Cindy Jeter, CPhT, CPP, BGS

Prescription drug shortages are an ongoing, complex issue and pharmacy buyers are accustomed to finding ways to mitigate them in a normal state. However, according to several pharmacy buyers who participated in a McKesson Buyer’s University™ webinar, trying to source during the pandemic was unlike anything they’ve ever seen before.

Particularly early in the pandemic, when the medical community was still discovering how best to treat patients with COVID-19, pharmacy buyers had little clarity on what medications were going to be needed.

Many of the supply constrained items were medications used in support of patients who are mechanically ventilated—medications that are not regularly stocked in large quantities. Yet, during the pandemic, ICUs were filled with patients being treated with these medications.

Demand shifts for critical care patients and increased utilization of alternative therapies challenged pharmacy leaders to quickly adapt purchasing procedures to ensure proper supply and communicate effectively with pharmacy staff and providers. Empowered health system pharmacy buyers were able to implement action plans to minimize the impact of supply shortages on patient care during the first wave of COVID-19 and move forward through anticipated surges as the pandemic continues.

1. Address crisis scenarios with structure

Once an action plan has been developed, it has to be implemented. One method that has worked for many health systems is to have an incident command structure. This command structure provides a clear path for key decision makers and stakeholders to engage in real time, especially in the current state in which the information is changing, not only daily, but by the hour in many cases.

According to Debra Carlson, pharmacy purchasing inventory analyst, St. Charles Health System, “the command structure gave us the ability to focus on just what was critical. This means that nominal operations were impacted, and this was actually a good thing—even though it sounds bad—because we were able to limit the number of decision-makers and people who needed information immediately. With this focus, we could all look at our business and ask: What do we need? What are the barriers? What are the gaps? Because we all had specific tasks, we could collect information, make decisions and act on it quickly.”

Medical specialists were critical to providing treatment protocols and medication needs to inform Carlson’s purchasing priorities and potential vulnerabilities.

“The incident command structure is really most effective when you stand it up sooner than you need to. So, for us, we stood up very early in the pandemic and that helped us to avoid panic buys and allowed us to coordinate with other hospitals and focus on what we needed to do,” Carlson said.

Even though shortages are beyond their control, health systems must be prepared. Just as organizations prepare for natural disasters, strategic planning is essential for managing drug shortages.

To create an action plan, the pharmacy executive team, in conjunction with the pharmacy buying team, must utilize data and analytics to determine the likelihood of COVID-19-driven drug shortages, prepare protocols for dealing with shortages, and communicate clearly with colleagues and patients. This has never been more necessary than during the pandemic.

Formed in response to pandemic-induced purchasing increases, McKesson’s Critical Care Drug Task Force (CCDTF) monitored medicines prescribed to manage patients with COVID-19 and anticipate demand across the pharmacy supply chain. The CCDTF compares the number of COVID-19 cases reported on a local and national level with customer demand patterns and coordinates the forecasted supply needs with pharmaceutical manufacturers.

The task force also keeps up with medical literature to stay current with drug therapy changes. These data are shared with health system customers to help them manage supply constraints.

The availability of these data is critical to translating the data points into useful and actionable information for key stakeholders throughout the health system. This knowledge informs the action plan and helps identify who is going to be impacted, as well as how to communicate about potential shortages so the team can act quickly to manage the risk to the health system and patients.

Under normal circumstances, buyers might simply walk down the hallway to inform stakeholders about pending shortages; however, the pandemic eliminated face-to-face as an effective way to communicate. This requires buyers to focus on making their communication as clear and concise as possible.

In addition, the one constant throughout the pandemic has been how rapidly things change, requiring buyers to focus on the most efficient and effective way to quickly get information to all key stakeholders.

Having the right amount of inventory is a balancing act. Keeping inventory too lean can cause issues, but stockpiling a scarce product is not a good practice either as it can create medication access issues for patients who are most in need of those drugs.

It is critical for buyers to have regular visibility into their baseline for days on-hand of key medications as well as forecasted demand. For example, if the medical team predicts the patient need for a particular drug is going to increase by 4 times, if the buyer doesn’t know how much they use per week, they can’t accurately know how much to increase it.

Pharmacies cannot prevent shortages, particularly with the complexities of treating COVID-19. However, they can strengthen their ability to prepare their organization to respond to those complexities by improving visibility into their baseline supply versus anticipated utilization, implementing an action plan for dealing with drugs in scarce supply, and communicating clearly with colleagues and patients.

Cindy Jeter, CPhT, CPP, BGS, is a supply chain management consultant for McKesson.

Articles

Pharmacies cannot prevent shortages, particularly with the complexities of treating COVID-19; however, they can strengthen their ability to prepare their organization to respond to those complexities.