As the novel coronavirus (COVID-19) crisis continues, one key issue for pharmacists, other health care professionals, and patients is the potential for drug shortages in the United States.

There is growing concern because although reserves exist, China experienced a drop-off in drug production during the height of its COVID-19 outbreak, though that is leveling off.1 And India, another big supplier, has also said that it will keep some of the medications it makes on reserve.2

“We are now starting to see spot shortages for a few different products, in part due to disease progression around the world, especially across Europe, which is a large producer of drugs,” Soumi Saha, PharmD, JD, senior director of advocacy at Premier Inc in Washington DC, said in an email interview with Pharmacy Times®. “Italy, for example, is the (number) 3 producer of active pharmaceutical ingredients behind India and China, so we’re keeping a close eye on the availability of raw ingredients from that region as part of our ongoing risk assessments.”

Premier is a health care improvement company that unites an alliance of approximately 4000 health systems and hospitals and more than 175,000 other organizations and providers. Saha said that Premier is also seeing an increase in the purchase of drugs that are expected to become frontline therapies for COVID-19.

For example, she said, “South Korea recently reported that certain anti-malarial drugs have positive outcomes in COVID-19 patients, and within 24 hours we saw a dramatic uptick in the purchasing of those drugs across the country.”

In terms of drug reserves, Premier is working with manufacturers to understand how much product is available to wholesalers, how much is in warehouses, or “how much could be on a barge coming across the Indian Ocean,” Saha said.

“We know that manufacturers of products for Premier’s drug shortage programs, including ProvideGx, have safety stock, and we are in discussions with suppliers, particularly for products that are in high-demand categories right now, such as metered dose inhalers and cholorquine, about ramping up production and ensuring adequate allocations in the supply chain,” Saha said.

Meanwhile, the FDA has announced a drug shortage caused by the COVID-19 outbreak but has not identified the drug or the country where it is made, in an effort to prevent hoarding and panic.3

However, the agency “should be sharing this information with private sector partners to help address the situation and ensure additional supply is available as soon as possible. At organizations such as Premier, if we know which drugs are in potential shortage, we can leverage our ProvideGx drug-shortage subsidiary to incentivize manufacturers to enter the marketplace and manufacture the drug,” Saha said.

Receiving such information would help Premier to help prevent a drug shortage before it becomes widespread, she said, adding that the company is in discussions with the FDA to “release this critical information to us soon.”

Despite the crisis, some pharmacists think that this is a good time to show their value.

“We can help with therapeutic interchange while navigating the patient’s formulary better than anyone on the medical team. We should be proactive and jump in when we can, never contacting the physician without a solution to the identified shortage,” Travis Wolff, PharmD, owner of Med-World Pharmacy in Sapulpa, Oklahoma, said in an email interview with Pharmacy Times®.

Although some pharmacies are marketing 90-day supplies to limit the number of patient visits, he said that pharmacists should discourage that practice.

“If an otherwise healthy patient gets new 90-day supplies, we will end up like toilet paper with empty shelves,” Wolff said. “We should screen and only grant 90 days or early fills to the most at-risk patients.”

Tara Fink, PharmD, pharmacy clinical services manager at Walmart Health & Wellness in Fort Worth, Texas, said in an email interview with Pharmacy Times® that “we have been managing significant medication backorders, shortages, and recalls on a variety of medications for the last couple of years, more so than ever before” in the retail setting.

“COVID-19 is creating a paradigm shift, but I am confident that we will find a way to take care of our patients should a shortage arise, as we have always done,” she said. “I’m very proud of my colleagues and encouraged by the brave pharmacists stepping up to meet all the new challenges that are coming our way.” 

Another concern is a shortage of medical supplies, such as personal protective equipment (PPE). Premier’s surveys of supply inventories in the acute space and at senior living facilities show that some providers are running low on PPE, such as masks.4,5

Many have initiated conservation strategies, and Premier is recommending that all providers immediately implement these strategies until manufacturing of these products ramps up, Saha said. Premier has compiled a one-page document of best practices during extended use of PPE, which it has distributed to its members, she said.6

Saha remains optimistic about the drug supply, however, because she says that the pharmacy profession is accustomed to dealing with shortages.

“We’ve had over 100 drugs on the FDA shortage list and 200 on the [American Society of Health-System Pharmacists] shortage list for years. While pharmacy manufacturing is not resilient, the practice of pharmacy has become,” Saha said.

“Pharmacists are adept at finding alternatives when the ideal drug is not available,” she said. “If anyone knows how to handle shortages, it’s pharmacy.”

References
  1. Lupkin S. How coronavirus is affecting the U.S. pharmaceutical supply. NPR. March 12, 2020. npr.org/sections/health-shots/2020/03/12/814623335/how-coronavirus-is-affecting-the-u-s-pharmaceutical-supply. Accessed March 19, 2020.
  2. Goel V. As coronavirus disrupts factories, India curbs exports of key drugs. The New York Times. March 3, 2020. nytimes.com/2020/03/03/business/coronavirus-india-drugs.html. Accessed March 19, 2020.
  3. FDA. Coronavirus (COVID-19) supply chain update. fda.gov/news-events/press-announcements/coronavirus-covid-19-supply-chain-update. Published February 27, 2020. Accessed March 19, 2020.
  4. Premier Inc. survey finds 86 percent of health systems are concerned about personal protective equipment shortages due to coronavirus [news release]. Charlotte, NC; March 2, 2020: Premier Inc website. premierinc.com/newsroom/press-releases/premier-inc-survey-finds-86-percent-of-health-systems-are-concerned-about-personal-protective-equipment-shortages-due-to-coronavirus. Accessed March 19, 2020.
  5. Premier Inc. survey: more than two-thirds of senior living facilities say they can’t access personal protective equipment needed for COVID-19 containment plans. [news release]. Charlotte, NC; March 16, 2020: Premier Inc website. premierinc.com/newsroom/press-releases/premier-inc-survey-more-than-two-thirds-of-senior-living-facilities-say-they-cant-access-personal-protective-equipment-needed-for-covid-19-containment-plans. Accessed March 19, 2020.
  6. COVID-19 and PPE conservation. Premier Inc website. premierinc.com/newsroom/education/covid-19-ppe-conservation. Published March 18, 2020. Accessed March 19, 2020.