New List of Essential Drugs Shows Hospital Supply Chain Fragility

A new list of essential medications is highlighting the fragility of the hospital supply chain. The list devised by group purchasing organization Vizient names 200 drugs that, if unavailable due to drug shortages or other circumstances, would prove the greatest threat to immediate and high-quality patient care.

These essential medications included 77 acute and chronic life-saving drugs, vital chemotherapy drugs, and life-saving reversal agents such as epinephrine and naloxone that have no alternative in the wake of any supply disruption. 

“While any drug shortage can create numerous clinical and operation hardships, the lack of certain medications would pose a greater risk of negative outcomes due to the novelty of the drug’s use and/ or the vulnerability of the patient to whom it is administered,” Dan Kistner, group senior vice president, pharmacy solutions for Vizient, stated in an official announcement of the list.

Vizient, representing more than half the nation’s acute care providers, voiced their goal to increase awareness of supply chain fragility and push manufacturers to increase the available supply of these classified essential drugs.

After conducting a review of the World Health Organization’s Essential Medicines list, the Advanced Cardiac Life Support and Pediatric Advanced Life Support algorithms, and direct input from clinicians, Vizient uncovered essential patient medications using three definitions:

• Acute treatment drugs with no alternatives
• Chronic treatment drugs with no alternatives
• High impact drugs

.Not only are these drugs essential in emergency situations, but they are also crucial in routine patient care, according to Kistner.  

Drug shortages continue to be an issue throughout the US due to manufacturing and quality problems, delays, and discontinuations and other reasons.

A Vizient survey conducted in July 2019 found that all hospitals surveyed had experienced a shortage, while two-thirds responded that they saw at least 20 shortages between July and December 2018. 

Thirty-eight percent of respondents said that they believed medication errors were directly linked to drug shortages. And they also said that shortages delay procedures and care delivery across departments, some even leading to cancellations altogether.  

These drug shortages not only posed a threat to patient care, but also the stability of the hospital supply chain.

Hospital leaders said they allocated over 8.6 million hours of additional labor hours to managing drug shortages each year. This translated to $359 million of additional supply chain spend every year. 

Hospital prescription drug spending is already slated to increased by 3.59 percent through next year, according to Vizient’s most recent outlook on drug prices. The increase may not be the double-digit percentage growth observed in the past, but the organization reported that the modest increase equates to over $2.5 billion in additional drug spend for member hospitals next year.

In light of the hospital supply chain’s fragility, seven health systems stepped up to address drug shortages.

In 2018, the health systems, later joined by 12 other health system, launched a non-profit generic drug company to lower prescription drug rates and tackle drug shortages for providers. The company expected to become an FDA-approved manufacturer of generic drugs and provide an affordable and steady drug supply to hospitals and providers.

The company provided its first medication to patients at Riverton Hospital in Utah in October 2019.

“Healthcare systems are in the best position to fix the problem in the generic drug market. We witness, on a daily business, how shortages of essential generic medications or egregious cost increases for those same drugs affect our patients,” explained Marc Harrison, MD, president and CEO of Intermountain Healthcare, one of the founding members of Civica Rx. “We are confident we can improve the situation for our patients by bringing much needed competition to the generic drug market.”