Solutions for drug shortages due to COVID-19

Just mention that a drug may be effective in treating COVID-19, and you can expect it to immediately become scarce.

That’s what happened on March 19 when President Donald Trump said doctors had seen encouraging results when COVID-19 patients were given the antimalarial drugs chloroquine and hydroxychloroquine. By that evening, pharmacies documented an increase of 46 times more first-time prescriptions for the medications than they had received the previous workday, according to a data analysis conducted by the New York Times.

Even though there was no scientific evidence showing coronavirus patients receiving the two drugs would improve, demand continued to spike. Patients taking hydroxychloroquine for the autoimmune diseases systemic lupus erythematosus and rheumatoid arthritis began to panic. They feared their medications would be redirected to COVID-19 patients and not be available to them.

In the midst of the shortage the U.S. Food and Drug Administration weighed in saying: “Hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19.” That news squelched the clamoring for these drugs and increased availability. Still, the desperate hunt for a COVID-19 treatment or cure continues to produce periodic shortages of other medications.

Stockpiling and drug shortages

Like almost any product, drug availability is driven by supply and demand. Manufacturers produce for anticipated use. At times, medications are difficult to get because they are discontinued, or a drug company has difficulty acquiring the raw materials they need for production. Shortages of drugs used in the treatment of coronavirus patients, however, can usually be attributed to something else.

“It is fear. Everybody is trying to stockpile medications,” said Elliott Mandell, senior vice president and chief pharmacy officer at University Health System.

Mandell said some patients with a prescription for a 30-day supply of a medication have been asking for a 90-day supply because they’re worried about a shortage. They’re also trying to get refills before they need them, and even if they don’t need them.

In March, the Texas State Board of Pharmacy stepped in. It added more drugs to a restricted list, limiting some of them to a 14-day supply. Still, other shortages continue.

Drug shortages linked to COVID-19

One website compiling drug shortages listed by the FDA and the American Society of Health-System Pharmacists, ASHP, recently identified two dozen medications that are harder to get because of COVID-19.

They include drugs used in hospitals for patients placed on ventilators, surgical anesthetics and medications for treating respiratory conditions. The coronavirus attacks the lungs and airways making it difficult to breathe. Asthma patients reported having difficulty in filling their prescriptions for albuterol inhalers, also called “puffers.”

“All drugs in short supply are available only on a daily allocation basis,” acknowledged Mandell during an interview in March. “Even some of the most common medications used in the intensive care setting are now on allocation and in short supply.”

Solutions to drug shortages

But circumstances can change quickly. A little more than a month has passed since patients began scrambling to fill their albuterol or hydroxychloroquine prescriptions. Now, in early May, the pharmacy shelves at University Hospital are filled with enough of these drugs to serve all of University Health’s patients.

Even if the shipments hadn’t resumed there were options for patients including those who use inhalers and traditional asthma medications.

“Drug shortages aren’t new to the pharmaceutical industry. There’s always a therapeutic option,” said Mandell. “Not just switching a brand name drug to a generic, but drugs are available in different strengths or form including liquids or tablets. There are drugs that can produce the same or similar pharmacologic result. No patient will be without treatment for their diagnosed condition.”

Mandell tells patients to work with their doctors and pharmacists who know the effective options that are available. He has another piece of advice he considers critical for patients who try to stretch their medication and don’t take the amount prescribed.

“Please don’t self-ration your medication. Take the full dose that was prescribed for you in the full amount per day,” he said.

Mandell urges patients to have faith that manufacturers will deliver more of a drug that’s limited or their provider will prescribe an equally effective alternative. Taking less than the prescribed amount to make the supply last longer can lead to serious health problems.