US Drug Shortages Reach Critical High, Threatening Patient Care and Straining Healthcare Systems
A surge in drug shortages across the United States is placing immense pressure on healthcare facilities, driving up costs, and potentially compromising patient safety. A recent survey by Vizient revealed a record 323 active drug shortages in the first quarter of 2024, a significant escalation of a problem that has plagued the industry for years.
The Escalating Crisis: A Record Number of Shortages
The landscape of drug availability in the US has deteriorated sharply, with hospitals now dedicating an estimated 20 million hours annually to managing these disruptions. This intensive effort translates to a staggering $900 million in labor costs – more than double the $359 million reported in 2019. “Drug shortages in the US are no longer an unfamiliar phenomenon and continue to rise, reaching an all-time high in recent years,” the authors of the Vizient report wrote. “Managing shortages has become an ongoing and labor-intensive process that further stretches already limited resources and tight margins.”
The crisis isn’t impacting all facilities equally. Pediatric hospitals are particularly vulnerable, monitoring at least 25% more shortages than their general counterparts, highlighting a heightened risk for specialized care settings. On average, hospitals are actively tracking 43 different drug shortages at any given time.
Financial and Staffing Burdens Intensify
The financial strain on healthcare institutions is substantial, with 74% of respondents to the Vizient survey reporting that drug shortages have caused them to exceed their pharmacy budgets – a figure consistent with the 75% reported in 2019. Pediatric facilities are experiencing even greater budgetary pressures, with 79% citing overruns compared to 72% of general facilities. Lorazepam injectables and oncology agents emerged as the drugs with the highest impact across both types of facilities.
The human cost is equally alarming. The time pharmacy staff spends managing shortages has more than doubled, increasing from 10.5 hours per week in 2019 to 24.2 hours per week in 2024. This dramatic increase in workload is unsustainable, and the report cautions that the trend will likely persist without significant intervention.
Staffing Adjustments and the Rise of Secondary Distributors
In response to the increased burden, nearly all (98%) of pediatric facilities have made staffing changes, significantly higher than the 83% of general facilities. While many facilities are redistributing workload among existing staff (48-60%), a notable percentage are offering overtime (23-36%) or, to a lesser extent, hiring additional personnel (2-11%). Pediatric facilities are demonstrating a particular need for additional pharmacy buyers to navigate the complex procurement landscape.
A concerning trend is the increasing reliance on secondary distributors. Nearly half (46%) of facilities are now purchasing medications from these sources, including critical drugs like cisplatin, carboplatin, and fluorouracil. However, this comes at a steep price, with an average price increase of approximately 214% compared to standard purchasing practices. Vizient’s National Emergency Stockpile (NES) program is positioned as a safer alternative, offering onshore inventory directly from manufacturers.
Patient Care at Risk: Errors and Disruptions
The impact on patient care is a major concern. The survey revealed that 43% of respondents have identified medication errors related to drug shortages, up from 38% in 2019. Alarmingly, 37% of respondents admitted to not tracking medication errors, highlighting a critical gap in understanding the full extent of the problem.
Patient care disruptions are widespread. Outpatient infusion services are the most affected, with 41% of cases being omitted, missed, or delayed. Planned medical procedures are impacted in 32% of cases, hospital admissions in 22%, and even emergency procedures in 15%. Facilities are mitigating these disruptions by seeking alternative medications, collaborating with other entities, and, in some cases, postponing non-urgent care.
Addressing the Gaps and Charting a Path Forward
Healthcare facilities are utilizing a variety of resources to identify shortages, including the American Society of Health-System Pharmacists, the FDA, wholesalers, and group purchasing organizations. Many respondents particularly value Vizient’s assurance programs. Mitigation strategies include identifying alternative medications, conserving existing inventory, and fostering collaboration among clinical teams.
However, significant gaps remain. The most pressing need is for earlier, more transparent notifications and accurate product release dates. Respondents also called for improved allocation management by wholesalers, increased medication production, and better oversight of the entire supply chain, including secondary distributors. Potential solutions include dedicated shortage management software, the application of artificial intelligence, and increased resources.
Vizient is responding to these challenges by leveraging data-driven insights, fostering collaborations, and developing new frameworks. The organization is promoting drug shortage stewardship and has revamped its Essential Medications List to include demand planning and market resiliency. A national workgroup has also been convened to establish standardized metrics for tracking supply chain issues.
The escalating drug shortage crisis demands urgent attention and collaborative action to safeguard patient care and ensure the stability of the US healthcare system.
