Drug shortages come with many implications for health systems

The number of drug shortages in the US is on the rise, and they have some serious implications for health systems.

Shortages can cost health systems hundreds of millions of dollars, force providers to work longer hours, and compromise patient care quality.

The “inability to provide optimal patient care” is the number one implication, Michael Ganio, senior director of pharmacy practice and quality at the American Society of Health-System Pharmacists, told Healthcare Brew.

For one, a drug shortage could mean a provider can’t prescribe their top drug choice.

In a 2017 survey from the Institute for Safe Medication Practices (ISMP)—a nonprofit focused on helping health systems prevent medication errors—71% of providers said they were unable to prescribe a preferred drug due to shortages in the six months leading up to the survey. Because of that, 47% of the providers said they believed their patients received a less effective drug.

Shortages could also mean patients have to wait longer to receive treatment. In the ISMP survey, 75% of providers said drug shortages had, at some point, caused their patients’ treatment to be delayed.

There are also medication safety concerns related to shortages, Ganio said. In a 2019 survey of US hospitals from healthcare services firm Vizient, 38% reported one or more medication errors directly related to a drug shortage during the last six months.

Nearly a quarter of respondents in ISMP’s survey said they were aware of at least one medication error related to a drug shortage during the last six months. Most of these errors involved an inaccurate dose or concentration of a medication, the participants reported. 

Working overtime

Drug shortages can require a lot of extra work. Vizient’s survey found that health systems spend on average more than 8.6 million hours of additional labor every year managing drug shortages.

That time is spent performing tasks like looking for alternative drugs and updating electronic health records with the new drug information, according to Erin Fox, associate chief pharmacy officer of shared services at the University of Utah Health in Salt Lake City.

“When you have to keep buying different products—maybe a different size, or a different strength—that all creates a lot of extra work,” Fox said.

All of that extra labor is expensive. Vizient’s survey found that labor costs associated with drug shortages add up to around $359 million annually—but that’s a conservative estimate.

“When you also add the cost of more expensive alternative therapies, direct purchases outside the hospital’s traditional channels, medication errors, and canceled or delayed medical procedures, we believe the actual cost of drug shortages to hospitals is significantly higher,” Dan Kistner, group senior VP of pharmacy at Vizient, said in a statement.

Unequal effects

Not all hospitals are equally equipped to handle shortages.

Larger health systems are more likely to be able to build “buffer inventories” of drugs, Ganio said, so they can maintain several months of supply at a time.

“They probably have a more ready-to-go drug shortage team to start talking through strategies on management,” Ganio said.

Larger systems also often have a pharmacist whose full-time job is managing drug shortages, according to Stephen Schondelmeyer, a professor of pharmaceutical economics at the University of Minnesota. Rural hospitals are less likely to have the same resources, Fox said.

On the other hand, larger health systems are “much more likely to be more impacted” by shortages because they see more patients, Fox said.

And during a time when clinicians are already experiencing high burnout levels, shortages are just  “one more thing for them to have to worry about,” Ganio said.