prescriber, you should stick to the prescribing guidelines of your institution, which likely were crafted with the current market limitations in mind. And prescribers should maintain lines of communication with pharmacists, or whoever is managing drug acquisition, about any shifts they’re seeing in demand.
"Within a health system, it can’t be just a pharmacist or a nurse addressing this."
— Mittal Sutaria, PharmD
“[The process] needs to bring all individuals together, including prescribers, to address these shortages. Communication is part of that process, too” Sutaria added.
What this means for you
Supply-chain shortages are actually a product of a lack of transparency. That’s a problem that predates the COVID-19 pandemic. Moving beyond these shortages will require collaboration among all healthcare supply-chain stakeholders, including clinicians. For their part, prescribers can stick to institutional prescribing guidelines. Institutions can develop prescribing guidelines that reflect changing market demands and have the ability to adapt to them. And all parties can communicate to stay abreast of market changes.