Bolstering the Medication Supply Chain and Ameliorating Medication Shortages: A Position Paper From the American College of Physicians

The U.S. health care system is experiencing numerous supply chain disruptions, including for important medications. Prescription drug shortages have been at record levels and have affected more drugs in recent years, especially generic sterile injectables and other low-margin medications. These shortages arise from a confluence of factors, including the complexity of the entire production and delivery supply chain, quality issues, outdated manufacturing facilities and practices, drug purchasing policies that prioritize lowest price over reliable production, changes in prescribing and usage patterns, geopolitical constraints, and market concentration, among other factors. When prescription drugs are in shortage, patients face negative health outcomes due to being unable to obtain necessary treatments, the stress associated with securing medications, and adverse effects from alternative treatments. Physicians also face substantial burden in navigating drug shortages because they must expend time and resources in identifying alternative treatment options and obtaining prior authorization for the coverage of alternative drugs, negatively affecting the patient-physician relationship. Policymakers, regulators, manufacturers, health systems, health professionals, and other relevant entities must collaborate to further efforts to ameliorate drug shortages and promote equitable access to treatments. In addition to short-term measures to address the immediate effect of drug shortages, policymakers, manufacturers, and drug purchasers should also undertake efforts to prevent future drug shortages by investing in, strengthening, and diversifying prescription drug supply chains and incentivizing procurement practices that emphasize reliable and sustainable production practices. Such efforts must be undergirded by policies to improve monitoring of and transparency into the prescription drug supply chain.