Drug shortages can often leave patients in a bind

A national drug shortage has left rural hospitals – including Yuma Regional Medical Center – in a bind, according to a report by Cronkite News Service.

Tom Van Hassel, director of pharmacy at YRMC, noted that the situation isn't good. “On any given day, there are 15-20 drugs we're scrambling to find.”

The drugs are surprising – morphine, propofol, chemotherapy, anesthesia, antibiotics, prednisone and nutritional products top the list – medications that are frequently prescribed to treat a wide variety of ailments.

This is a major problem for the hospital, and the community as a whole.

The shortages make a doctor's job that much more difficult. It creates an onion-layer style problem. Ideally the patient would take drug A and B. However, drug B isn't available, so now, the patient must take drug C, which reacts poorly with drug A. So now, the patient is on drug C and drug D … and so the list goes on. It forces doctors to get somewhat creative, which isn't always a good thing, and could result in more health issues for the patient.

Neil MacKinnion with the University of Arizona points out that the problem extends past prescribing medications for treatment. Out-of-stock medications can also lead to postponing surgery or treatment, or having to travel to another hospital for procedures – a problem in a community such as Yuma, which is isolated from other medical centers.

There are a variety of reasons for the shortages – an inconsistent supply of raw materials and fewer manufacturing plants lead the list, according to Van Hassel. And once suppliers realized shortages could occur, they bought up the existing stock.

Now, Van Hassel notes, medications that once cost less than a dollar per pill now might cost $8-$20 per pill, a change that directly impacts the patient.

What's not clear is why the price has gone up so substantially. Is it simple supply and demand, or is it tied directly to the suppliers buying up the stock?

This is a situation the federal government is already working on. The Food and Drug Administration has been actively working on the drug shortage problem since an executive order by President Obama in 2011, which sought to prevent drug shortages. As part of the order, the FDA reports any evidence of stockpiling or price gouging to the Department of Justice for further action.

This is good news for the patient, but it's worrisome that the shortages continue and that, in some cases, the price per pill has skyrocketed.

Hospitals across the nation are faced with the same set of circumstances, and are examining a variety of options to help mitigate the situation. A group in Ohio, for example, is looking at allowing more drug compounding – which is where drugs are concocted from raw materials at the hospital's in-house pharmacy. Another group is lobbying for a bill that would prevent wholesalers from purchasing drugs in order to prevent resale at a high markup.

The bottom line is, drug manufacturers should produce medications that are safe for the consumer – in a consistent flow, with fair pricing.

While one could expect minor fluctuations in pricing due to a shortage of materials, the ones described by Van Hassel are extreme, and need to be addressed.

Hopefully, the actions of the FDA are only the first step in resolving the issue.