The drugs you need to treat your asthma or migraines could be at risk of running out or being swapped for another medication.
That’s because hospitals and pharmacies are facing shortages in drugs that lead them to make tough decisions about how to make the most of what’s available.
C. Michael White, a pharmacist and professor at the University of Connecticut told Business Insider this problem has become more prevalent in the last decade, driven mainly by a decrease in competition among generic companies.
And it’s not relegated to one disease area: The American Society of Health-System Pharmacists (ASHP) lists 150 compounds that are currently facing shortages. The list includes everything from antibiotics to vaccines to cancer medications. Last month, The New York Times reported an instance at Johns Hopkins Hospital in which pharmacists were faced with the troubling decision of whether they should give smaller doses of medication to multiple children or give the same amount of medication to one adult.
“The discussions became, ‘Why are two kids more important than one adult?'” Dr. Kenneth Cohen, the clinical director of pediatric oncology at the hospital, told the Times.
If drug shortages continue, the results could become even more intense — and would likely affect far more people, from inaccessible medications to others that will come at a much higher cost.
“The result could be disastrous,” said White. “There would be more shortages, and generic drug costs would not go down as significantly as they had in the past.”
The ASHP cites a number of reasons for the shortages. Most are related to manufacturing problems. Sometimes, some of the companies who make large portions of the drug simply stop making it. Other times, a drug is only being produced by a single manufacturer.
And therein lies the problem: There simply are not enough companies making the drug to keep up with demand.
It’s all part of a consolidation of the manufacturers who produce generic drugs.
US generic companies have had a harder time turning a profit on generic drugs while competing with companies outside the US that are able to make the same drugs at a cheaper cost. That’s caused manufacturers to home in on certain generic drugs and discontinue others that don’t make as much money. And if a generic manufacturer has a shortage, there’s no easy fix — you can’t just pass off the job to another company while the first fixes its problems, since getting approval to take on a new drug can take years.
“It isn’t like, if you have a home business making cookies, and a competitor goes out of business, you can just bake more cookies,” White said.
Pharmacists are facing a mounting dilemma.
Instead of stocking up on life-saving medications ahead of time, health care providers are only able to order on a week-to-week basis. They’re also having to make tough decisions about how to treat their patients with the amount of a drug that’s available.
In the event of a shortage, some medications can be substituted with alternatives. These alternatives can either come in the form of another, similar medication or a combination of other, “compounded” formulations of drugs.
Compounded drugs, while sometimes safe, aren’t always a good idea. Nevertheless, given recent drug shortages, they have become increasingly common. To make a compounded drug, pharmacists make specific combinations for specific patients (for example, if a patient can’t swallow, they will substitute a pill with a liquid version of the same medication by making their own versions of the drugs). And the US government doesn’t regulate this process as closely as it does the process for making generic or branded drugs.
More than just the safety concerns over how the new versions of the drug are made, White said using compounded pharmaceuticals is “inefficient,” and ultimately more expensive. When pharmacists have to make their own versions, it takes more time and energy and can cause more confusion when it’s time to give it to a patient, since different versions of the same drug might appear in different packages or colours on the shelf.
The best chance we have at ending drug shortages, then, is mending the generic drug business.
“Generic drugs have saved billions and billions to the US consumer, but we might have to look more carefully at what is a reasonable price point what allows manufacturers to have a level of profitability,” White said.
By setting up a better infrastructure for generic drugmakers, the US has the potential to kill two birds with one stone: drug shortages AND drug price gouging.
“[Overseas competition and consolidation aren’t] just bad for drug shortages, it’s also bad for drug prices,” White said. When there isn’t more than one generic out there, manufacturers don’t have to price it at much less than the original branded drug. “That’s why some of the Wall Street hedge fund people started getting in to business of buying generics where they were the only ones manufacturing.”
Turning the tide against these practices won’t be easy and single-faceted, but being able to pull it off could save health care providers a fair amount of daily strife.
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