On February 18, 2020, we wrote an article titled: “Will There be Drug Shortages Resulting from the Coronavirus?” Is there a possibility of worldwide drug shortages? China makes key ingredients for many critical pharmaceuticals. Are we prepared for drug disruptions? Two weeks later, we are concerned enough that we are warning our readers to stock up on critical medicines.
A Quick Overview of Coronavirus Cases:
Five weeks ago, there were fewer than 3,000 reported cases of coronavirus worldwide. Today there are roughly 90,000 acknowledged cases, with more than 3,000 deaths. China is still the epicenter for the virus, but the World Health Organization has warned that most countries around the world are likely to be affected by COVID-19 infection.
Will the Coronavirus Impact Pharmacies in the U.S.?
Most of our medications are now made abroad. Many of the raw ingredients (Active Pharmaceutical Ingredients or APIs) are made in China. Indian generic drug companies make APIs but they also buy APIs from China and convert them into finished products. If there is a hiccup anywhere along this complex pharmaceutical supply chain, many patients in the U.S. will eventually be affected.
It’s not just generic drugs. The Wall Street Journal reported on March 1, 2020 that:
“Some of the world’s biggest drugmakers have begun warning that their businesses could be affected by the spread of the coronavirus.
“AstraZeneca, Merck & Co. and Pfizer Inc. are among the companies that said recently the epidemic could affect supplies for certain drugs or sales, depending on how long the epidemic lasts.”
Most drug companies are very tight-lipped about where their APIs and finished products come from.
The Wall Street Journal article quotes an insider about what can happen if there is disruption:
“‘There is no such thing as a simple supply chain anymore,’ said Steven Lynn, a former FDA official who consults with drugmakers on quality and compliance. ‘Things are coming from all over the world. If one part of that breaks down, then you’re scrambling.’”
Where Is the FDA When it Comes to Drug Shortages?
The Commissioner of the Food and Drug Administration reported last week that:
“As I have previously communicated, the FDA has been closely monitoring the supply chain with the expectation that the COVID-19 outbreak would likely impact the medical product supply chain, including potential disruptions to supply or shortages of critical medical products in the U.S.
“A manufacturer has alerted us to a shortage of a human drug that was recently added to the drug shortages list. The manufacturer just notified us that this shortage is related to a site affected by coronavirus. The shortage is due to an issue with manufacturing of an active pharmaceutical ingredient used in the drug. It is important to note that there are other alternatives that can be used by patients. We are working with the manufacturer as well as other manufacturers to mitigate the shortage. We will do everything possible to mitigate the shortage.”
To our disappointment, the FDA has not identified the drug that has been impacted.
The agency went on to state:
“Also, as part of our efforts, the FDA has identified about 20 other drugs, which solely source their active pharmaceutical ingredients or finished drug products from China.”
Again, the FDA has not identified any of these medications.
What Should Patients Do?
We suspect that the FDA does not want to create panic. We get that. If the feds alerted health professionals and patients to the possibility of specific drug shortages, there would likely be a run on pharmacies. That would turn a potential shortage into a definite shortage. All you need to do is look for face masks, N95 respirators, disinfectants, bottled water or toilet paper to realize that people are starting to hoard such products.
How should patients prepare for potential drug shortages in the coming weeks and months? An insider told us that the supply chain of active pharmaceutical ingredients from China to India is good for about two months. That means that in the next couple of weeks many generic drug companies in India may start to run out of the APIs they need to make their finished products. It is hard to predict how that will impact U.S. patients.
People’s Pharmacy Perspective:
Millions of people cannot afford to run out of critical medicines. We would encourage people with lung conditions such as COPD or asthma to make sure they have at least a 90-day supply of all essential drugs on hand. Ditto for people with heart disease, hypertension, cancer, diabetes, epilepsy, AIDs, auto-immune conditions such as lupus, MS, Sjogren’s or rheumatoid arthritis.
People taking pain medicines or drugs for mental health should also try to have at least a three-month supply on hand. That’s in part to control the condition being treated, but also to avoid withdrawal symptoms should you run out suddenly. Drugs like tramadol, gabapentin, prednisone, clonazepam, duloxetine, sertraline, or venlafaxine can trigger unpleasant symptoms if patients suddenly stop taking them.
How to Get Enough Medicines to Avoid Drug Shortages:
1) Enlist your physician. You will need an ally to avoid drug shortages. Your physician understands why your medicine is essential. Ask her to write you a prescription for a 90-day supply. If your insurance company rejects the new prescription, perhaps someone in the doctor’s office can arm-wrestle the gatekeeper into submission.
2) If your medicine is essential and not too expensive, you may have to pay for the extra supply out of pocket. Enlist your pharmacist as your ally in this approach. Your doctor will also have to assist.
3) If you need a brand-name drug that is pricey, you may need to get a paper prescription you can fax to a Canadian pharmacy. Drugs are often substantially less expensive in Canada. If you identify a legitimate Canadian pharmacy from PharmacyChecker.com you may be able to have your physician submit the prescription electronically. Canadian pharmacies often offer 90-day supplies.
Do Not Panic!
We remain hopeful that our drug supply chain will not falter. When we talked with FDA officials a month ago in Washington, we could see that they were already scrambling to stay on top of drug shortages. Most major pharmaceutical manufacturers are also working hard to prepare for disruptions in the supply chain. They are trying to avoid drug shortages too because this would reflect badly on their reputations.
We hope that pharmacy chains and other pharmaceutical outlets are also preparing for the possibility of drug shortages. In the meantime, though, we hope you can take prudent action to avoid any personal drug shortage for critical medicines.
