Prescription drug shortages worse than last summer

Drug shortages are more severe than a year ago at Jefferson County Health Center according to hospital pharmacy director Carri Pumphrey.

Although Pumphrey said the hospital is in an exciting time of expansion and has hired a new pharmacist to help her keep up with demand, drug shortages have reached new levels this summer, forcing her to ration an important medication in one instance.

?Other hospitals are hit hard by the economy, ours is growing,? said Pumphrey. ?But we have all these shortages to deal with.?

Drug shortages came into the national spotlight last year after the American Hospital Association surveyed its members to find 82 percent of hospitals were delaying treatment due to shortages. And 69 percent of hospitals reported giving patients a less effective treatment because of shortages.

Last October, President Obama signed an executive order in response to the drug crisis. It called for the U.S. Food and Drug Administration to approve expansion of drug manufacturing more quickly, and gave the FDA the authority to investigate suspected price gouging.

The FDA reported Obama?s measure successful this summer, saying it has prevented 128 drug shortages since then, with 42 new drugs going into shortage in the first half of 2012, compared to 90 during the first half of 2011.

But Pumphrey said these improvements have not yet become apparent in Fairfield.

?For us I think it?s worse now,? said Pumphrey.

This summer she ran out of IV diarretics for the first time, which she said is essential in treating people with heart failure.

Pumphrey watched her supply dwindle, and was forced to tell doctors to begin rationing.

?When we got down to last 10 vials, we said ?Don?t use any unless it is an emergency,?? said Pumphrey. ?A couple of times they had to make tough calls.?

?That?s just a terrible thing,? she said. ?We really haven?t gotten to that point in the past when there wasn?t an alternative.?

Pumphrey said currently she ?really worries? about roughly 10 medications, which she can?t obtain and have no easy alternatives. She said she has trouble with another 50 drugs, which are unavailable, but do have reasonable alternatives.

She signed up with an alternative supplier to use in emergencies, but she said sometimes medications aren?t available anywhere. Pharmacy staff follow certain steps in dealing with shortages. First, they will look for the same product with another manufacturer or wholesaler. Then they will look for the same drug in a different package size or different strength. If both fail, they will check to see if the drug has a reasonable alternative.

Drug shortages have been concentrated in older generic drugs, which tend to be less expensive, according to a health department study in 2011 showing drug manufacturers are moving away from less profitable drugs. The FDA has cited other causes such as quality problems, increase in demand, shortages in raw materials, limited manufacturing capacity and market concentration.

Pumphrey said shortages are a moving target however, waxing and waning across all treatment categories.

Last year, Pumphrey had critical shortages of emergency medications, which she said could cost 100 times the price of the generic brands. Though she?s seen a slight improvement in those areas, this year she?s short on propofol, a hypnotic agent used to help patients fall asleep before surgery.

The alternative for propofol costs more than three times the price.

?Although we can provide it, its an economic burden for us,? she said. ?The price of alternatives are often much higher.?

The pharmacy manager at Fairfield Hy-Vee Food and Drug Store, Tom Wetrich, has noticed the same trend. He said when people bring a prescription to his pharmacy from the doctor?s office, if he doesn?t have it, he or the patient will call the physician for an alternative.

?Prices for alternative drugs can easily triple or quadruple,? said Wetrich.

Pumphrey has paid higher prices for drugs such as chemotherapy to treat bladder cancer, and said she?ll buy the more expensive alternative to propofol if she runs out. She said the hospital does not question her purchases.

?They give us enough freedom to do our job,? she said. ?They know we put patients first.?

Pumphrey said she has focused on communicating with physicians and nurses to eliminate error when working with unfamiliar drugs with different doses.

?I can?t recall we?ve made an error because of drug shortages,? she said, ?but it?s because we really work at it.?