Panelists discuss the prevalence of drug shortage and whether the community understands the severity of this pervasive insufficiency.
Troy Trygstad, PharmD, MBA, PhD: Hello, everybody. Thanks for joining us again at Pharmacy Times® for our Peer Exchange®. Today’s discussion is about drug shortages and their systemic effect on our health care system.
I’m Dr. Troy Trygstad. I’m the vice president of pharmacy and provider partnerships at Community Care of North Carolina. I’m also the executive director of CPESN [Community Pharmacy Enhanced Services Network] USA, as well as the Pharmacy Times® editor in chief.
Also joining us today are Dr. Erin Fox, a pharmacist and the senior director of drug information and support services, as well as an adjunct associate professor of pharmacotherapy at the University of Utah; and Richard Montgomery, pharmacy contracts and operations manager at Adventist Health System.
Let’s begin. Well, let’s start off with the prevalence of drug shortages. We hear about them in the news and through social media. We have both of you as experts today. What’s the prevalence of drug shortages? Is this something that happens every once in a while, where you work, or is it an everyday sort of a circumstance?
Erin Fox, PharmD, BCPS, FASHP: Drug shortages are pretty much a daily disaster right now for most hospitals. We have been following drug shortages since 2001. We provide all the content for the ASHP [American Society of Health-System Pharmacists] website. Since 2001, we’ve seen many shortages. We had a bit of a decline, but pretty much since 2010 it’s been part of your daily pharmacy activities at any hospital or pharmacy.
Troy Trygstad, PharmD, MBA, PhD: It sounds to me that we’re just hearing about it more.
Richard Montgomery, RPh, MBA: There’s more coverage in the news because it’s mission-critical drugs that are short. It’s not drugs for which we have multiple suppliers; it’s the 1 or 2 companies that source the products. It’s fentanyl [Duragesic] and lidocaine [Lidoderm]. It’s the drugs the general public know about because they’ve probably used them at one time. This is why there has been more press in recent years.
Troy Trygstad, PharmD, MBA, PhD: Both you and Erin deal with this on a daily basis, it sounds like. Does the average person walking down the street understand the magnitude of the issue?
Richard Montgomery, RPh, MBA: I would say probably not because, behind the scenes, there is so much going on that the patient is not affected in the scramble that happens every day where we’re sourcing drugs and moving product around. Being inside a health system, we have that advantage where we can move drugs. But I don’t think the general public, unless they see a press article on normal saline shortage, are truly understanding what’s going on.
Erin Fox, PharmD, BCPS, FASHP: Rich talks about how the people might not really be affected, and honestly, that’s true. In your pharmacy, you probably can get some of what you want. It’s just often not the right strength or the right size. Patients aren’t actually going without products, and so they’re not showing up to clinic and not able to get their infusion—but there’s a lot of work happening behind the scenes because so many basic products are short.
Troy Trygstad, PharmD, MBA, PhD: It sounds to me that the newspapers are the tip of the iceberg and folks don’t see what’s below the waterline because there are this whole team of folks who are trying to prevent that iceberg from going through the tip of the surface water, right? In other words, what I’m hearing you say, then, is that there’s all this work that goes on to deal with a lot of drug shortages that never make the newspaper, but there are teams of people involved. Can you describe the sort of teams that you have? You have a whole set of protocols and people who are working on these drug shortages to prevent that newspaper article, right?
Erin Fox, PharmD, BCPS, FASHP: That’s right. I’m always willing to talk to the press about how things are going. We have at least 2 full-time pharmacists critically devoted to drug shortages, but it’s mostly a team. I actually have 6 different people working on shortages in any given day. We have a team of technicians and pharmacy buyers, and then we have a daily huddle with our pharmacy leadership. We also work on an almost-daily-to-weekly basis with our nursing colleagues and physician colleagues, depending on what the shortage is.
Troy Trygstad, PharmD, MBA, PhD: Rich, you come from an environment in which you’re looking after 9 different states and 48 different hospitals. What kind of team does that take?
Richard Montgomery, RPh, MBA: It’s a layered process. I look at it across the country. We go as west as Texas, into Missouri, and then we go north into Kentucky, and we have a high concentration in Florida. Each state has a different distribution center, so I’m looking across the whole span of where it’s short, who has it, and who doesn’t. That drills down into the local level, where the hospitals will create their own teams based on what’s going on in their local area. My job is to be the liaison back to vendor—finding out time lines, shortage length, and why the drug is or is not available.
Troy Trygstad, PharmD, MBA, PhD: In each of those 48 hospitals, do you think the staff of those units appreciate the importance of the work you’re doing?
Richard Montgomery, RPh, MBA: I hope so. We range from a 1500-bed to 25-bed critical-access hospital, and the guys downstream in the smaller hospitals don’t have the manpower to manage some of this stuff. This is where we kind of help, and we get feedback from all those different hospitals.
Troy Trygstad, PharmD, MBA, PhD: This is daily.
Richard Montgomery, RPh, MBA: Pretty much.
Troy Trygstad, PharmD, MBA, PhD: Drug shortages happen daily.
Richard Montgomery, RPh, MBA: Right.
Troy Trygstad, PharmD, MBA, PhD: How many days of the year do you lose sleep?
Richard Montgomery, RPh, MBA: There are probably 8 to 10 hours a week that I solely commit to vendor relations and drug shortages on top of everything else that we’re doing.