Managing the Medicine Shortage Mess

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Navigating the struggle of medicine shortages has become an everyday part of a pharmacists workflow. In August of this year, a joint report was released by the PSA, the Pharmacy Guild and the Society of Hospital Pharmacists of Australia, calledMedicine Shortages in Pharmacy – A snapshot of shortages in Australia”, whereby a profession wide survey was undertaken in April-May 2021 to assess the impact of shortages on patients and pharmacists.

Some of the findings of the survey were:

  • Almost all, (98%) of pharmacists surveyed said they had experienced a medicine shortage in the previous 7 days.
  • Pharmacists reported an average of 30 medicines in low supply over the preceding 7 days, with some reporting up to 600.
  • An average of 5 hours of pharmacist time and 4.5 hours of non-pharmacist time per week was dedicated to solving medicine supply issues.
  • Of the 136 medicines identified being short in the preceding 12 months, 71% were reported on the Therapeutic Good of Australia ’s (TGA’s) Medicine Shortages Information Initiative (MSII) website (now referred to as the medicine shortage reports database).
  • 86% of pharmacists indicated that the situation had not improved over a 12-month period.

Since the survey was conducted there has been no reprieve from this issue, despite new legislation being passed to allow pharmacists to substitute a different medicine, when a patient’s usual medicine has been declared to be in ‘serious scarcity’.

As per the National Health (Pharmaceutical Benefits) (Pharmacist Substitution of Medicines without Prescription during Shortages) Determination 2021, pharmacists can supply a patient a prescribed medication that has been issued a Serious Scarcity Substitution Instrument (SSSI) by the TGA, with a substitute listed under the Pharmaceutical Benefits Scheme (PBS).

The agreement allows a pharmacist to:

  • dispense different strengths of a medicine (eg. two 20 mg tablets in place of a 40 mg tablet)
  • dispense a different dose form of the same medicine (eg. a capsule instead of a tablet, or as one transdermal patch for another transdermal patch)
  • substitute a product that is an extended/sustained-release variant of a prescribed immediate-release medicine, or vice-versa.

As long as the alternative medicine is supplied by the pharmacist in accordance with the specifications of the SSSI, the patient is not required to return to the prescribing doctor for a new or amended prescription. The pharmacist does, however, have an obligation to seek the patient’s consent to substitute the prescribed medicine before supplying a substitute benefit and to inform the prescribing doctor in writing within 72 hours.

However, pharmacists are increasingly seeing shortages have a negative impact on the patient’s health, due to extended periods of shortage or irregular patterns of supply availability. The situation is further compounded when an equivalent alternative medicine is not readily available, or its supplies have also been exhausted. With only one medication (Isosorbide Mononitrate SR 120mg) currently listed on the SSSI, it is understandable that pharmacists and doctors are frustrated.

The three key recommendations from the review were:

  • The TGA’s medicine shortage reports database, should accurately reflect the availability of medicines that can be purchased through wholesaler ordering portals.
  • The government should engage and partner with pharmacy organisations to improve the management and coordination of medicine shortages.
  • Medicine manufacturers should improve the accuracy, timeliness and consistency of information being communicated to pharmacists, prescribers and patients on issues relating to medicine shortages.

In light of the data collected, it is clear that medicine shortages will remain a substantial problem for pharmacists across Australia with significant implications for patient care, staff resourcing and expenditure. Further reforms are desperately required to alleviate the stress placed on patients, prescribers and pharmacists.