Record drug shortages across the United States are delaying potentially lifesaving treatments for thousands of patients around the country.
Congress and the White House are scrambling to address a shortfall in prescription drugs — everything from painkillers to cancer treatments.
“Hospitals all across the country, on a regular basis –sometimes weekly — have to review which drugs are in short supply or not available that week.” Senator Gary Peters (D-MI) said in an interview with MSNBC.
The shortage is being most acutely felt in the generic drug market, which accounts for nearly 90% of U.S. prescriptions. The exact number of drugs being affected depends on who you ask — according to a Senate report at the end of last year, the U.S. reached a peak level of 295 active drug shortages, although as of March, the FDA claims there are 130. The American Society of Health reports 301 drug shortages as of the first quarter of 2023.
According to the FDA, the average drug shortage lasts for about 18 months, but some shortages have stretched on for over 15 years.
Some of the medicines that have been in short supply include Adderall, Tylenol, various antibiotics including amoxicillin, saline mixtures used in IVs, and almost two dozen kinds of anti-cancer drugs.
That last group is especially troubling because, unlike some other drugs in short supply, patients don’t have a lot of alternate options for treatment. Chemotherapies for breast cancers, ovarian cancers, lung cancers, bladder cancers, and some forms of leukemia have been delayed or disrupted, sometimes with fatal consequences.
According to one recent survey by the Society of Gynecologic Oncology, doctors in 35 different states said they had little to no supply of multiple chemotherapy drugs, including specialists at cancer centers. According to Laura Bray, founder of the non-profit Angels for Change, which helps micro-source rare medications for patients, 9 out of 10 oncologists say the shortages have caused patient harm up to and including death. With less medicine and the same number of patients who need it, doctors around the country have been having many hard conversations about who does and doesn’t get their dose.
With dozens or hundreds of active shortages, there is no single overriding factor that explains all the shortfalls, but several trends have emerged.
Some drugs, like Adderall and Ozempic, are skyrocketing in popularity due to alternative uses, exhausting limited supplies. Adderall is meant to treat ADHD but is abused by some students and professionals to increase concentration on various cognitively demanding tasks. Ozempic is meant to treat Type-2 diabetes but has been used as a “miracle weight loss drug.” Supply hasn’t caught up with the surge in demand.
Other observers have attributed the shortages to disruptions in the global supply chain. Exact statistics are difficult to come by — part of the problem is that the supply chain for some pharmaceuticals is not totally transparent, to the point where regulators don’t even know for sure where everything comes from — the FDA actually petitioned Congress for more resources to figure that out.
Near as the Senate can tell, though, about 80% of “pharmaceutically active ingredients” – the most important part of any drug – are manufactured outside the U.S. If these foreign sources had their economies locked down or started hoarding supplies, that could completely gut our supply chain. China has often been highlighted as a prominent and problematic international supplier and many lawmakers view this as a serious strategic weakness of the United States.
Other observers have claimed that the problem is more domestic in nature — they say doctors have a tendency to overprescribe antibiotics to patients that don’t actually need them, which makes them less available and less effective for patients who do.
“Panic buying“ has also been blamed – a perceived shortage can become a self-fulfilling prophecy as consumers rush to buy up all available supply.
But while all these immediate causes have drawn considerable attention, some are claiming that more basic market forces are to blame.
Many lifesaving drugs aren’t very profitable to make – with some bringing in only pennies per dose. Those narrow margins discourage newcomers from entering the sector, and if there are supply chain issues that make the product more expensive, established players are more likely to cut corners or stop making them altogether.
There’s been an upward trend in the number of drug shortages over the last few years, while the prices of generic drugs have dropped 50% since 2016.
Several factors have prevented drug prices from shifting as a function of supply and demand
The pharmaceutical market is highly consolidated – while there are thousands of hospitals and pharmacies, most get their supplies from a small number of intermediary firms. A review by a healthcare analytics company called IQVIA found that 3 buyers purchase 90% of all generic drugs. With so few potential customers, each one has substantial leverage over what price they’re going to pay.
The U.S. government is a major player in healthcare, and lawmakers have passed limits on how much companies are allowed to charge for various drugs.