Many generic drugs are in short supply

SCOTT SIMON, HOST:

Prescription drug shortages seem to be common right now. Industry veterans say they’re pretty severe. NPR consumer health correspondent Yuki Noguchi and pharmaceuticals correspondent Sydney Lupkin join us. Thank you both for being with us.

YUKI NOGUCHI, BYLINE: Thank you.

SYDNEY LUPKIN, BYLINE: Hello.

SIMON: Yuki, why are drugs in short supply? What’s making it worse?

NOGUCHI: Well, there are lots of things that can cause shortages – you know, the pandemic stalled imports, for example. And this year, a tornado hit a Pfizer drug factory. But the biggest problem is the business itself – especially for generic drugs. As a country, you know, we depend on generics for, like, 90% of our prescriptions – 90%. So those are very valuable to us from a health perspective, but they’re treated as having almost no value in the marketplace. You know, basically, the wholesale system is set up to push prices lower and lower. And that might sound good, but it isn’t if prices are too low. And, you know, fewer profits mean fewer investments in factories, and fewer factories make us more vulnerable to shortage.

LUPKIN: Right. So, like, low prices can lead to quality problems. The FDA inspects factories for quality, but there’s no reward for producing higher-quality products. There’s no way for hospital buyers to compare quality. So basically, they just shop based on the lowest price.

SIMON: Does that translate to making it hard to get many common prescriptions filled?

LUPKIN: So some people will experience this at the pharmacy counter, but they’re more likely to encounter it at the hospital. That’s because a lot of the drugs in shortage are what’s called sterile injectables. And they’re exactly what they sound like. Sterile drugs, like saline bags or anesthesia or chemotherapy, are more difficult to make. Sometimes there are substitutes. When one exists, the patient might not even know the original drug is in shortage. But other times, especially with chemotherapy, there aren’t substitutes, and that’s devastating. Health care workers also say shortages have led to medical errors – patients getting the wrong dose, for example.

SIMON: How have hospitals and cancer centers been dealing with this?

LUPKIN: You know, it can be tough. Sometimes there actually is no drug to be had, at least in the short term. Often one of, say, five versions of a drug isn’t available, so hospital pharmacists will try another manufacturer’s version. But shortages tend to have ripple effects, causing shortages of other products. Hospital pharmacists sometimes look for different strengths of the same drug, different formulations, different products. It’s time-consuming and expensive. Hospitals spend more money on overtime and on drugs because they have to buy outside their usual supply contracts.

SIMON: And this affects care, undoubtedly, doesn’t it?

NOGUCHI: Yeah. Well, like Sydney said, I mean, it can upend it. Baltimore oncologist Thomas Unguru says this is a huge problem for cancer drugs for kids, and those are in particularly short supply.

THOMAS UNGURU: Now the first thing I do is I call the pharmacy – the chemo pharmacy. I’m not kidding. I have to say, hey, do we have these drugs which I’m going to need? That’s crazy.

NOGUCHI: So he can’t even tell the child’s parents until he knows whether he can deliver treatment. You could imagine the outrage and panic that families feel when they need to alter or delay treatment because of this. Polly Wall (ph) ran into this problem four years ago. Her teenage son’s chemo drugs ran short, and so did the pain meds and antibiotics that made treatments tolerable. And at one point, he was in such pain that Wall sat on the bathroom floor with him, you know, coaxing him to keep fighting.

POLLY WALL: He had just given up hope. I mean, he literally told me that he didn’t want to have any more treatment at all and it was over for him – over an IV antibiotic.

NOGUCHI: And he did end up fighting and surviving. But, you know, those shortages of those products are for the same business reasons.

SIMON: That’s very hard to hear. Are the shortages getting any better?

LUPKIN: There are fewer of them than there were over the summer, when the country was approaching a 20-year record number of drug shortages. That said, the shortages that have lingered have been severe. And often we don’t know why. Companies don’t have to publicly say why something is in short supply. And even if they say when they think the drug will be back, it doesn’t always happen on that timeline. Now, the FDA works with companies to help them ramp up supply when they’re having problems and work around supply chain issues. But the FDA can’t force the company to make something if it wants to discontinue it, which happens because sometimes prices are so low that these companies just aren’t making money anymore.

SIMON: If part of the problem is that generic drugs may be priced too low, what about the possibility of just increasing prices?

LUPKIN: You know, in Europe, they actually have pricing floors to prevent prices from going so low that companies go out of business or skimp on factory maintenance, but we don’t have that. Raising prices sometimes happens – for instance, when all but one manufacturer is left standing, and we usually hear about it when that company gets greedy and raises the price from a couple hundred bucks to tens of thousands of dollars. When I talk to researchers and economists about this, they say that this is fundamentally an economics problem that’s persisted for decades and will take a big market change to fix it.

SIMON: NPR’s pharmaceuticals correspondent Sydney Lupkin and consumer health correspondent Yuki Noguchi. Thank you both so much for being with us.

LUPKIN: Thank you.

NOGUCHI: Thank you.

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