I hate to learn that another medication is on back order again, forcing pharmacists to come up with an alternative plan. It involves identifying patients who are on this medication, determining when supply will run out as well as coming up with equivalent options based on diagnoses and indications.

I never ran into this drug shortage crisis 10 years ago, or at least it was rare and occurred in drugs that were truly difficult to manufacture, or there was a problem with raw materials procurement.

Now it seems to occur in all types of drugs. But drug shortage seems to occur most often  in the “undesirable” drugs, or drugs that have been around for a long time, cheap and not profitable.   I don’t see the latest blood thinners such as Apixaban or the latest inhalers such as Ellipta to make it on the list. They are still aggressively marketing these new drugs, have set the price high enough to manage any production problems and quite frankly, there is no room for drug shortage during a product launch. It’s suicidal to the new drug product. It’s bad business.

But for drugs that have been around for years and the patent has expired, the only source of production rests with the generic drug companies.  Generic drug companies are often bombarded with the demands to manufacture tons of other generic medications, all at a cost much less than their brand name equivalents. There is a need to prioritize which drugs to produce and which drugs to stay on the waiting list. At least this is what I suspect is happening and accounts for the drug shortage crisis we see today.  Eventually, the decision will come to discontinue any drugs that are not profitable to manufacture anymore, forcing the doctors to prescribe alternatives, usually alternatives that are more expensive.

Another reason for the drug shortage is that FDA and Health Canada have raised the bar in terms of quality control for medications for injection. These medications must meet specific standards such as passing sterility and microbiology tests. These tests require additional resources and again, cost money. When I hear that the oral tablet of benztropine is available but the injectable formulation is on “back order indefinitely”, I wonder why  – too expensive to meet these quality control measures.

When drug companies make decision about what drugs to manufacture or not, they look mainly at the financial numbers.  Does it make sense financially to manufacture this old drug when the cost is much higher? They do not have to be accountable to the patients.  We do. Patients who will run out of their critical medications will expect us to do everything in our power to secure the medications. Pharmacists and pharmacy staff run around like chickens looking for alternative suppliers, speaking to physicians to recommend the closest alternatives, changing orders as needed. This drug shortage crisis is taking time away from pharmacists to do what we normally do. But no one pays us to manage the crisis.  No one looks at how the crisis is affecting pharmacists.

Both US and Canada have now set up drug shortage databases to help track and inform the public about drug shortages of essential medications.  This helps to develop some plans to address the drug shortage but it does not fix the problem.  We will continue to see notices of drug shortages of essential medications, we will continue to deal with them in hope not to interrupt medication therapies or affect patient care.  But ultimately, this selective drug shortage is a powerful and desperate way of driving our prescribing practice – forcing us to prescribe more expensive alternatives. I think that is a very smart business plan but also a very unethical practice.  Where is the business ethics? It is indeed an oxymoron.

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