Shortages of prescription drugs and even some over the counter drugs are continuing to plague our healthcare system causing stress on both patients and their providers. While drug shortages are not a new issue and can result from obvious reasons such as delays and discontinuations; in 2023 drug shortages surged. And as of February 2024, there are now over 300 drugs affected. Drug shortages are the highest they’ve been in over a decade. There are various reasons for the current situation and it’s important to know how to decipher what the root of the issue is with each drug in order to know how to navigate a resolution.
Supply Issues
Supply issues typically drive drug issues and in recent years drug shortages have remained fairly stable, but in 2023 the consumer demand increased. Attention Deficient Hyperactivity Disorder (ADHD) medications were one of the affected categories. There was initially a shortage in these medications due to increased demand. However, the shortages have persisted because of increased mental health awareness efforts causing more people to seek help as well as restrictions that have been put on opioids which in turn caused decreases in manufacturing these drugs. ADHD medications are not the only drugs impacted. Cancer treatments, antibiotics, pain medications and many others also make the list.
The impacts we are seeing right now vary from annoyances such as having to visit several pharmacies in order to locate one that has a particular medication in stock to more serious life or death situations such as cancer patients not having the medications necessary to extend their life. Chemotherapy and hormonal drugs were characterized as some of the most severe shortages in 2023. Alternative medications don’t always give the same result. Consumers also face higher out of pocket costs and adverse health outcomes.
The US has had to outsource manufacturing to other countries which has raised quality control concerns adding to the stress. The majority of antibiotics have been manufactured in China. The FDA has authority to perform inspections in the US but it's far more difficult to inspect international supplier sites.
How to Navigate Shortages
So what do we do on a consumer level when faced with a drug issue? The FDA updates the drug shortage list daily with new and resolved shortages and this list also includes information provided to them by suppliers which can be helpful. The list focuses on the shortages that have the largest impact on public health and it is not an all-inclusive list. If a shortage is expected to be resolved soon it likely won’t make the list. However, it can be a useful resource in some situations and help you determine whether there is a shortage, or the drug isn’t available to you for another reason.
In some cases, coverage can be the culprit although manufacturing and quality issues are the major players currently. If you believe you are having trouble filling a prescription due to your current coverage, there are resources you can utilize to confirm that. You can call your carrier directly or visit the carrier’s website to review a list of prescriptions your plan covers or review your summary of benefits and coverage which you can obtain from your carrier or plan administrator. Clients with Generous Benefits can access their summary of benefits and coverage under the documents section of their unique employer website. Reaching out to your broker for assistance can also help navigate these concerns. We are here to help our clients with any issues that may arise and ensure employers are able to provide the coverage their employees need. We can review any necessary medications prior to selecting plans and help find the best options for your workforce.
If a drug is no longer covered on your plan there are various things, you may be able to do. It’s always helpful to make sure you are using an in-network pharmacy. Some plans will allow a one-time refill after you first enroll. This buys you time until you can discuss an alternative with your doctor. You also have the right to follow your insurance company’s drug exception process which may allow you to get a drug that is not normally covered by your plan. Contact your insurance company for specifics on this process as it varies between carriers. There are conditions that must be met in order to be approved. They may also give you access to the drug while the decision is pending.
There are many different prescription programs such as Clever Rx that may allow you to fill certain prescriptions at a lower cost as well. We can help you navigate and explore those additional options.
Don’t be afraid to ask questions when you are being prescribed a new mediation. Ask your doctor if they are aware if the drug has experienced recent shortages or if they’re aware of other patients struggling to fill the script. Asking questions such as does my insurance cover this medication, what alternatives are available or are there cheaper options can help you be proactive and know whether a drug may be difficult to find. Asking these questions before leaving your doctor’s office can set you up for success. Don’t hesitate to contact your carrier and ask questions about your coverage. When you are paying for insurance, you have the right to ensure you can get the most out of your plan. Your broker can help direct you and explain any language that you are unsure about.
Sources:
https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages
http://www.aha.org/lettercomment/2023-07-aha-responds-request-information-drug-shortages
http://acadpharm.org/dos_public/IQVIA_DRUG_SHORTAGES_USA_2023.PDF
