Pharmacy Insights

JULY 18, 2011

Rx Shortages Waste Time and Money
In the July “News & Trends” column, Pharmacy Times reported on prescribing trends that are driving up the nation’s health care costs. With the release of a new study, the American Society of Health- System Pharmacists (ASHP) added drug shortages to the list of cash drains plaguing US health systems. 

Much has been made of the impact of drug shortages on patient care, but few studies have pinned a dollar amount to the growing problem or investigated its effect on pharmacy work flow. In the new report, ASHP estimates that labor costs associated with prescription drug shortages add up to an annual total of $216 million. “The amount of time required by pharmacy and nonpharmacy personnel to effectively manage drug shortages can be extensive,” study authors reported online July 11, 2011, in the American Journal of Health-System Pharmacy. How much time? Pharmacists and technicians managed drug shortages for a median of 9 and 8 hours, respectively, according to the report.

The survey of 353 directors of pharmacy was designed to identify the scope and severity of drug shortages nationwide, assess the personnel resources needed to handle drug shortages, and evaluate the adequacy of information resources available to hospital staff. The findings showed that:

  • Labor costs associated with managing shortages translated to an annual impact of $216 million nationally.
  • Pharmacists and technicians spent more time dealing with drug shortages than physicians or nurses.
  • 32% of respondents reported reallocating staff away from patient care duties to allow time to attend to drug shortage issues.
  • More than 90% of respondents agreed that drug shortages were associated with increased burden and increased costs today, compared with 2 years ago.
  • Shortages of dextrose syringes, epinephrine injections, and succinylcholine injections affected more than 80% of respondents.
  • 70% of respondents said the information resources available to manage drug shortages were “less than good.”

Drug shortages also leave patients vulnerable to medication errors, according to Henri R. Manasse, Jr, PhD, ScD, ASHP’s executive vice president and chief executive officer. Under his leadership, the pharmacist group is advocating for regulatory and legislative measures to address what it calls a “national health crisis.”

“Pharmacists are being pulled away from clinical duties to manage shortages,” said Dr. Manasse. “This means that patients don’t have access to the medication expertise that pharmacists provide, making patients even more vulnerable to harm.”

Generics Key to Affordable Preventive Care 
The increased availability of generic drugs is changing the economics of chronic illness in the United States, according to a report in the July 2011issue of Health Affairs. Researchers say preventive care is significantly less costly than in the past, thanks to the expanded use of cost-effective generic alternatives. 

“There is no question prevention is more affordable with the use of generics,” said lead study author William H. Shrank, MD, MSHS, of Harvard and Brigham and Women’s Hospital. He says the findings, which show dramatic reductions in the cost of critical preventive therapies, should be a springboard for policy decisions regarding health care and generic drugs.

Previous studies estimating the cost of preventing chronic disease relied largely on the cost of branded medications, Dr. Shrank and colleagues reported. For example, a 2008 study estimated the cost of lowering cholesterol to be $83,327 per quality-adjusted life-year (QALY), a measure used to evaluate treatment according to its impact on quality and length of life.

Today, the same treatment—administered using generic alternatives now available—would cost just $17,084 per QALY, or 20% of the original estimate. The cost of drugs to maintain glucose control in cardiovascular patients has plummeted even more since the 2008 study, from an estimated $48,759 per QALY to just $1022 per QALY, or 2% of the original estimate.

With 80 million Americans suffering from some form of cardiovascular disease, the savings potential of generic medications is enormous. “Using generic medications has to be a key part of managing treatment for chronically ill patients,” said study co-author Troyen A. Brennan, MD, MPH, executive vice present and chief medical officer of CVS Caremark, which funded the study.

To increase generic utilization, the researchers called for changes in policy that would encourage the use of generics, such as limiting “dispense as written” scripts and coordinating physician education campaigns on the safety and effectiveness of generic drugs. Generics should also be promoted in the new treatment standards for Accountable Care Organizations, the authors said.

“The topic of generics and effective preventive treatment should be central to any debate on making health care more affordable,” said Dr. Shrank.

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