By Sean Wardwell

Killeen Daily Herald

A nationwide shortage of prescription drugs largely used in hospitals and surgical clinics is taking its toll on Central Texas.

"In 2011, there were 267 drug shortages and 2012 looks as if it's going to be equal to or worse," said Tricia Meyer, director of pharmacies for Scott & White Healthcare. "It's greatly impacted us. I doubt there's a hospital or institution in the country that hasn't been affected."

A survey conducted by the American Hospital Association in 2011 showed 82 percent of hospitals in the United States have to delay patient treatment due to ongoing shortages. Meyer said that while Scott & White wasn't part of that percentage, it has been impacted by a shortage of surgical anesthetics, local painkillers, such as lidocaine, and chemotherapy drugs for cancer patients, such as methotrexate.

"There's been an ongoing shortage of Lidocaine for the past two months," said Meyer. "That's concerning because anytime you go into a (surgical) procedure, we use Lidocaine."

The process of getting a drug from its manufacturer to the patient is complicated and, according to the Federal Drug Administration, wrought with chain of custody, quality control and manufacturing issues.

Ideally, a drug goes from a supplier to the manufacturer to a wholesale distributor and then to a hospital or pharmacy before it is distributed to patients.

Yet, according to the FDA, a "gray market" exists when a manufacturer sells the drugs to a repackager, which then sells them to a primary or secondary wholesale distributor that marks up the price before attempting to sell the drugs to hospitals or pharmacies.

Rep. Elijah Cummings, D-Baltimore, a ranking member of the House Oversight and Government Reform Committee, has sent several letters to drug manufacturers asking why they allow the gray market to exist.

Those letters are starting to bear fruit, as Hospira, an Illinois-based drug manufacturer, stopped doing business with Superior Medical Supply, a gray market distributor in Colorado that has not cooperated with Cummings' investigation. Cummings said Superior is selling Paclitaxel, a drug in short supply that is used to treat breast and ovarian cancer, for nearly $500 a vial, when its normal purchase price is $65.

"We'll receive faxes and phone calls (from gray market distributors). They'll suddenly say they have a drug (that's suffering a shortage) and offer it at an increased price," said Meyer. "We never purchase from those entities. In our institutions, we only purchase drugs from credible, authenticated sources."

Meyer said the reason is so the hospital can be certain the drugs it gets have been properly handled, stored and haven't expired - assurances hospitals don't get on the gray market.

As far as addressing the shortages, Meyer said her staff holds daily meetings to address how critically needed a drug is, calculating its normal usage and assessing the number of manufacturers that can provide it.

They also check the FDA's drug shortage website daily, as well as the American Society of Hospital Pharmacists website.

Meyer said because Scott & White is such a large institution, it's able to transfer drugs between locations when needed and no patients have been subject to a delay in treatment. She said it's difficult to pin down why some drugs are harder to find than others.

"Availability temporarily rises, then it falls, depending on the drug," she said. "You're never sure when the supply problem is resolved. It's a difficult process."

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