Drug supply shortages still widespread across medical groups

An already fragile supply chain that was pushed beyond its limits during the COVID-19 pandemic is still prone to breaking when it comes to drug supplies for medical groups.  

A June 27, 2023, MGMA Stat poll found that more than three in four (76%) medical groups report being impacted by drug supply shortages in 2023, while only 24% did not. The poll had 488 applicable responses. 

Major headlines have reflected the severity of this supply chain disruption: 

• Considerable spikes in demand for children’s acetaminophen amid the “tripledemic” of RSV, flu and COVID-19 led to intermittent shortages in the past year and some major pharmaceutical chains rationing supplies, per Axios. 
• Similarly, a rough winter season strained supplies of amoxicillin — an issue made worse by the relative lack of tracking of “run-of-the-mill" strep infections to gauge shifting need, per NPR. 
• Adderall, commonly prescribed for adult and pediatric patients with ADHD, went into shortage status in October 2022; as recently as May, the American Pharmacists Association cautioned that the impacts of that shortage will continue to be felt. As one respondent told MGMA, ADD and ADHD medications are “still very difficult to come by unless your insurance will pay for branded prescriptions; most do not or require a prior authorization they will deny.” 
• The Washington Post recently documented the issues around shortages of the chemotherapy drug cisplatin, precipitated by the suspension of work at a pharmaceutical plan in western India that accounted for about half of the U.S. supply of the drug.  
• And The New York Times noted in its reporting on cancer drug shortages that the American Society of Clinical Oncology recently advised doctors with low supplies of medication to reserve them for patients with the best chance for survival and/or deny them for patients with widely spread disease. 

These challenges in procurement intensify the burdens on medical group practices already looking to find ways to focus limited resources on care delivery. As one MGMA Stat respondent succinctly noted: “We have had to hire more people to handle the amount of calls we have on locating medications like stimulants — it’s a pandemic all its own, psychiatry is suffering.” 

These significant challenges for healthcare providers prompted a congressional hearing to examine the root causes of drug shortages last month, highlighting the difficulties in securing an adequate supply of generic prescription drugs and drugs administered by injection. While manufacturing/production interruptions are often cited, the U.S. Food & Drug Administration (FDA) previously has cited that economic factors — specifically, low profit margins for low-price prescription drugs — as “intermediaries” (e.g., pharmacy benefit managers and wholesalers) have “substantial market power to determine the price they will pay for generic drugs” and that such savings are not always passed onto healthcare providers, patients or plan sponsors, per the hearing memo (PDF). 

Among medical group leaders who responded to the MGMA Stat poll, the most reported areas of shortages and lengths of impact were: 

• Supplies of lidocaine, Marcaine and epinephrine injections have been disrupted for more than a year, and many groups report that Bicillin injections have recently been more difficult to acquire. Several medical group leaders specifically mentioned the difficulty in acquiring the more highly concentrated 2% lidocaine. “At one point we did find a supplier who had a limited supply of 1% [lidocaine] and we paid an exorbitant amount for it,” one respondent told MGMA. 
• Some groups reported stimulant medication shortages that began throughout the pandemic persist today. 
• The past six months have seen increased reports of shortages of ADHD medications and some antibiotics. 
• Fluorescein and other diagnostic contrast agents have been difficult to obtain in the past year following the shutdown of operations of Akorn Operating Co. in Illinois, which produced 100% of the U.S. supply of various injection solutions, per Becker’s Hospital Review. 

Additionally, some medical groups have reported impacts in acquiring Misoprostol in the past year following the Supreme Court’s Dobbs decision that triggered several states to restrict reproductive care, which spurred a sudden demand for the drug in states seeking to stockpile it following legal challenges to the FDA’s decades-old approval of mifepristone. 

Another recent development in drug supply shortages has been the surge in interest in GLP-1 receptor agonists — including the semaglutide injections Ozempic and Wegovy — leading to them making the FDA’s Drug Shortages list earlier this month. 

All these challenges add up for medical groups that are otherwise looking to continue their post-pandemic recovery. “Some shortages have forced us to use other medicines that are less desirable or that have slowed down our procedures,” one medical group leader told MGMA via the poll. Another respondent noted that rising prices are especially impactful: “Medical supplies have doubled or tripled, and I cannot get my hands on any lidocaine with epinephrine.” 

There have been improvements in drug supplies, however: Some groups note that difficulties finding pharmacies with adequate supplies of pain medications for patients’ post-surgical needs have eased in recent weeks, allowing their nurses to spend less time on the phone searching for pharmacies that can fill prescriptions or match up quantities of certain drugs needed to avoid narcotics or patient allergies. 

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