Focus Rheums| Dr. Jekyll or Mr. Hyde? (video)

An official publication of the ACR and the ARP serving rheumatologists and rheumatology professionals

Rheumatologists Struggle with Drug Shortages

  |  Issue: October 2011  |  

Dr. Dao says, “some patients have been resourceful.”

Some, like Greenway, have been dogged with insurance coverage, with mixed success. Others have managed to buy their drug from hospital pharmacies and others have warily bought their medication online. If their attempts fail, they check with the doctor about alternatives.

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Greenway seems to have been fortunate. She says she now has the name of a helpful supervisor with the insurance company she hopes will allow her to circumvent much of the frustration next time. “It’s not my fault that they’re not making the generic,” she says. “But, unfortunately, it’s my problem.”

Rheumatology Feeling the Lack

Dr. Cush emphasizes that drug shortages in rheumatology, while a serious problem, have not risen to a catastrophic level. He says that none of his patients has suffered permanent harm or damage due to a drug shortage, as has been seen with cancer patients.

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“While there are certain patients who’ve been inconvenienced by this, I would not say this has been a show-stopper for rheumatology,” he says. “We have enough alternatives that short supply has not shut down patient care.”

Dr. Fudman says that, for many patients, there is only one optimal drug.

“There’s not such a wide variety of drugs in rheumatology that it’s easy to switch off of various things,” he says. “If somebody’s on methotrexate, they’re on methotrexate. If they’re on leflunomide, they’re on leflunomide. These are drugs that take a long time to build up their efficacy. It’s not something you can switch back and forth.”

The FDA says it confirmed 178 cases of drug shortages in 2010—a record number. That was up from 55 shortages five years ago.1

According to the University of Utah Drug Information Service, there were 120 shortages reported in the U.S. in 2001—but that number has risen to 211 in 2010.

Through September of this year, 200 shortages were reported.2

Senate Bill Would Require Advance Notice of Potential Shortage

If rheumatologists and pharmacists were to get early warning that a drug might soon be in short supply, they may be able to better prepare their patients and help them adapt, perhaps pursuing other medications sooner, if possible.

Advance notice, though, is often more of a wish than a reality.

But a bill (S. 296) proposed in the U.S. Senate by Sens. Amy Klobuchar (D-Minn.) and Bob Casey (D-Pa.) would require that drug manufacturers notify the U.S. Food and Drug Administration of factors that might lead to a drug shortage.

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