While personal protective equipment (PPE) supply disruption continues to dominate the headlines, COVID-19 has also jolted the global pharmaceutical market and exacerbated a problem that dates back several decades.
Drug shortages have long plagued U.S. healthcare providers with more than 250 shortages over the past few years. Today, waves of pandemic-induced supply chain challenges and caseload surges are compounding the issue, at times leaving providers struggling to secure therapies for patients.
A recent executive order from the Biden Administration recognized these challenges as well as the need for private sector input and support in shoring up U.S. supply of essential medications.
For our part, through pioneering models that create market stability and security, Premier has been a long-time leader in addressing shortages and building greater drug supply chain resiliency – a commitment we’ve continued through COVID-19. Just last year, we released the first-ever annual report on our efforts.
Here we take a look at our progress during the pandemic era to protect patients and healthcare workers and insulate us from future drug shortages.
Remedies to Cure an Unhealthy Market
While shortages are triggered in a number of ways, a 2019 Food and Drug Administration (FDA) report points to economics as a main driver. For example:
- About 40 percent of generic drugs are supplied by a single manufacturer.
- Almost all shortage drugs are older, low-cost generics costing less than $9/dose and some as little as $1/dose.
- Because these products don’t generate blockbuster profits, manufacturers are less willing to invest capital to improve quality, build redundant capacity or source safety stock.
It’s this dynamic between lack of profitability and lack of suppliers that leads to a fragile market not strong enough to handle fluctuating demand ─ especially during a pandemic or other crisis.
Through innovative programs that target these root causes and leverage novel commitment models from all market stakeholders, Premier members bring supply and price stabilization to the market by identifying priority shortage medications and engaging suppliers in aggregated buying contracts over the long term. This creates a positive ripple effect, giving manufacturers proper demand signaling, predictable revenue and the surety needed to increase production or move into new markets.
Overall, Premier’s drug shortage programs aggregate $684 million in total generics spend from 2,700 hospitals across the nation.
- We’ve created the industry’s only comprehensive, multi-faceted drug shortage program with more than 330 high-risk products protected through the ProvideGx and PremierProRx programs.
- Since March 2020, our members have weathered demand spikes of 150 percent or more – with limited interruptions in supply.
- Efforts have paid off as six products added to ProvideGx, including metoprolol and cysteine, have since been delisted from the FDA drug shortage list.
Yet alongside case spikes, resumption of elective procedures and ongoing stockpiling efforts, our nation’s drug supply remains precarious. As a result, Premier is continuously monitoring weekly fill rates for more than 250 drugs necessary for COVID-19 care and requiring contracted manufacturers to retain sufficient safety stock of both active pharmaceutical ingredients (APIs) and finished medicines.
Bringing Shortage Drugs Back to Market in 2020
Many of the drugs in shortage we saw in 2020 were impacted by COVID-19 therapeutic demands – including demand for anesthetics and other medicines used to ease intubation.
According to a November 2020 Premier analysis, the top 10 drugs that experienced the biggest demand spikes were those used to support mechanical ventilation. Fentanyl, for instance, a controlled substance often used to provide pain relief to COVID-19 ventilated patients, saw a 7.5X demand surge during peak periods.
Together with our members, Premier is executing on our collective vision to build a more robust and resilient supply chain by ensuring that vital medications supplied through our programs are available to save the lives of critical COVID-19 patients:
- Through a partnership with Pfizer, ProvideGx added fentanyl and four other drugs that are not only essential during the pandemic, but are also vital for routine and elective care longer term.
- Diprivan® (propofol), another critical sedation drug, experienced a 5X demand spike in the spring of 2020 per Premier data. Stock available through prime wholesalers was gone in less than two weeks, and many providers were stuck scrambling for this product. In July 2020, ProvideGx introduced Diprivan to its portfolio to stabilize the supply for members.
- Dexmedetomidine was added to the program, stabilizing the long-term supply of yet another medication needed to care for the most acute COVID-19 cases. According to Premier data, dexmedetomidine demand in April 2020 increased more than 360 percent when compared to the same period in 2019, and providers typically only received about 62 percent of what they ordered.
- The program also gives members access to sterile water, which has seen average daily usage increase by 350 percent due to its use in COVID-19 patient ventilation and a variety of other patient care settings.
- Prior to the pandemic, Premier added a line of emergency syringe products, which have proven vital for providers administering COVID-19 vaccines.
- Beyond essential COVID-19 products, ProvideGx brought in three cephalosporin antibiotics, creating sustainable supply of these medicines commonly used for routine patient care and treating bacterial infections.
Premier’s drug shortage programs are proving their ability to more effectively deliver product to members and patients in and out of a pandemic.
In addition to the shared commitments from our members, supply source visibility and sourcing diversity are also program requirements, including criteria for reporting on both finished dose manufacturing sites as well as APIs sources.
This greater transparency yields a diverse and balanced approach. It is not just a better contingency plan, but it also addresses the need for global sourcing to keep costs in check and help our members and patients get supply of the basic, lifesaving medications they need, when they need them.
Continuing Our Progress
This past year has unquestionably placed unprecedented demand on the pharmaceutical supply chain.
While drug shortages continue to be a pervasive problem for patients and their providers, Premier and its member hospitals are taking a leadership role, stepping up to systematically address the root causes and provide the right economic models that incent manufacturers to increase supplies, invest in redundancies, enter or re-enter markets and explore new therapeutic categories for innovation.
The success of Premier’s drug shortage solutions also goes far beyond mere numbers. While the programs’ model and the scale are important, what really matters are the patients whose lives have been demonstrably improved as a result of care teams’ access to these therapies.
Protecting patient care and the health of our communities is at the heart of our mission. Through our programs, Premier members have experienced exclusive supply protection with access to a broader range of shortage products than anyone else in the market. Although there is still much to do to fix global shortages, we’ll continue to fight until every drug on the shortage list has been resolved and patients are protected from drug supply disruption.