The United States is currently facing a severe drug shortage crisis, as reported by the Food and Drug Administration (FDA). Over 1,450 pharmaceutical products, ranging from antivirals to painkillers to pediatric treatments, are in short supply, and the situation is anticipated to worsen.
This crisis is pushing doctors and patients to extreme measures, including rationing drugs or delaying vital treatments. Among the affected drugs, 14 are crucial oncology medications, predominantly injectables used for chemotherapy. The shortage of these medications is forcing cancer patients to postpone their treatments, leading to potentially harmful consequences for their health.
Reasons behind the Drug Shortage:
While some drug shortages may be attributed to high demand or overprescribing, the majority of the affected drugs are facing chronic supply issues rather than a surge in demand. The disruptions caused by the COVID-19 pandemic may have contributed, but these mostly occurred overseas, while the shortages mainly affect US-manufactured generic drugs rather than imports.
The Predicament of Generic Drugs:
The primary issue with the drugs in short supply is that they are mostly generics. Unlike brand-name drugs, which can command high prices due to patents, generics predominantly compete based on their affordability. Large buyers, such as Walgreens, Red Oak Sourcing, or ClarusONE, who account for 90% of generic drug purchases, prioritise low prices over other factors, including the manufacturer's ability to provide a reliable drug supply.
Underinvestment in Reliable Supply:
Many generics are manufactured by single-plant companies, making them susceptible to supply disruptions caused by even minor infrastructure issues. This underinvestment in reliable manufacturing plants is partly due to the emphasis on price by buyers, creating disincentives for manufacturers to invest in robust plant infrastructure and personnel. Furthermore, large buyers often enter sole-source contracts with a single drugmaker to secure volume pricing, leaving them with no alternatives when the supply chain fails.
The Price-Quality Dilemma:
Generics account for approximately 90% of drug prescriptions in the US but only 17% of spending. The median price of drugs that experienced shortages between 2013 and 2017 was a mere $9, and generic prices have not risen to match inflation. This lack of profitability discourages manufacturers from making necessary investments. Virginia senator Morgan Griffith highlighted this issue, emphasising the need for payers to recognise the importance of quality and be willing to pay for it.
Potential Solutions:
Addressing the US drug shortage crisis requires a multifaceted approach. Encouraging investment in reliable supply infrastructure is vital to ensure the consistent availability of medications. Policy interventions could incentivise buyers to prioritise quality over solely focusing on low prices. Creating financial incentives for payers to recognise and reward manufacturers for reliable supply can help break the cycle of underinvestment. Additionally, exploring partnerships between generic drug manufacturers and healthcare organisations could facilitate collaboration and mutual commitment to ensuring a stable drug supply.
The drug shortage crisis in the United States poses significant challenges, particularly for cancer patients who rely on essential medications. The chronic shortage of oncology drugs and other generic medications necessitates immediate attention and action. By addressing the underlying factors, such as underinvestment in reliable supply infrastructure and the price-focused approach of buyers, policymakers and stakeholders can work together to find sustainable solutions. Ensuring the availability of critical medications for cancer patients is not only a matter of patient well-being but also an urgent public health priority.
