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Many health systems in the United States experience drug shortages. Often, these happen without disrupting patient care. When medicine shortages do impact care, patients may experience drug changes or delays in treatment. The most recent supply shortage includes older, inexpensive drugs and injectable medicines, such as chemotherapy drugs used to treat cancer.
Huntsman Cancer Institute at the University of Utah (the U) has a team of more than 150 individuals whose work centers on educating patients about prescription drugs, consulting with doctors and other hospital and clinic staff, and managing drug shortages across our health system.
“We have our patients in mind, first and foremost,” says Makala Pace, PharmD, pharmacy director for Huntsman Cancer Institute. “There's an entire support staff that is dedicated to working through drug shortages.”
Led by Pace and Erin Fox, PharmD, associate chief pharmacy officer at the U and national expert on drug shortages, this team has worked to mitigate these shortages for our hospitals and clinics, and to ensure patients receiving cancer care are not impacted.
Our Commitment to Our Patients
“We’re not immune to shortages, but right now, our patients are not going without treatment,” says Fox. “We're tracking the cancer drug shortage very closely.”
In her role, Fox leads the pharmacy infrastructure for all of University of Utah Health. Since 2001, her team has also tracked all the drug shortages in the United States. This information is posted online by the American Society of Health-System Pharmacists (ASHP).
“When people hear about a shortage, they often think about something as completely gone, but it’s actually really rare for the United States to have a medicine that is 100% gone,” says Fox. “It's usually that you can't quite get the amount that you're used to ordering, or you might have to order a different strength, size, or product.”
Patients rely on a variety of treatments and therapies for their cancer. Ensuring that our patients have access to the drugs needed for their care is of the utmost importance to us.
“We know all of the patients that are on these drugs, how much they need, and when they're going to need it based on their chemotherapy infusions,” says Fox. “We use this information to forecast with the amount that we have on hand, and, so far, that's been matching up.”
Pace has been a pharmacist at Huntsman Cancer Institute since 2012. Her work encompasses the cancer hospital and all oncology care throughout University of Utah Health. As pharmacy director, she works closely with the community and Huntsman Cancer Institute and University of Utah Health hospitals, clinics, and pharmacy leadership.
“I have had a lot of experience working with Dr. Fox’s team very closely in the identification and mitigation of various drug shortages,” says Pace. “As more time goes on, the frequency at which I have to engage with Dr. Fox and her team increases as there is an uptick in these shortages, particularly related to the medications used to manage the oncology patient population.”
Despite the national shortage, Fox and Pace remain optimistic about Huntsman Cancer Institute’s ability to continue to serve and treat our patients.
Why Drug Shortages Happen
Drug shortages can happen for many reasons. In the case of cancer medicines, short supplies often occur with injectable drugs that are older and less profitable. This lack of financial incentive often results in drug companies deciding against producing these medicines or implementing poor quality control measures.
The current cancer supply shortage can be attributed to a factory that failed a U.S. Federal Drug Administration (FDA) inspection. The facility made 50% of two critical chemotherapy drugs. Its failure to meet quality standards resulted in a shortage of methotrexate and cisplatin. The factory has not resolved the issue or produced any drugs since then, and other facilities have not been able to make up the difference. The shortage of these drugs has also caused supply issues in related medicines like carboplatin.
“Our pharmacy teams are communicating with your providers on the drug shortage and offering alternatives, if needed. Your doctors are not prescribing drugs that you will not be able to have.”
The FDA’s Role in National Drug Shortages
The FDA plays an important role in ensuring the safety of medicine made by drug companies. While they can't compel companies to produce specific drugs, they are responsible for overseeing manufacturing practices to maintain the quality of the drugs. But this doesn't guarantee that shortages can be prevented.
In some cases, the FDA identifies alternative sources for imported drugs to address short supplies. In the most recent cancer drug shortage, the FDA is exploring importing cisplatin from China. To ensure safety, the FDA is taking extra precautions, including relabeling and adding English stickers to packaging. Right now, they are still trying to find another supplier for methotrexate but haven't found one yet. The FDA is working hard to fix shortages and make sure patients get the medicines they need while staying safe.
“If a patient today was to ask any of our prescribers for cisplatin or methotrexate, the answer would be 100%, we have the drug for you. We have the medication. We've planned for this.”
The Role of Health Systems in Drug Shortages
Hospitals and health systems are responsible for having the medicine that patients need. Fox and Pace lead their pharmacy teams to forecast needs, source and purchase drugs, and ensure that enough stock is on hand.
Pharmacy teams work closely with providers and communicate frequently. Huntsman Cancer Institute takes a multidisciplinary approach to cancer care, and each patient’s care team includes a specially trained oncology pharmacist. While providers decide the type of treatment a patient needs, pharmacists partner with doctors to alert them on drug interactions and supply issues. They may also make recommendations on alternative drugs.
What Patients Can Do
Fox and Pace remind patients that there is a team focused solely on drug shortages at Huntsman Cancer Institute.
“Patients have enough on their plate. Our pharmacy teams are focused on solving this,” says Fox. “They are communicating with your providers on the drug shortage and offering alternatives, if needed. Your doctors are not prescribing drugs that you will not be able to have.”
However, there are steps patients and community members can take:
Advocate for yourself
If you believe your medicine is in short supply, talk to your provider. It is OK to ask them direct questions and assure you that the drug is available. “If a patient today was to ask any of our prescribers for cisplatin or methotrexate, the answer would be 100%, we have the drug for you,” says Pace. “We have the medication. We've planned for this.”
Stay informed
Patients can rely on their health care team to stay informed and seek guidance. You can also visit the ASHP website managed by Fox and her team. “This website really tries to help clinicians understand what's going on, what drugs are available, when will they be available, and what you can or can’t get,” says Fox. “We also try to provide some information about safety and ways to really mitigate the shortage and the impact of our patients.”
Contact your state representatives
Drug shortages are a bipartisan issue. While Congress can’t pass a law that requires drug companies to make medicine, there are steps they can take to reduce the occurrence of shortages. You can find your representatives and learn how to contact them at utah.gov.
“You are at the right place. Huntsman Cancer Institute is the premier place where you want to be receiving your cancer care therapy,” says Pace. “We put the patient first. We are going to do everything we can to ensure that you have access to the therapy you need, whether it is a procedure or medication. Even if that medication is in shortage, we're going to do everything we can to ensure you get the right treatment at the right time.”