Drug shortages are an ongoing fact of life, and many Americans have known the inconvenience of having to wait to fill a prescription. But shortages have mounted in recent years, alarming observers and generating headlines.
The number of prescription drugs in shortage climbed to a 10-year high of 323 in the first quarter of 2024 — but it’s not just about the numbers. Patients and their health care providers are also being hit with much more consequential shortages, some with potentially life-altering results.
Hospital crash carts, used to provide emergency treatment to patients with critical conditions like cardiac arrest, have run short of premeasured packages of drugs like epinephrine, forcing clinicians to spend extra time measuring a dose from a vial, and increasing the odds of a medication error.
Some cancer patients, if their first-choice chemotherapy is unavailable, have had to take another drug that has much worse side effects.
Shortages can affect everyone connected with health care in any setting. “Drug shortages impact patients, families, caregivers, pharmacists, hospitals, nursing homes, hospices, and other individuals and entities across the health care system,” according to an April 2024 white paper from the U.S. Department of Health and Human Services.
To make matters worse, over the past 12 months, there have been shortages of medicines for which there is no alternative, says Erin Fox, senior pharmacy director at University of Utah Health. Fox gives one example: oxytocin, a drug that’s ordered by obstetricians to induce labor or, after delivery, to help stop maternal bleeding.
Which drugs are in short supply?
Hundreds of prescription medications are difficult or impossible to obtain as of April 2024. Among them are quinapril, which is primarily used to treat hypertension; injectable acyclovir, an antiviral; and propofol, for general anesthesia.
You can check the availability of a prescription drug by searching the U.S. Food and Drug Administration’s FDA Drug Shortages database or the American Society of Health-System Pharmacists’ ASHP Drug Shortages List. Click on any drug name to learn more about that specific shortage.
The effects of shortages on patients and their providers can be profound. Scott Matsuda, a member of the Patient and Family Advisory Council at the nonprofit Patient Access Network (PAN) Foundation, has worked with cancer patients “who, all of a sudden, find their chemotherapy drugs aren’t available.” Sometimes, patients report that symptoms of their cancers return soon after they stop taking their first-choice chemo, he adds.
No health care setting has been spared, not even hospital operating rooms. Dr. Jesse Ehrenfeld, an anesthesiologist and the president of the American Medical Association, at times has had to use second-choice drugs to induce anesthesia. These medications may have additional side effects, such as lasting longer than necessary, he said.
“Complex workarounds also have the potential to introduce errors,” says Ehrenfeld. “And I’ve had colleagues who had to delay or cancel care due to a shortage.”
Why are so many drugs in short supply?
What causes shortages? About 12% of them are due to manufacturing problems, as when a tornado hit a Pfizer plant in North Carolina, according to drugmakers’ reports compiled by the ASHP. Another 14% of shortages happen when demand suddenly outruns supply; for example, that occurs when demand for the antiviral Tamiflu spikes during a severe flu season. And 12% are due to a business decision, like when a drug manufacturer decides they can reap greater profits by making a different drug.
But the biggest category of reasons that manufacturers give for a shortage, at 60%, is “unknown/would not provide.” Ehrenfeld says, “That’s called flying blind. In most cases, we really don’t have an attributable cause, which makes it hard to pinpoint sustainable solutions.”
What’s being done to solve this multifaceted problem?
Drug shortages are a tough problem because they have such diverse causes. Stakeholders have been seeking solutions for decades, but shortages have continued throughout health care.
ASHP has recommended that, for starters, Congress give the FDA the power to levy “meaningful penalties” on drugmakers that fail to report manufacturing and supply chain problems. Failure to report is rampant in the industry.
“We think FDA requiring greater transparency in manufacturing and distribution could help us understand the causes and mitigate the challenges,” says Ehrenfeld.
The pharmacist group also recommends that to improve the profitability of generics, the FDA waive some fees on manufacturers who promptly bring these lower-priced drugs to market.
Some observers are hopeful that momentum is gathering for impactful action. “I’ve been working on drug shortages since 2001, and we now have the most interest in Congress and elsewhere that I’ve ever seen,” says Fox, who has testified about the problem at Senate committee hearings.
How can you work around a shortage of your drug?
The bottom line for health care consumers is that systemic problems with prescription drug supplies will likely persist. If you’re faced with a shortage of a drug you need, these steps will improve your chances of getting hold of it more quickly.
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Refill prescriptions as early as your insurer will let you. Ordering prescriptions ahead can give you more options for obtaining a refill before you run out.
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Contact your prescriber. Let them know that your prescription isn’t available at your pharmacy or will be delayed. Solicit their suggestions for other ways to get the drug, a generic or brand-name equivalent, or an alternative medication that would work for you.
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Ask your insurer to cover the brand-name version if the generic drug is unavailable. If your insurer resists paying for the more expensive brand-name drug, ask your prescriber to go to bat for you.
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Develop a long-term working relationship with your pharmacist.
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If the pharmacist knows you’re a regular customer, they may be more likely to hustle to find a supplier that has your medication.
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Try other pharmacies. Drugs in shortage are often distributed unevenly among pharmacies. Call around and see if another retailer in your area has a supply. If your insurer has a mail-order prescription option, consider trying it.
(Photo by Sean Rayford/Getty Images )
