Medication shortages can make it challenging for pharmacists to maintain patient access to necessary drugs. Drug unavailability can occur due to many factors, including unexpected increases in drug usage, discontinuation of a drug, quality control issues at a production facility, or a natural disaster that interrupts material access or supply routes.
While the reasons behind these shortages are complex, there is still one common goal for pharmacy professionals: act in the best interests of patients to ensure consistent supply of essential medications and provide consistent care. Further, while these shortages can undoubtedly be a cause of frustration, they are also an opportunity to reassess drug therapy and consider overall appropriateness of medication regimens.
Strategies
The following strategies can be useful during a drug shortage:
- Communicate with patients regarding the nature of shortages, assess the timeliness and their need for prescription therapy, and explain options for therapeutic continuity.
- Coordinate with various sources, such as other pharmacies or suppliers, to determine availability of product and facilitate patient access by arranging a timely transfer of prescription records or drug product.
- Determine whether there are alternative formulations such as other generic/brand options, alternative strengths, or other methods of administration. Consider if an appropriate compounded formulation is a viable option. If necessary, consider switching to an alternate, but therapeutically equivalent drug therapy option. As always, gather information from your patient and other sources to determine if it is appropriate to adapt prescriptions and document your rationale within the patient record. Ensure that you establish a monitoring plan to assess patients for the efficacy and safety of these adaptations. As a reminder, pharmacists who do not have their additional prescribing authorization (APA) must limit adaptation practices to when they receive a new prescription. The Standards of Practice for Pharmacists and Pharmacy Technicians outline other considerations for pharmacists when initially prescribing (for those with APA when the original prescriber cannot be reached in a timely manner and the pharmacist is competent to asses, prescribe, and follow up on the prescribed therapy) or adapting a prescription.
- Communicate with third-party payers to inform them of drug shortages and determine options for temporary coverage approvals, especially when dealing with expected long-term supply interruptions.
- Collaborate and communicate with other regulated health professionals whose care of the patient may be affected by an interruption or change in medication. Include specifics of drug shortage timelines in your collaborative communication, so that prescribers are aware to adjust their ongoing practices accordingly. Any adaptation or initial prescribing completed by the pharmacist must be communicated to the other regulated health professionals involved in the patient’s care.
- Ensure your medication supply management processes are consistent and well understood by all staff members to maintain timely and well-communicated resolutions of treatment interruptions to patients.
It’s also important to stay current on shortages, recalls, adverse reactions, safety notices, drug research, and newly available medications and products.
Resources
- Healthproductshortages.ca is a helpful resource as the most up-to-date drug supply information tool, enabling pharmacists to provide accurate information to patients and aid in decision making. Drug manufacturers and suppliers may also send you information about shortages.
- The Canadian Pharmacists Association has a guidance document containing helpful tools to guide pharmacists through managing drug shortages
- For information on recalls and safety alerts, visit the Health Canada website.
- You can stay informed about new or emerging information about health product safety and effectiveness by subscribing to MedEffect Canada’s RSS feeds or e-Notices.