Shortages of drugs have become a chronic condition in health-system pharmacies over the last five to seven years, and are a critical issue for both US1,2,3 and European4,5 health-system pharmacies. Excess costs for health systems are generated by higher costs of shorted medications and the extra labor required to manage shortages. Incurred costs vary by hospital and inventory size,2 although markups for shorted medications have been noted to be as high as 3000%.6 Incremental labor costs have been estimated to be between $25,000 and $49,000 annually per hospital, which extends to a national increase in labor cost of $216 million annually.2
Drug shortages have been shown to drive up drug costs. Increased drug costs at five VA sites studied ranged from $150,000 to $750,000 annually1, however, this did not include costs for procedures that had to be deferred or canceled because required drugs were not available. Roughly 70% of health systems nationwide report a delay in treatment due to drug shortages.7
Within the VA system, the impact of drug shortages is uneven, and some researchers have proposed that more centralized shortage management could leverage that disparity to move shortage medications to where they’re most needed, as well as reduce the effort expended at each facility.1
Audience participation comments at a presentation on managing shortages at the June 2018 Summer Meeting of the American Society of Health-System Pharmacists (ASHP)8,9 further described management of shortages as a “daily crisis”, and decried the lack of a more systematic way to handle shortages. Most reported using spreadsheets as tools to keep track of the shortages they manage.
Both the US Food and Drug Administration (FDA)10 and ASHP11 maintain listings of known drug shortages. Both databases require the user to specify the products they are looking for, which means that they can assist providers dealing with a currently known product. They may help to determine the scope and timeline of shortages a pharmacist encounters, but may be less useful in learning about new shortages because the user must log into these lists and scan them to determine what new items are on shortage.12,13 Because the methods and editorial practices for these lists are different, their contents differ as well—to be better informed, pharmacists must monitor both, adding complexity to a health-system pharmacy’s management of drug shortages.