Western Pa. hospitals juggle worsening medication shortages

Briefings on medication shortages are part of Dr. Arpit Mehta’s routine.

As director of pharmacy at Allegheny General Hospital, Mehta sits down with his team for an hour every week to talk about medications the hospital may have difficulty keeping in stock.

“Our list is 100-ish medications that we are monitoring, where the supply is lower than our demand,” Mehta said. “Medication shortages are certainly a challenge to manage.”

At any given point, 50 of those medication shortages require the hospital to focus on mitigation strategies, he said.

“The point of the call is we want to preemptively prevent running out of medications,” said Dr. Sarah Young, clinical pharmacy specialist in AHN’s neuro intensive care unit.

“If we get notified that something is going to go on shortage, we’ll meet and strategize and say, ‘What are we going to do?’ ” she explained.

“We’ll come up with a plan,” Young said. “Is there an alternative that we could pivot to and use? Is it something that we have to notify our prescribers and say, ‘Hey listen, we are short on this stock, and we are worried we are going to run out; we are going to suggest you use it for this particular patient population only and use an alternative for all other indications?’ We work really hard to make sure we don’t run out.”

These types of strategy sessions have become commonplace for hospital systems in the region and across the nation. Supply chain challenges that started during the pandemic coupled with unpredictable natural disasters have each impacted the flow of needed medication, and the unprofitability of some generic medications has meant less companies are interested in producing them.

Shortages have impacted hospitals for years, but they are worsening. All the factors combine into a perfect storm — one where ongoing and active medication shortages have risen to their highest levels since the American Society of Health-System Pharmacists began tracking them in 2001.

“This is something we’ve been dealing with for 15-plus years. It just ebbs and flows. I don’t expect it to change,” Young said. “I feel like we’ll always experience a shortage of something.”

Hard-to-source supplies

Among the 323 medications that are experiencing shortages are IV injectable drugs used to treat blood pressure problems, as a sedative, for chemotherapy and as fluids to compound medications or hydrate patients.

Fewer companies make generic injectables because they are less profitable, Mehta said. Natural disasters also disrupt the supply chain, he noted, such is the case of a tornado that hit a Pfizer plant last year.

“Pfizer is one of the major generic injectable producers,” he said. “The market had to be resupplied with those medications because they were all destroyed at that point.”

“It’s lack of redundancy of plants in the U.S., and limited control of what’s happening overseas,” noted Dr. Rebecca Taylor, vice president of pharmacy service with UPMC Corporate Services. She also called out generic IV drugs as a shortage stressor.

“Right now, there’s a shortage of an immune globulin that we give to pregnant women, and we can’t even really get an answer to why there’s a shortage. We’re sourcing it from five different companies and doing everything we can to make it safe for our patients.”

At UPMC, pharmacists are tasked with monitoring and addressing drug shortages.

“Sometimes we have to change the patient to a different drug or ask is there another drug that we could shift the doctors to, or shift the patients to,” she said. “There’s a lot of administrative work around that.”

Taylor noted hospitals have improved at responding to shortages over time — but it still takes up valuable portions of a pharmacist’s schedule.

“It’s at a cost of, this is what pharmacists have to spend time doing. Talking to doctors, pulling doctors away from care so that they can help us come up with a plan,” she said. “It adds to that stress and burnout (when we) don’t have the tools to do our job.’”

Michael Sekhon, vice president of ancillary services at Independence Health System, said Independence handles shortages similarly.

“The pharmacies and the hospitals are really good at shifting things around or changing dosages, or borrowing from other areas to actually get to the patient what they need,” Sekhon said. “It’s uncommon that a patient goes without their drug. Maybe that’s a little different in the outpatient world — in the hospitals, right now, and maybe I should knock on wood, we are doing all right. It’s a daily, full-time job for some people here — we have buyers that are working on this every day.”

Substituting different drugs or different formats of drugs can help with shortages but can introduce a safety concern into the mix, he said.

“Human nature is, you look at that drug box and remember that ‘I’ll use the red cap one,’” he said. “If it changes color, you’re kind of in trouble. We do a ton of med safety and patient safety stuff to get ahead of that. We do barcode scanning. I want all of my nurses and all my techs to read that vial, never (decide) off of the look, and scan every product.”

Covid-era supply chain shortages still reverberate in the health world, he said.

“We’re still seeing some of the aftershocks there,” he said, highlighting the worker shortages in the field. “Everything’s trying to catch up with, ‘How do we fill enough workers at the factory or whatever raw materials source,’ down to the drivers of the freight trucks and the drivers of the boats.”

Prognosis

The shortages began to ease up in the past six to 12 months Sekhon said.

“Things have gotten more better than worse, but they’re still the worst they have been,” he said. “We seem to be on an upswing with them.”

“There were times, especially during covid, where your main drug size that you wanted to get was unavailable, the size up was unavailable, and your two or three backup drugs were unavailable. Then you’re at the point where what do you do? We’re at the point now where if the first two, the drug itself and the next size, aren’t available, I can’t think of too many instances where a substitute was unavailable. It’s getting better.”

AHN partners with generic manufacturers such as Civica RX, Mehta said, to help ensure there will always be some level of supply of needed medications.

“There’s several medications that we are partnered with Civica for that we are partnered to obtain. We may pay a little bit higher price, but we are guaranteed that supply,” he said.

Taylor said UPMC continues to talk to legislators to highlight the issue of medication shortages. Administrators want manufacturers to be required to notify hospital systems if they expect a problem or major delay.

Now and in the future, the supply chain will impact hospitals’ ability to get the medications they need, said Chris Chamberlain, vice president of emergency management at the Hospital and Healthsystem Association of Pennsylvania.

“Right now, more than ever, hospitals have to pay attention to the intricacies of the supply chain. A weakness in that chain can really have a significant impact on their ability to operate and care for patients,” he said. “Many have developed some contingency planning or other procedures to adapt to that.”

The health world has learned some lessons from covid, he said.

“It does benefit hospitals to pay attention to threats such as supply chain weaknesses, and then (we’re) probably better at doing that now because of the experience that we had during the pandemic,” Chamberlain said. “It’s definitely changed — we pay more attention now to those types of things than probably we did in the past.”