If you opened the newspaper and saw an article that said drugs were in short supply and thus their street cost is skyrocketing, causing buyers to go deep into the black market and overseas to replenish their stores, what would immediately come to mind? Pablo Escobar? Willie Nelson needs to re-route his bus? Plot of Cheech and Chong’s comeback vehicle?
But the fact of the matter is that this is the very true story of the U.S. pharmaceutical market right now, where critical shortages of legal prescription drugs are leading physicians and hospitals to turn away patients and/or delay the administration of life-saving medicines. According to a recent NY Times article, “So far this year, at least 180 drugs that are crucial for treating childhood leukemia, breast and colon cancer, infections and other diseases have been declared in short supply — a record number.”
By the way, by “other diseases” they don’t mean weird stuff like cat scratch fever, they mean everyday problems such as diabetes, heart disease, and even drugs for surgery and anesthesia. In other words, we are talking shortages of drugs that could send everyone’s grandma to the area under the nearest high school bleachers to whisper, “psst…I’ll trade 4 dozen of my best cookies for a dime bag of metformin.”
Michael Fitzhugh of The Burrill Report writes that, “Shortages of common medicines have reached a record high and are a nearly universal problem for community hospitals in the United States, where the problem is leading to rationing and higher costs for care… Among 820 community hospitals surveyed by the American Hospital Association, 99.5 percent reported experiencing one or more drug shortages during the last six months and nearly half of the hospitals reported 21 or more drug shortages.”
We all worry about things like whether we’ll have insurance coverage and whether we can get in to see the right doctor fast when we are seriously ill, but this is the first time I can imagine anyone having to be genuinely worried about whether, once they are already under a doctor’s care, they can get the medicine they need to get better. For cancer patients, where reliability and adherence to a particular drug regimen can mean the difference between life and death, this is literally a problem with potentially disastrous consequences.
According to the NY Times article, “Many institutions say they have delayed patient treatment as a result of drug shortages and more than half were not always able to provide patients with the recommended treatment, they said.” Not a good situation.
And if the clinical nightmare of this isn’t bad enough, the Burrill Report cites that a recent industry survey of 353 hospital pharmacy directors found that labor costs associated with managing shortages cost an estimated annual $216 million in the United States. So in other words, healthcare costs are skyrocketing whether we can treat people or not. Perfect. To make matters worse, the NY Times article reports that executives at Premier, a hospital buying cooperative, have recently “received hundreds of offers from obscure drug wholesalers to sell drugs in short supply at vastly inflated prices. Of the 636 offers that included a price, 45 percent were at least 10 times the normal rate and 27 percent were at least 20 times normal.” Gotta love that Adam Smith and his trusty old invisible hand.
The cause of these medicine shortages is complex and many-fold and, as usual, industry and government are pointing their fingers at each other to affix blame. According to various articles on the topic, the causes of the critical medicine shortages includes:
- Problems, such as contamination, found by government or company inspectors at newly inspected foreign pharmaceutical manufacturing facilities
- manufacturing capacity problems at certain plants
- raw materials shortages
- pharmaceutical company consolidations leading to the reduction in less profitable product lines
- FDA technical and regulatory hurdles rendering it more difficult for drugs to get to market, even when they have long been approved; and even,
- unexpected natural disasters
So now what?
There is a range of solutions out there being discussed including everything from the government creating a national stockpile of cancer medicines to the formation of a doctor-formed nonprofit company to import scarce drugs to forcing pharmaceutical manufacturers to report potential signs of drug supply disruption to the FDA. There are recommendations that the FDA streamline its approval processes when it comes to critical drugs and that the government provide financial incentives to pharmaceutical companies to bring less profitable but highly e
ffective low cost drugs back to market. Say what? On the one hand, under the PPACA health reform law, we are taxing pharmaceutical manufacturers on profits to pay for health reform and, with the other hand, we are talking about paying the same guys to sell more of the stuff that they find unprofitable. This has to be the very definition of irony at work.
I guess the lesson in all this, given the state of the healthcare system and the economy, is this: you should be stockpiling both gold and Lipitor. Note to self: get a bigger mattress.
In closing, for those of you who enjoy the occasional medical comedy videos I post, here is one on a new pharmaceutical miracle, as envisioned by Robin Williams. Warning: Robin Williams is not afraid to use swear words in his routines, so don’t watch it if the only four-letter word you want to hear is “love”.
