Wanted: Strong supply chains

Abstract

Anyone who has worked in a pharmacy over the past few years knows that medication shortages have continued to become more of a problem, with no apparent end in sight. Because the pharmaceutical supply chain is a highly complex global enterprise, there are likely no quick solutions to this growing problem. This often leaves pharmacists and technicians feeling frustrated when trying to order medications that are high in demand and short in supply. So, what can pharmacies do to be better prepared for future and continued medication shortages? And, more importantly, is anything being done on a national or global level to help mediate this ongoing issue? In 2018, the American Society of Health-System Pharmacists published in-depth guidelines on how to prepare for managing drug product shortages. These guidelines offer recommendations that are more specific to health systems’ pharmacists on how to plan and prepare for drug shortages that will occur. Even though these were published specifically for a health systems audience, there are a number of transferrable pieces that could be used by pharmacists in most practice settings. One of the key recommendations is to identify and create a drug shortage team. The guidelines recommend an interdisciplinary team within a health care system, but in other practice settings it would still be beneficial to designate several key people who will oversee keeping track of product shortages, ordering products that are in short supply, and communicating the status of these shortages to the rest of the team. The importance of communication when shortages occur is also discussed—communication is important both within the pharmacy as well as with patients or caregivers who will be affected by the shortages. Talking with impacted patients or caregivers in an outpatient setting is crucial to ensuring that they are still receiving the care they need. Another potentially useful recommendation is to work with other health systems or pharmacies in the area to strategize on how to best serve the community during times of supply chain issues. This could be particularly helpful if allotments differ between pharmacies. The Johns Hopkins University Bloomberg School of Public Health published a white paper in November 2020 titled The Pandemic and the Supply Chain: Addressing Gaps in Pharmaceutical Production and Distribution. The paper highlights 6 problems the authors believe must be addressed including unexpected increases in demand for critical medications, the disruption of production of critical medications, an interruption of global trade, and inadequate supply chain planning and management. In addition to discussing some of the actions that had been taken by the White House administration, Congress, and FDA, the authors offer 7 policy recommendations they believe will help alleviate supply chain issues. These recommendations include increasing production capacity by expanding the mutual production agreement between the U.S. and Europe, having Congress incentivize domestic production of pharmaceuticals, and having the government create a way to monitor and manage the U.S. pharmaceutical supply chain. The good news is that the current administration has listened to stakeholders about the seriousness of the pharmaceutical supply chain problem and has taken steps toward mitigating it. The administration is working with a task force to increase onshore manufacturing of active pharmaceutical ingredients, improve pharmaceutical supply chain transparency, ensure that essential drugs are available, and collaborate with global allies and partners to strengthen the global supply chain. Three simple steps to help your pharmacy navigate medication shortages▪Designate 2 or 3 team members to be responsible for monitoring shortages and communicating any changes to the rest of the pharmacy team.▪Have a simple plan or protocol in place listing how your pharmacy team should navigate potential medication changes that may be necessary during a shortage.▪Develop an understandable way to communicate medication shortages to your patients. ▪Designate 2 or 3 team members to be responsible for monitoring shortages and communicating any changes to the rest of the pharmacy team.▪Have a simple plan or protocol in place listing how your pharmacy team should navigate potential medication changes that may be necessary during a shortage.▪Develop an understandable way to communicate medication shortages to your patients.