Drug Shortages: Pervasive Challenges, Proven Solutions

U.S. healthcare providers continue to navigate about 200 active drug shortages every quarter ─ shortages that contribute to millions more in annual costs and less-than-optimal patient care therapeutic choices. While pharmaceutical supply chain disruptions remain prevalent, progress has been made in deploying innovative strategies that help improve resiliency and access.

For more than two decades, Premier and its members have taken a leadership role in tackling drug shortages head on. And today, Premier has released the inaugural edition of INSCRIPT, a new Pharmacy thought leadership publication, with insights and recommendations on managing and mitigating current and future drug shortages.

Documented shortages in recent months have included essential medications like diluents, fluids, anticoagulants, emergency drugs, antibiotics and more. As of December 2021, Premier data also shows several drugs vital to ongoing patient care have slipped into shortage as manufacturers prioritized COVID-19 vaccine production ahead of other routine drugs.

While the pandemic exacerbated pharmaceutical sourcing challenges, many of these shortages are the result of marketplace dynamics and cracks in the supply chain that originated long ago.

A Problem Decades in the Making

Extensive research exists to pinpoint the challenges and root causes that contribute to drug shortages. Despite heightened awareness, a fragmented supply chain and lack of visibility has largely left stakeholders in a reactionary mode. In shifting to a proactive approach grounded in innovations that may stave off the clinical impact of disruptions, providers are seeking expertise, insights and data signals to help mitigate the impact of essential medication shortages.

According to Premier’s recent survey of 156 health system pharmacists and staffas well as 56 generic drug manufacturers:

• 94 percent of health system pharmacy leaders and front-line staff have been impacted by interruptions in their pharmaceutical supply in the past 18+ months.
• Providers primarily receive supply chain updates from their GPO partners and wholesalers, and they ranked confidence in supply availability as the biggest influencing factor in purchasing strategy.
• Pharmacy leader respondents cited developing shortage risk assessments as the most useful strategy to prevent or mitigate drug shortages.

As providers navigate issues at the end-user level, suppliers face challenges of their own. Generic drug manufacturers rank unpredictable demand and volumes among their top challenges to consistently supply drugs, according to the Premier survey. And when asked what they wished health systems better understood to help prevent or mitigate drug shortages, “participating in a supplier’s committed programs” emerged as the number one opportunity. From a manufacturer’s perspective, redundancies and raw material safety stock are key, but equally important is a steady demand signal from the market.

To make meaningful progress, a combination of diversification, commitment, predictive data, advocacy and market-based strategies are needed.

In truly tackling drug shortages once and for all, pharmacy leaders and supply chain stakeholders must collaborate to influence behaviors that pivot towards quality and sustainability. Sustainable solutions will decrease barriers to entry, namely the time and cost to enter the market, while maintaining product standards and safety.

Continuing Our Progress

This past year has placed unprecedented strain on the pharmaceutical supply chain.

While drug shortages continue to be a pervasive problem for patients and providers, Premier and its members are leading the way, stepping up to systematically address the root causes and provide the right economic models that incent manufacturers to increase supplies, invest in redundancies, enter or re-enter markets and explore new therapeutic categories for innovation.

From being the first to quantify the scale, scope and financial impact shortages have on hospital operations to testifying on the matter before Congress, Premier has been a leader in generating national attention and advocacy on drug shortages.

Together with our members, we’ve also continued to provide the industry with concrete solutions that are working to create healthier pharmaceutical markets, including the PremierPro® generic sourcing program, ProvideGx® drug shortage mitigation program and our shared investments in domestic drug manufacturing.

Since 2020:

• Premier programs have successfully resolved 14 drug shortages, resulting in their official delisting from the FDA shortage list.
• We've been able to ensure uninterrupted supply of many shortage drugs despite demand spikes of more than 150 percent during the pandemic.
• We continue to bring resiliency to the market by incenting the domestic manufacture of vital drugs through our investments in VGYAAN and Exela Pharma Sciences, which combined are working to bring new, domestic sources of competition for 20 different shortage drugs and counting.

Today, more than 153 health systems participate in Premier’s ProvideGx drug shortage program with more than 320 drug commitments made. We’ve also contracted with an additional 29 suppliers for generic injectables — suppliers that were not in the injectables market in 2012, adding much-needed competition to these therapeutic categories.

Drug shortages are a multi-faceted issue that requires a thoughtful, diversified strategy. As such, a key first step to an enduring solution is recognizing that this is a multi-stakeholder problem requiring action by all parties.

Now and always, Premier will continue to share vital education, recommendations and best practices ─ and pursue crucial strategies to help our members get access to vital therapeutics. Standing together with our members and in collaboration with stakeholders across the supply chain, we will continue to take action ─ our commitment to protect providers and patients from pharmaceutical supply disruption will never waiver.

Download your copy of the INSCRIPT thesis on drug shortages today.