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COVID 19 is impacting the drug supply chain and leading to dangerous shortages.  By now, if you haven’t been impacted by drug shortages, you have at least heard about them.  As the pandemic continues, the drugs impacted have changed and the shortages have become more critical.  Do you use midazolam, fentanyl, propofol or antibiotics?  You will need to have a plan in place to avoid negatively impacting patient care.

We are all accustomed to hearing about occasional drug shortages that are often more than just an inconvenience.  As a consultant pharmacist, I deal with these daily and know the impact they have on the day to day operations of my clients.  I’m constantly working to stay ahead of the curve and provide alternatives that are equally safe and effective.  I have written about these issues in previous posts such as Drug Shortages: Three Reasons Why It’s Different During COVID-19 and New Drug Shortages and the Second Wave of COVID-19.  Some of the themes are consistent, so why write about it again?  Because although some of the same forces are at play, the situation continues to evolve both in breadth and scope.  Some of the drugs showing up on the most recent lists are common everyday drugs such as midazolam, fentanyl, propofol, rocuronium and many antibiotics.

Although drug shortages have been officially tracked for nearly 20 years, the issue has not been resolved.  The drug supply chain is global and so is the pandemic.  This includes factories of active pharmaceutical ingredients being shut down in other countries, such as China, who is responsible for nearly 80% of the world’s antibiotics.  This is further exacerbated by travel and exporting restrictions.  Additionally, ongoing fluctuations of COVID cases in certain areas worsen shortages beyond what we would normally expect.  One reason for this is hospitals using some of these drugs to treat COVID patients.  Although this often leads to limited supplies and higher drug costs, we are also seeing cases where the drugs are not available at any cost.

So, what can be done about it?  In a recent report from the Center for Infectious Disease Research and Policy (CIDRAP), researchers describe the current vulnerabilities of our drug supply chain and what can be done to improve it.

Key recommendations from CIDRAP:

1. The United States should have a national process and infrastructure for analyzing, predicting, managing, and preventing shortages of critical medications.
2. An in-depth map of the US drug supply chain is needed to identify where each drug product in the US market was made, including where the starting materials, active pharmaceutical ingredients, and finished drug product were produced.
3. The country should develop and regularly update lists of essential or critical drugs to be used for ensuring a high-quality and resilient drug supply for the military, triage during natural disasters, and the general public’s need for critical drugs for both acute and chronic conditions.

These changes would go a long way to improve our knowledge of the drug supply chain and where the vulnerabilities lie so we can avoid critical shortages instead of finding out after the fact.

What can you do at the facility level? There is no quick and easy solution here.  Completely avoiding all drug shortages is nearly impossible.  Navigating your way around them, is very possible, but requires expertise.  If you’re not working with a consultant pharmacist who specializes in your area, consider doing so.  Always make sure you are working with someone who is qualified…remember, anyone can call themselves a consultant.

One of my go-to lists of suggestions is something I wrote about last year, long before we worried about COVID.  Here I discussed  Ten Steps to Dealing with Drug Shortages, which should help you avoid the worst of the problem.  Being ahead of the curve is critically important.  I suggest starting with the list of  FDA Drug Shortages.  This will allow you to confirm shortages and perhaps stay ahead of the curve.

Secondly, the FDA’s  Search List of Extended Use Dates to Assist with Drug Shortages will allow you to extend the expiration date on certain products, so you can continue using medications that would otherwise be considered expired.  We recommend properly labeling any medication that has been extended by the FDA, or that may be unavailable, and track and document all attempts to obtain these medications. We provide a tracking tool for all our customers.   Please reach out to us if you are currently not following this process or need help with a proper tracking document.

One additional option that may save the day is the use of compounding pharmacies.  Although they face many of the same restrictions in obtaining products, they often have options that may save you in a pinch.  You will have to do some due diligence prior to exercising this option.  Your consultant pharmacist should guide you on properly vetting a compounding pharmacy prior to working with them.  This includes verifying state licensing, FDA 503B registration, and reviewing all FDA inspection findings to help you make an informed and safe decision.

If you have questions or need help navigating drug shortages to avoid interruptions in care and maintain patient safety, please contact us and we will walk you through a plan specific to your facility.