At a time when the healthcare system and public are stressed beyond belief there has become another “New Normal” when it comes to local pharmacies running out of some of the most commonly used prescriptions.
Medical offices that routinely send electronic prescriptions to a patient’s pharmacy of choice are getting overwhelmed with patients calling them back to say their pharmacy is temporarily out of their prescriptions. This is stressing the system and the patient even more so doctors are going back to basics and using compliant paper prescriptions where they can.
Medical providers are now recommending that patients take the paper prescription with them and check with the local pharmacies to see if it can be filled. They are also finding that patients who have multiple prescriptions may need to go to one or more pharmacies.
Patients are now requesting 2 written prescriptions for drugs so they can use one for local pharmacies for a small supply and a second for a 90-day supply, including the fills that can be submitted to a Mail Order Pharmacy.
What Factors Are Causing This?
Confusion with electronic prescriptions - Transferring an electronic prescription to another pharmacy is not an easy process and has to meet both DEA and state guidelines depending on what the prescription is for.
It is a lot of work for both the pharmacy and the medical provider and most of the time it is just cancelled and the provider has to resubmit it to another pharmacy. The question is where do you transfer it to? Medical offices do not usually have the time to find prescriptions for their patients.
Surge Demands - The unprecedented demand created by the global pandemic is creating shortages, for even basic over-the-counter drugs like Tylenol, as supply chains are strained from the manufacturers that produce the medications to the wholesalers that deliver them to pharmacies, making it extraordinarily difficult to keep shelves fully stocked.
The “State of Emergency” guidelines for most states allow prescriptions to be filled for 90 days. Across the country pharmacies have been experiencing inventory issues as patients seek to extend 30 day prescriptions to 90 days to ensure access to their medications amid the prolonged COVID-19 crisis.
In an article published by CNBC on April 4, 2020 they interviewed the pharmaceutical wholesaler AmerisourceBergen, who said the pandemic is pinching supply chains worldwide. As the company places large orders to meet surging U.S. demand, manufacturers in countries like India, which is under nationwide lockdown, are balancing those orders with obligations in regions like the European Union, which is also severely impacted.
“What we’re seeing in the supply chain today particularly from the pharmacy side is an insatiable demand for a limited amount of product,” said Heather Zenk, senior vice president of secure supply chain at AmerisourceBergen. “We are seeing manufacturers talk about things like historical inventory demands and historical product movement,” she said.
Worldwide Supply Chain Problems - The FDA continues to take steps to monitor the supply chain. The Drug Shortage Staff within the FDA’s Center for Drug Evaluation and Research (CDER) has asked manufacturers to evaluate their entire supply chain, including active pharmaceutical ingredients, finished dose forms, and any components that may be impacted in any area of the supply chain due to the COVID-19 outbreak.
The FDA is watching our supplies closely because there is huge global need for pharmaceuticals and the supply to the United States will be rationed accordingly. Countries that make the drugs have been shut down, just as we have, and the new demand for drugs is unprecedented. China is the source of the active ingredients of many drugs produced elsewhere. India, another major source of drugs for the U.S., gets about 75 percent of its active ingredients from China.
China is a dominant force when it comes to generic drugs in particular, which account for the vast majority of medicines that Americans take. We rely on China for 90 percent of our antibiotics, and for drugs to treat everything from cancer to depression.
Exponential Demand Expected
Since March 18, 2020 when the Centers for Medicare and Medicaid Services (CMS) and other government agencies limited all “non essential” elective medical and surgical procedures they in effect limited most new prescriptions from being written. This is because “non essential” elective medical offices have stopped physically examining patients or doing procedures and tests that create a need for new prescriptions.
Every week that patients can’t get to their doctors creates a huge backlog that will surge the pharmacies once the medical offices re-open, new diagnoses are made, treatments are modified and surgical procedures resume.
The anticipated backlog and surge for more new prescriptions can’t even be calculated at this time.
The U.S. projections for the year 2020 showed that an average of 89 million prescriptions would be written each week. These calculations were made before the COVID-19 outbreak and the FDA is bracing for a greater need for new COVID-19 treatments, antivirals and vaccines which could cause many of the components for common drugs to be depleted.
In Conclusion - What Medical Offices Are Doing
The best thing a medical office can do is make the patients aware of the supply situation when prescribing a drug.
Patients are all aware by now that supplies of any product can be limited due to surge buying and supply chain issues. They are currently very familiar with stocking up or looking for other supplies they need. Prescriptions are quite different though because their life and well being can be greatly affected by not taking them.
Doctors need to ask patients if they want a printed prescription so they can check availability and also advise them that there may be difficulties moving an electronic prescription to another pharmacy.
If any medical office needs to check their state guidelines of paper prescription printing or needs a resupply, their local medical printing company will be happy to help. For further information you can contact me or our team to assist you further.