Premier data indicates that demand for chloroquine and hydroxychloroquine spiked dramatically between March 1-17. According to Premier data:
- Chloroquine: From January 2019 through February 2020, hospitals ordered an average of 149 units monthly of chloroquine, or about 75 units ordered every two weeks. From March 1-17 this year, we saw 2,357 units ordered – a 3,000 percent spike compared to typical demand.
- Hydroxychloroquine: The average monthly units ordered for hydroxychloroquine was 8,800 from January 2019 through February 2020, or about 4,400 units ordered every two weeks. From March 1-17, we saw 16,110 ordered – a 260 percent spike compared to typical demand.
The chart shows Premier’s historical ordering data beginning January 2019 for the quantity ordered of hydroxychloroquine and chloroquine (grey and blue lines, respectively) compared to the quantity Premier received from suppliers (yellow and orange lines, respectively.)
Increased demand is being spurred by reports from South Korea and France, which indicate these two antimalarial drugs may influence positive outcomes in COVID-19 patients. While the U.S. Food and Drug Administration is still investigating the effectiveness of these drugs, providers started buying up the available supply in anticipation that these products may become the frontline treatment.
Keeping up with Demand
To manage this spike in demand, all the major wholesale distributors put hydroxychloroquine and chloroquine on allocation this week. Allocation is a process that restricts ordering to historic purchasing volumes in order to protect the supply chain and prevent hoarding.
However, the spike started before the allocations went into place, meaning that many healthcare providers may already have large quantities on hand that they can use to treat patients. That being said, it is uncertain if the right quantity of product is in the right location. Wholesalers should work with the group purchasing organizations (GPOs) and their members to ensure the supply gets to providers who need it most: hospitals that are treating COVID-19 patients.
Once those supplies are depleted, re-ordering will be capped at historic levels. Since these are older drugs not typically used in the acute-care setting, historic purchasing has been low (see chart above), so replenishments will not match current demand.
To offer immediate help, drugmakers such as Teva and Bayer have announced they will donate millions of tablets of hydroxychloroquine and chloroquine tablets to hospitals or the federal government for further testing.
As additional reports come forth from countries suggesting treatment protocols for COVID-19, a single source of truth in the U.S. is needed to mitigating panic-buying. For example, the Centers for Disease Control and Prevention (CDC) should take point in studying the international data and make recommendations for treatment protocols domestically. This will help forestall providers prophylactically prescribing these medications to patients who have not even tested positive for COVID-19 – which, anecdotally, is already occurring and certain to further strain supply.
If these drugs do prove effective in treating COVID-19, plans must be created now to increase supply.
Fortunately, these are older, relatively inexpensive solid oral dose drugs, which means their manufacturing is far less complicated than it is for other drugs. For chloroquine, there is currently a single manufacturer producing products. However, four additional manufacturers are approved by the Food and Drug Administration (FDA) to make it. For hydroxychloroquine, there are 10 suppliers with FDA approval, but, not all of them are currently manufacturing.
Essentially, this means that there are a large number of potential manufacturing partners that could be tapped to meet provider needs.
Organizations like Premier have a history of being able to persuade manufacturers to either increase production or re-enter markets they have abandoned, as evidenced by our track record through the ProvideGx™ drug shortage program. In this case, we are already hard at work trying to expand this model to include hydroxychloroquine and chloroquine.
Respiratory Devices Also in Demand
Premier data shows that there has also been a surge in hospitals ordering metered dose inhalers (MDIs) but not nebulizers (NEBs).
The chart shows Premier’s historical ordering data beginning January 2019 through March 15, 2020, for the quantity ordered of MDIs and NEBs (blue and grey lines, respectively) compared to the quantity Premier received from suppliers (orange and yellow lines, respectively.)
From January 2019 through February 2020, the average monthly units ordered of MDIs was about 358,600, or nearly 179,300 every two weeks. From March 1-15, 2020, hospitals ordered 380,724 MDS – a 112 percent increase.
The reason for the increased demand is the fact that metered dose inhalers do not aerosolize during use, while nebulizers do. Considering that coronavirus is transmitted through the air, many hospitals are reluctant to use nebulizers, which could increase the risk of disease spread among healthcare workers and other patients.
The problem with meeting the increased demand lies, once again, with allocations. Metered dose inhalers are not common in the hospital setting, so historic purchasing caps will be lower than current demand and leave many hospitals scrambling for supplies.
An alternative Premier is exploring for its members is closed circuit nebulizers that contain the aerosols and therefore do not pose the same risk of spreading the disease.
About Premier’s Data
Premier tracks hospitals’ purchasing data for pharmaceuticals and supplies through its group purchasing organization, which serves 4,000 U.S. hospitals and health systems and more than 175,000 non-acute providers. Our data provides a strong early indicator of how hospitals are prioritizing drugs, devices and supplies in their efforts to treat and mitigate COVID-19.
During COVID-19, Premier continues to act as a trusted connection point for healthcare providers, suppliers and the government. We are working 24/7 to address challenges as they occur and help our alliance of more than 4,000 hospitals and health systems and 175,000 non-acute providers access the supplies they need to serve their communities. We are also partnering with the Administration and private sector to create both short-term and long-term solutions, and sharing our insights to help inform the public understanding.
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