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COVER STORY Cumulative Trend US Drug Shortages 2001–2012

300 250 200 150 100 50 0

267 Shortage

Drug Shortage crisis erupts

166 149 120 88 73 58 01 02 03 04 05 06 07 Source: United States Government Accountability Office

Number of Prevented Drug Shortages Per Year, 2010 Through September 30, 2015

300 250 200 150 100 50 0

282 08 09 10 11 12 195 170 128 101 38 2010 2011 2012 Calendar Year Source: US Food and Drug Administration

priority to their larger purchasers,” she says. “If you have a good relationship, however, your drug representative will tell you ahead of time if there is going to be a shortage.” Even with that infor- mation in hand, an ASCs could end up losing money because it might stock up on a drug that it does not use often and the medication could expire before it is used.

ASCs also must have good utiliza- tion practices, she suggests. “Keep track of what you need and how much. Once a drug becomes unavailable because of a shortage, it becomes very expensive,


like Vasopressin, which is used in the crash cart; it is very expensive now.” It would be a good idea to have a

good rapport with other ASCs in the area, she adds. “Even though trans- fer of medication from one facility to another is a no-no, ASCs can alert their neighbor if they hear of an upcoming shortage, so they can stock up on the essential medications they need and keep their facilities stocked.” Last, certain centers are keeping

recently expired essential medications in their crash cart that are currently unavailable with a note attached say-

2013 2014 2015 Q1–Q3

Legislation to Address the Issue “As the costs of drugs continues to be a congressional concern, legisla- tors, such as Rosa DeLauro (D-CT), are calling for more oversight of the costs of prescription drugs and med- ical devices,” Sones says. “She has recently introduced legislation to cre- ate a price review board that would be positioned to collect data on drug prices and manufacturing costs, and potentially impose fines if prices are deemed excessive.” The FDA has had a comprehensive plan since 2013 to address expiration dates and drug integrity and is track- ing shortages to rev up production with other companies and give temporary permits to other companies, Tomaka says. “This has never happened before. The government never worked with private companies before.” The FDA has now implemented a

mandatory reporting system where the manufacturers have to let the FDA know if they foresee a shortage or the FDA will put them on a published list, Charles- Hosten says. “There were two compa- nies whose names were published. That is one way the FDA is working to curb these shortages,” she says. “The situation is improving as opposed to the past five years,” Tomaka adds. “The drug circulation is more robust, but the price level is substantially higher. However, we are exercising a free market. The pharmaceutical profit pic- ture is at a humongous high showing a profit of 42 percent overall.”

74 70 129 97 211

ing medication is on “back order,” she says. “I spoke with The Joint Com- mission about this, and they said that as long as the facility has proof that a good faith effort has been made to acquire the medication, its govern- ing body is aware that there is expired medication in the facility and it is documented, it is okay to keep those medications rather than to not have them at all.”

Number of Prevented Shortages

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