Drug shortages: Whose problem is this, anyway?

I have spent the better part of two weeks dealing with drug shortages. There are three big ones plaguing community pharmacy right now: Ozempic, transdermal estradiol patches and rabeprazole. None of these have simple solutions. So whose job is it to create the solutions? My (not uncontroversial) take is that it’s our problem—community pharmacists—and we need to own it. What we’re seeing is something similar to the pediatric antibiotic and fever reducer shortage last winter: patients calling dozens of pharmacies looking for the product. But we know that patients should be getting all their medication at ONE pharmacy. Their regular pharmacy can manage all potential drug/drug and drug/disease interactions. Getting prescriptions from many places can be dangerous and harmful. Additionally, we have a policy at our pharmacy where we do not transfer in a prescription for a back ordered med. Where we have stock it’s because we’ve done work to secure meds for our established patients. We also know transferring Rx in and out is a great deal of (unpaid) work further increasing the burden on community pharmacies. I’ve heard tell of pharmacies telling patients “we don’t have this med, you’ll need to find it elsewhere.” Or “You’ll need to call your doctor.” I’ve seen a naturopath on Instagram advising patients to call around to other pharmacies. I’ve seen a letter from a specialist outlining “we cannot see all patients in the short term” and then a follow up “we don’t prescribe through an intermediary especially pharmacists.” So, I understand why patients and even pharmacists are confused about how to help in these situations. I’ve been telling those patients who’ve been told to call around “our patients don’t call around for meds. We’re experiencing the same drug shortages, but we are dealing with this for our patients," and then outline the questions they may need to ask to get additional care from their regular pharmacy. The reality is that no one, not the specialist, not the patient, no one but the community pharmacist knows: what’s available, what’s covered on a patient’s plan what the med actually costs and what the patient’s capacity for that cost is. We are also in the know about: diagnosis indication disease/condition control. So it really should be us dealing with these shortages. Granted, most prescribers are grateful for the work we do on managing these shortages for patients but that specialist above raised some ire when I saw that! How can we deal with the shortages? Get to know your patients Run a drug-use report and sort out who is going to need the medication sooner rather than later Pick up the phone, have a conversation with the patient and walk them through their options Document this interaction and forward a suggestion to the prescriber (or if you live in Pharmacy Utopia, Alberta, write the new Rx yourself) Plan to follow up with the patient once the new Rx is received But Kristen, how can we do all this? It’s flu shot season? We’re managing new prescribing authority and all the things. True. But this is a pillar of patient care. And one that only we can manage (see above). Pharmacies should staﬀ accordingly to deal with patient care. I should not be checking blister packs or retail prescriptions. I should be providing pharmaceutical care. I shouldn’t have MedsCheck targets or professional service dollar expectations. Yes, this is usually unpaid and that’s an entire other ball of wax (calculate the lost revenue if you do nothing for the patient vs. provide an alternative, now times that by ALL your patients affected). More and more, pharmacies have a duty to provide care. Simply doing nothing is no longer good enough. We need to use our expertise to provide solutions to our patients. This isn’t going to be the last season of drug shortages. I know it’s “one more thing,” I really do, I’m living it too. But I truly believe investing in this level of care for patients pays dividends, for staff, in practicing high level care, for patients, in providing comprehensive care, and as always of course, there’s a business case for patient care and retention. Many of my blogs get tagged with comments about competing interests. There’s a case to be made that addressing drug shortages for patients head on is win/win/win.

Drug shortages: Whose problem is this, anyway?

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Kristen Watt

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