The number of drugs in short supply in the United States has fallen for the first time in three years, according to a quarterly count by a university drug information service. But the shortages that remain are concentrated in the products hospitals rely on most: cheap, old, sterile injectable drugs used in emergency rooms, operating rooms and cancer wards.
The service counted 241 active shortages at the end of the last quarter, down from 287 a year earlier. Sterile injectables made up 58 percent of the remaining shortages, up from 44 percent.
Why injectables are different
Most of these drugs are decades-old generics that sell for a few dollars a vial. They are hard to make, because they must be sterile, and there is little profit in making them. When a single factory has a quality problem, there is often no backup.
«A pill shortage is a pharmacy problem. An injectable shortage is a surgery-gets-postponed problem,» said Dr. Renata Kowalczyk, a hospital pharmacist in Philadelphia who manages shortages for a five-hospital system. Her team holds a shortage meeting every morning at 8:15.
What hospitals are doing
Kowalczyk’s system has started buying some drugs directly from a nonprofit generic maker that guarantees a supply in exchange for a long-term contract. Others are stockpiling, which can make shortages worse for everyone else.
Federal officials have proposed paying hospitals more under Medicare for buying from makers with reliable supply records. Kowalczyk said that would help, but slowly. «Factories take five years to build,» she said. «Shortages take five minutes.»