Q&A: Buying Smart, Not Scarce—Pharmacists at the Center of Drug Shortage Prevention

In this Q&A, Vimala Raghavendran, Vice President of Informatics Product Development at United States Pharmacopeia (USP), discusses how protective purchasing can unintentionally worsen drug shortages and strain patient access. She explains how limited supply chain visibility and decentralized purchasing decisions often drive overbuying, particularly for essential, generic, and injectable medications. Raghavendran highlights the importance of proactive stewardship, encouraging pharmacists to build safety stock before shortages emerge rather than reacting once supply constraints are already in place. She also emphasizes the value of shared data tools and collaborative initiatives that provide advance warning of potential shortages, helping pharmacists make more informed purchasing decisions. Together, these strategies aim to improve coordination across the supply chain and protect patient access to critical medications.

Pharmacy Times: How can protective purchasing—while intended to safeguard patient access—worsen shortages at the point of care, particularly for smaller hospitals or community pharmacies?

Vimala Raghavendra: So, I would encourage your readers to check out our blog. I think it is a phenomenon that is actually quite well understood in the pharmacist community. The dynamic is basically that there is an alert of some sort. It may come from the FDA or [the American Society of Health-System Pharmacists] ASHP, but very often it also comes from gray marketers. There may be social media posts or emails, and this causes hospitals and other purchasers that are in the know to essentially buy up supply.

That then leaves smaller purchasers that may not have the same level of human resources to monitor this sort of information. It is sort of like the toilet paper shortage we all experienced in 2020, right? Those who were on the up and up went and bought all the toilet paper, and then many people were left without toilet paper, even though there was a lot of toilet paper in the country at the time.

So, it can be pretty damaging. What we wanted to do with this analysis was to really quantify this, and I think that is what is new about what we have done here. We wanted to quantify the extent of protective purchasing and also understand where and in what context it tends to happen. That is the first step to then start to think about how to mitigate that risk

Pharmacy Times: USP’s analysis shows that nearly half of newly announced shortages trigger immediate demand spikes. What are the early warning signs pharmacists should watch for to distinguish a true supply constraint from a demand-driven surge?

Raghavendra: One suggestion that my colleague Laura Bray always has is that every hospital and pharmacist know which medicines are important to their patient community. To summarize, buy when the situation is green rather than red, and participate in buffer inventory programs.

If pharmacists are signaling that they want to keep a safety stock of certain essential medicines and they are doing it before there is a shortage, that is great, because it gets built into the forecast. Essentially, you are not exacerbating a bad situation when there is a shortage, right? That is one really good strategy.

It is also important to differentiate. In our analysis, we showed that certain types of medications are more prone to protective purchasing behavior. It tends to be generic medications, injectables, and really essential medications. For protective purchasing to happen, you need both an increase in demand and available supply to meet that increase in demand. If you are not seeing it in certain categories, it is either because there is not an increase in demand or because the supply is already so constrained that there is not that option.

As a pharmacist, I would not try to predict which categories of medicines are going to see protective purchasing. If you participate in programs like Civica, or if you have a GPO contract with buffer programs, those are all good ways to make sure you are protected when there is a shortage.

The USP Medicine Supply Map has something called a predictive vulnerability score. This is an additional tool pharmacists can use to identify which drugs are most at risk of shortage and plan accordingly. You cannot buy extra stock of everything because that costs money and takes up space, so vulnerability scores are a good way to identify which drugs are actually at risk of shortage.

Pharmacy Times: Information gaps seem to play a major role in amplifying protective purchasing. What types of real-time data or visibility tools would be most valuable for pharmacists when making purchasing decisions during emerging shortages?

Raghavendra: Again, I do want to highlight—and maybe this is the place to do so—that the USP Medicine Supply Map has information and insight into which drugs are at impending risk of shortage. It takes a long-term view. The idea is not to promote protective purchasing but to give pharmacists enough advance notice so that they are buying when the situation is green rather than when it is red. That is a great tool.

Pharmacists should also track ASHP and the FDA as official sources of information, and those are always great resources. I will also give a shout-out to the End Drug Shortages Alliance. They have a transparency pilot underway right now where hospitals are sharing information and distributors are sharing information about their stock levels. This acts as an early warning if there is a likelihood of a shortage for a particular drug.

The nice thing about doing this through the End Drug Shortages Alliance is that it centralizes information. This allows coordination so that everyone is buying what they need and not more than what they need. It creates situational awareness across the system about where supply stands, who needs what, and how to make sure everyone is getting what they need without overbuying. Distributors are part of that as well, which helps inform their allocation decisions.

Pharmacy Times: Allocation strategies can help temper protective purchasing, but they can also limit access. How can pharmacists work collaboratively with distributors and manufacturers to ensure allocations protect patients rather than exacerbate inequities?

Raghavendra: That is a really great question, and I know that this is something distributors are working on. I will again flag that the End Drug Shortages Alliance is a great resource. It is a place to share real-time information about real need and real availability and to match availability to need.

These kinds of programs are still in the pilot stage, but the idea is that if you can scale them, you then have a place where people can share information that informs allocation decisions. Those decisions are based on current patient need, as opposed to historic buying patterns.

Pharmacy Times: Looking ahead, what role do you see pharmacists playing in national efforts, such as USP’s Medicine Supply Map or transparency pilots, to reduce volatility in the drug supply chain and ensure essential medicines reach patients who need them most?

Raghavendra: Yeah, I mean, pharmacists are the front line, full stop. They understand what patients need and are often making the purchasing decisions. Every pharmacist is buying for their own patients and does not have visibility into what other patients need or what other hospitals and purchasers might need.

We have a system of decentralized purchasing, which is what causes this issue to begin with. There is a lack of visibility across silos. I think the more pharmacists can participate in efforts like the End Drug Shortages Alliance and start using tools like the USP Medicine Supply Map, which try to break down those silos and create a more holistic view of what is happening in the supply chain, the better. This allows pharmacists to act with more knowledge about what might be coming down the pike.

Another thing the USP Medicine Supply Map does is show how long a shortage is likely to last. With that information, pharmacists can say, “Maybe I do not need 100 units of this medicine. Maybe I only need 20 or 30 to meet my patients’ needs, plus a small buffer.” They now have reliable, confident information from manufacturers, distributors, and tools like the Medicine Supply Map to guide those decisions.

One of the things we highlight in the article is something I have heard from pharmacists, which is that they will buy products from manufacturer A but also from manufacturers B and C because they do not know whether manufacturer A is going to be able to fulfill supply. Suddenly, they may end up with three times as much stock as they need.

These are all issues that we can fix with more coordination and more centralized visibility. I would say to pharmacists that participating in these types of initiatives is really the way to go. It helps overcome the challenges of decentralized purchasing and supports more informed decisions that consider the entire system.