In all of my 20 years of ordering inventory for pharmacies, animal shelters, and veterinary hospitals I have not encountered backorders and shortages like we have been dealing with over the past few years. The problem definitely started when the economy went south. We experienced side effects from vendors merging, manufacturers discontinuing production of medications, raw material shortages, and the FDA closing down production lines due to violations. Most recently, West-Ward Pharmaceutical Corporation voluntarily shut down production of doxycycline, prednisone, and methocarbamol after the FDA handed them citations on multiple violations. The results of this will affect the market by not only causing shortages and backorders but also by increasing prices (due to increased demand) to the point in which they become ridiculously expensive.
There are multiple reasons that the market is facing a famine. When drugs that cross over between human and veterinary medicine are on shortage the veterinary field is either cut-off or put on allocation to reserve those drugs for human use. One way to deal with this is to open accounts with human medical vendors, and create relationships with inventory staff at both human hospitals and pharmacies. I have been able to source drugs by these means when I cannot purchase what I need from my veterinary vendors. I often have to pay a higher price but our patients will have the drugs that they need.
Another obstacle is when manufacturers merge. The issue that we have seen at times with mergers is that company ‘A’ buys company ‘B’ and company ‘A’ decides that it is not profitable to manufacture some of the drugs that company ‘B’ produced for the market. Company ‘A’ does not share that they are going to stop production on generic drugs 1, 2, and 3 and therefore the other companies that produce these generic drugs will feel an increase in demand but may not have the capacity to keep up with production. The result is overall drug shortages.
Yet another issue we see with manufactures is that they often produce more than one drug on the same production line. When that line has to be shutdown for repairs or violations, all of the drugs produced on that line will now be unavailable.
The FDA maintains a website where hospitals can track drug shortages and backorders (http://www.fda.gov/Drugs/DrugSafety/DrugShortages/default.htm). The Food and Drug Administration Safety and Innovation Act of 2012 addresses drug shortages and the safety of the supply chain. Buried in the 200 pages of legal speak, is a 12-page summary which discusses drug shortages (found in sections 1002-1008). In short, it discusses increasing communication and preventive measures to reduce shortages. Hopefully, the market will get better instead of worse.
The current problem with the West-Ward Pharmaceutical Corporation is that they have voluntarily closed down production of prednisone, doxycycline, and methocarbamol due to federal violations. They are not the first company to do this over the past few years. West-Ward is a big company for generic drugs. Doxycycline has been almost impossible to source and when it has been available, the price has been so high that most of our clients would not be able to afford the cost. Recently, we scripted out sixty tablets of 100mg doxycycline for a client who preferred to use their own pharmacy. When the client went to fill the prescription at their human pharmacy they were charged over $200. At one time, doxycycline was on some of the pharmacy $4 lists. Doxycycline is a generic drug and now costs more than some brand name drugs. What does this mean for our patients? It means that we are going to have issues with poor owner compliance because the drugs are not affordable.
Yet another factor in the slow flow in the drug market is raw material shortages. For example, let’s say that Scooby Snacks, Lasagna, and Gummiberry Juice all use Cartoon Ink in their production. Cartoon Ink is currently unavailable because of a drought in Toontown which means these products can not be produced. Patients who rely on these products will suffer. What will Scooby Doo, Garfield, and Sunni Gummi do without their medication? I talk about this with a little color to lighten up this dry subject but it is a very serious issue. Raw material shortages have been behind some of the shortages of parenteral nutrition (PN) supplies. Currently, I cannot source any lipid products or multitrace vitamins from my veterinary or human medical vendors. We worry about this in the veterinary field for patients who require IV feeding for short periods of time while they are in the hospital. The big picture is that there are a lot of humans who are dependent on TPN and PN feeding to live. As long as these shortages continue for PN products we in the veterinary field will most likely not be able to source any. So, what do we do? We ration and keep the stock that we do have for the most critical patients just like the human medical field is doing.
I do not see an end to shortages, allocations, discontinuations, higher prices, raw material shortages, or backorders anytime in the near future. My response to this is to get creative. I create as many relationships with vendors as I can so that I have multiple avenues to source medications and choose the best prices. I monitor shortages and backorders on the FDA website and plan my ordering accordingly when drugs are available. I maintain lists of drugs we stock that are unavailable so I can check on availability weekly. I alert some of my vendors to drugs that I am seeking so they can tell me when they are available. If I come across a drug that is difficult to source, I stock up but I make sure to ask what the expiration date is before doing so. I keep the hospital staff up-to-date on shortages and backorders so they can keep those drugs for the most critical cases or switch to a readily available drug. The key to getting through this drug crisis is communication. If the manufacturers, vendors, purchasers, and local medical community communicate and share resources we should all be able to stay afloat and ride this out to the hopefully, not-too-far-away finish line.