(Management Case Study) Calling in the Subs! Combating a Known Drug Shortage

Purpose: i. Monitoring and mitigating medication shortages have become a daily task for most hospital organizations. Despite proactive approaches being implemented at hospitals many known, upcoming Medication shortages are still being treated as urgent, unknown Medication shortages. Our goal was to proactively prepare for an upcoming, known Medication shortage by reducing the percent of active medication administrations by 80% without adversely impacting pharmaceutical spend. We anticipated that our agile approach to a known Medication shortage in a non-urgent, systematical manner would reduce the cost associated with the Medication shortage and improve patient care.

Methods: i. The known shortage was announced a couple of months prior to the shortage. Our institution proactively developed a committee including pharmacists, informatics, contractors in supply chain management, providers and operations managers. The committee validated with the manufacturer that the shortage would last six-months. We developed a step-by-step approach for known Medication shortages. Informatics built treatment plans to transition patients to the next, lowest cost medication. Contracting wrote “Failure to Supply” language within the contract to reduce the cost burden of switching medications. Operation managers assessed average usage to calculate the number of patients requiring the Medication over the known shortage. Pharmacists reviewed the use of the medication and compared it to the inventory on hand to project the maximum and minimum number of doses needed for the alternative medication. After the Medication shortage has been resolved our step-by-step process will be utilized to convert back to our formulary Medication of choice.

Results: Our institution is large with several hospitals located throughout the United States. We identified the primary sites of high usage and began tracking historical orders. Our institution decreased 99% of our usage of Medication down to 19% within 2-months, prior to the start of the shortage. Treatment plans were modified well in advance of patient appointments thereby minimizing the impact to patient care. The Failure to Supply language within the contract of the Medication on shortage saved our institution $166K over a 7-month period by requiring the Medication manufacturer to pay back a certain percentage based on the amount we spent on the non-contracted Medication during their shortage.

Conclusion: Pharmacy needs to become more robust and agile in relation to Medication shortage management. Our approach to known, non-urgent Medication shortages can be replicated and we encourage others to follow the steps to reduce financial liability and improve patient care. Our contracting team plans to continue including “Failure to Supply” classes. Our relationships with Medication manufacturers to gain advance notice of a Medication shortages continue. Lastly, we plan to repeat our tried and true method of rapidly engaging our pharmacists and providers through the step-by-step process to identify the scope of the shortage and the seamless implementation of alternative use.