Over 99% of US Hospital Pharmacists Reported Drug Shortages

The American Society of Health-System Pharmacists (ASHP) recently published statistics on ongoing drug shortages in the United States. The organization’s survey of hospital pharmacists revealed that over 99% of hospital pharmacies in the United States have been affected by prescription drug shortages.

The ASHP noted that, as of July 2023, the US was experiencing 309 ongoing drug shortages. According to the organization, this is the most significant shortage in the past decade, nearing the most considerable shortage, impacting 320 drugs.

Attempting to understand the impacts of the shortage on healthcare facilities and patient care, the ASHP released an online questionnaire to its members. The survey yielded results from 1,123 participants in varying roles, including pharmacists, pharmacy technicians, and pharmacy residents. Patients worked across various work settings such as hospitals or health systems, ambulatory clinics, outpatient or specialty pharmacies, and other care settings.

Despite wide variations in prescription volume, nearly all respondents reported a drug shortage at their facility. Most participants reported a drug shortage with moderate impact, with 63% of respondents explaining that the effects impacted patient care but could be managed with operational strategies.

Roughly 32% of survey participants expressed concerns about critical shortages that resulted in medication rationing, canceled treatments, or delayed treatment and procedures.

Asked to classify severity by drug class, most respondents identified chemotherapy drugs as the most likely to have a critical impact. In cancer care, early detection and treatment are two of the most significant indicators of survival outcomes. With 57% of surveyed pharmacists reporting critical shortages, patient outcomes will likely suffer. Beyond critical impacts, 29% reported moderate impacts, and 10% reported minimal effects.

Other drug categories — in descending order of reported critical impact — include corticosteroids or hormonal drugs, oral liquids, crash cart drugs, cardioplegia solutions, intensive care unit (ICU) or operating room drugs, attention-deficit/hyperactivity disorder drugs, outsourced parenteral nutrition products, antimicrobials, and injectable opioids.

In addition to analyzing the scope and severity of the drug shortage problem, the ASHP gathers information on clinical and operational strategies for managing the impacts of ongoing supply chain issues on healthcare facilities.

The most common clinical management strategy was replacing a patient’s treatment regimen with a therapeutic alternative. However, in oncology, a therapeutic or second-line option that may not be as effective as the first-line choice can significantly alter patient outcomes.

Other clinical management strategies included implementing rationing criteria, converting to different dosage forms, changing the order sets or protocols, and delaying or canceling treatments.

Operational management strategies included purchasing drugs in other vial sizes or concentrations, centralizing or consolidating inventory, changing products, insourcing, and more.

Additionally, ongoing drug shortages continue to impact healthcare spending, with 32% of participants reporting that their facility had a 6–10% drug and labor budget increase due to the shortage.

The pharmaceutical supply chain has faced a plethora of issues in recent years. Impacted significantly by the COVID-19 pandemic, this healthcare sector needs stability. As manufacturers work to keep up with drug demand, government officials are tasked with developing a plan to minimize the impacts of shortages.

In an interview with PharmaNewsIntelligence earlier this year, Michael Ganio, PharmD, Senior Director of Pharmacy Practice and Quality for the American Society of Health-System Pharmacists (ASHP), proposed multiple long-term and short-term management strategies. While short-term plans are vital for managing immediate impacts, long-term strategies such as supply chain transparency, manufacturing technologies, and national stockpiles can help prevent shortages of this magnitude.