During Drug Shortages, There Are Resources so Pharmacists ‘Never Need to Ration Life-Saving Drugs’

Oncology drug shortages have been present for over 2 decades, and the root causes have been known for some time, explained Laura Bray, chief change maker and founder of Angels for Change, during the keynote presentation at the 2024 Advanced Topics for Oncology Pharmacy Professionals (ATOPP) Summit in St Louis, Missouri. Despite this knowledge, Bray noted that little change has been made to address these underlying causes.

“The data have been there for years and there were even hearings about it 10 years ago, but then people just lost interest,” Bray explained during the ATOPP session. “I thought perhaps one of the reasons why this sense of urgency and interest had been lost is that there was no space for patients to have a voice, and no space really for pharmacists and physicians to have a voice [that’s] only focused on drug shortages.”

Bray explained that with so many access-based issues present in the field, the overlapping issues can appear to cloud one another. Further, Bray noted that some solutions that may address one of the problems can lead another to arise.

Additionally, Bray explained that the loss of interest in drug shortages 10 years ago may have been due, at least in part, to a lack of an organization present that was entirely devoted to advocacy around drug shortages.

“There was no one to share patients’ stories and to share what kind of work you guys are doing on a daily basis as physicians and pharmacists because of this crisis,” Bray said. “Perhaps that's why it wasn't getting the attention it needed.”

Bray explained that this realization led her to found Angels for Change, which is a non-profit entirely focused on advocacy around drug shortages and ensuring patients can obtain access to life-saving drugs. After Bray had experienced drug shortages first-hand affect the care of her young daughter with cancer, she learned how to navigate the supply chain and find the drugs her daughter needed. Through her foundation, she developed new pathways and new methods to ensure other patients would be able to gain access to the life-saving drugs they needed as well.

“I want to let you know that you don't ever have to open up those files and start rationing [drugs for] patients. We are very good at getting supply and emergency supply through working with the entire supply chain, including the government, to ensure patients get care,” Bray said. “We are almost 100% effective at getting patients and facilities the supply that they need to move care forward without rationing. So first and foremost, call us before you open those files.”

Additionally, Bray noted that the earlier those conversations begin with her foundation, the more efficient the process will be at responding to a patient’s need when it arises. Specifically, this helps to foster a proactive rather than a reactive response, which Bray noted can help bolster the supply chain to better manage such crises.

Furthermore, Bray explained that she has found that the causes of oncology drug shortages boil down to 4 key issues, with the first being the price of the drug.

“The lower the price, the more likely it is to be in shortage. In fact, last year 98% of oral solid shortages were less than $15, and 85% of injectable shortages were less than $15,” Bray said. “So what we have in the drug shortage space is really important, essential, lifesaving medicine costs less than the meal I ordered on Tuesday from Wendy's.”

Bray explained further that essential medicines should not be priced so low that manufacturers will lose money to make those drugs, as that will ultimately lead to a shortage.

Bray explained further that essential medicines should not be priced so low that manufacturers will lose money to make those drugs, as that will ultimately lead to a shortage. Image Credit: © Zahid - stock.adobe.com

The second reason drug shortages happen is the complexity of the manufacturing process, according to Bray.

“And this is where your oncology patients are really harmed, because the drugs that can save their lives are very complex to make,” Bray said. “If you have a complex to make oncology product, and it's less than $20, you can bet it's probably vulnerable to shortage and it can be going on and off shortage over and over again.”

Bray noted that the third root cause of shortage is a past shortage. However, Bray explained that in her career as a professor of economics before her work with Angels for Change, she taught extensively on the subject of supply and demand. Yet with oncology drugs, Bray was confused as to why the market never seemed to fully recover from a prior shortage.

“That does not make sense. This is not how supply and demand and the theory of scarcity should work. The best predictor of shortage [being a past shortage] is also not something new [for oncology drug shortages],” Bray said. “Since 75% of generic oncology drugs have been short in the last 20 years, that does not bode well for your patients.”

Bray noted that the fourth issue leading to drug shortages is the consolidation of the market, which is a trickle down effect of the first 3 issues. “Really, it just means that people leave the market, so there's only 1 person making it or 1 area of the world making it, which means the next time it goes short, the things we relied on to get out of short last time are even less available.”

Bray explained that all of these 4 key issues are economically driven, which means that economically-driven solutions will likely be able to lead to a new path forward.

“Our principles of solving this are about transparency, redundancy, and connectivity. No one member of the supply chain can solve this. However, all of us together, working together in a patient-centric design for the benefit of the patient can solve this,” Bray said. “I think the best way to show that this is possible is—I always joke that I'm just a lady from Tampa, and somehow figured out how to get the entire supply chain together and make the global supply chain work reactively and proactively to move supply and increase supply for every shortage event we've been called on in the last 4 years. So, I think that's proof that it's possible, but it needs to be scaled, and we all need to be doing it.”

REFERENCE
Bray L. Keynote Address: Gateway to Change: Building Bridges to Treatment Access. 2024 ATOPP Summit; St Louis, Missouri; June 27-29, 2024.