Americans rely on generic drugs for 90% of their prescriptions. However, shortages have become a chronic problem. The manufacturing of generic drugs is a competition to aim for the lowest price.
SCOTT SIMON, HOST:
Currently, prescription drug shortages seem to be common. Industry veterans say it’s pretty tough. NPR consumer health correspondent Yuki Noguchi and pharmaceuticals correspondent Sidney Rapkin join us. Thank you both for joining us.
Signed by Yuki Noguchi: Thank you.
SYDNEY LUCKIN, BYLINE: Hello.
SIMON: Yuuki, why are there drug shortages? What’s making it worse?
Noguchi: Well, there are many things that can cause a shortage. For example, the pandemic has held up imports. And this year, a tornado struck a Pfizer pharmaceutical factory. But the biggest problem is the business itself, especially when it comes to generic drugs. You know, as a country, we rely on generic drugs for 90 percent, 90 percent, of our prescriptions. That is, they are of great value to us from a health perspective, but are treated as having little value in the marketplace. Basically, the wholesale system is set up to drive prices lower and lower. That may sound like a good thing, but not if the price is too low. And, as you know, if profits decrease, investment in factories will also decrease, and if there are fewer factories, it will be easier to run out.
Luckin: Yes. That is, low prices can lead to quality problems. The FDA inspects factories for quality, but there is no reward for producing a higher quality product. There is no way for hospital buyers to compare quality. In other words, you basically shop based on the lowest price.
SIMON: Does that mean it’s going to be harder to get many common prescriptions filled?
Lupkin: Some people experience this at the pharmacy counter, but you’re more likely to encounter it in the hospital. This is because many of the drugs in short supply are so-called sterile injections. And they sound exactly like that. Sterile drugs such as saline bags, anesthetics, and chemotherapy drugs are more difficult to manufacture. In some cases, there are substitutes. If present, patients may not even realize they are missing the original drug. But in other cases, especially with chemotherapy, there may be no alternative, and that can be devastating. Health workers also say the shortages are leading to medical errors, such as patients receiving the wrong dose.
SIMON: How are hospitals and cancer centers dealing with this?
Luckin: Well, that can be difficult. There may not actually be a cure, at least in the short term. Often, for example, one of the five versions of a drug is not available, so a hospital pharmacist tries another manufacturer’s version. However, shortages tend to have a ripple effect and cause shortages of other products. Hospital pharmacists may look for different strengths, different formulations, and different products of the same drug. It takes time and money. Hospitals spend more money on overtime and medicines because they have to buy them outside of their normal supply contracts.
SIMON: And this definitely has an impact on care, right?
Noguchi: That’s right. Well, as Sidney said, that means it could turn it upside down. Thomas Angle, a Baltimore oncologist, said this is a big problem for cancer drugs for children, especially since they are in short supply.
Thomas Ungle: Well, the first thing I do is call the pharmacy, the chemotherapy pharmacy. no kidding. Hey, are there any medications I need? That’s crazy.
Noguchi: You can’t even tell the child’s parents until you know if it can be treated. You can imagine the anger and panic that families feel when treatment has to be changed or delayed because of this. Polly Wall (ph) said she ran into this problem four years ago. Chemotherapy for her teenage son was in short supply, as were painkillers and antibiotics to withstand her treatment. And at one point, he was in so much pain that Wall sat with him on the bathroom floor and coaxed him to keep fighting.
Polly Wall: He had just given up hope. I mean, he literally told me he didn’t want any more treatment and that he was done with IV antibiotics.
Noguchi: And he ended up fighting and surviving. However, the shortage of these products is also due to the same business reasons.
SIMON: That’s very difficult to hear. Is the shortage improving?
Rapkin: That number is down compared to the summer, when drug shortages in this country were approaching a 20-year record. However, serious shortages still persist. And often we don’t know why. Companies don’t have to publicly say why something is missing. And even if they say when that drug will come back, it doesn’t always happen on that timeline. Currently, the FDA is working with companies to help them increase supply and avoid supply chain problems if they are having problems. However, the FDA cannot force a company to make a product if it wants to discontinue it. This is because prices are so low that these companies may no longer be profitable.
SIMON: If part of the problem is that generic drug prices are too low, what are the chances of just raising prices?
Rapkin: You know, in Europe they actually have a price floor to prevent prices from going so low that companies go out of business or don’t maintain their factories, and we don’t have that. Price increases occur from time to time. For example, all manufacturers but one survive. Usually you hear about it when the company gets greedy and raises the price from a few hundred dollars to tens of thousands of dollars. When you talk to researchers and economists about this, they tell you that this is fundamentally an economics problem that has been going on for decades, and that solving it will require major market changes. Masu.
SIMON: NPR pharmaceutical correspondent Sidney Rapkin and consumer health correspondent Yuki Noguchi. Thank you both very much for joining us.
Luckin: Thank you.
Noguchi: Thank you.
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