Drug supply chain problems are more likely to lead to shortages in the US than in Canada

The analysis looked at medicines that had reported supply chain disruptions in both countries between 2017 and 2021. It found that within 12 months of an initial US report, almost half resulted in drug shortages in the US, compared to about a third in Canada. There was also a consistently lower risk of shortages in Canada each month after the reports.

“Drug shortages cause real disruptions in patients’ lives, often resulting in interrupted or delayed treatment,” said senior author Dr. Katie J. Suda, Pharm.D., MS, professor at the Pitt School of Medicine and associate director of the Center for Pharmaceutical Policy and Prescribing. “We can learn from other countries that are successful in mitigating the impact of drug shortages on patients.”

The researchers used reports on supply chain issues from the U.S. Food and Drug Administration, the American Society of Health-System Pharmacists and Health Canada. They then compared these reports with actual drug use in both countries, defining a drug shortage as a decrease in the number of units purchased monthly of at least 33% compared to the average number of units in the six months prior to the report.

Most reports of supply chain issues were due to production or shipping issues. However, a quarter of US reports did not specify a reason. Generic medicines accounted for 95% of reports in both countries, and own-source medicines accounted for one in five. However, route of administration, time since Food and Drug Administration (FDA) approval, and unit drug price did not predict drug shortages..

“The pharmaceutical supply chain is global and every person who touches a medicine is essential, from manufacturers to dock workers to pharmacists,” said lead author Mina Tadrous, Pharm.D., PhD, Leslie Dan assistant professor at the University of Toronto. Faculty of Pharmacy. “Supply chain shocks will occur, and it is important to work together internationally to develop strategies to minimize disruptions to patients.”

Although the article did not explore the reasons behind the differences in drug shortages in the two countries, the authors note that Canada is seeing more collaboration between regulators, healthcare systems, public payers and other key players such as manufacturers and wholesalers. Canada also uses its pharmaceutical stockpile mechanisms to address drug shortages, while the U.S. stockpile is intended for acute events, such as terrorism or mass casualties. The authors also said policymakers should consider incentivizing the production of lower-profit generic drugs.

Other authors are Katherine Callaway Kim, MPH, Scott D. Rothenberger, Ph.D., Tina B. Hershey, JD, MPH, Lisa M. Maillart, Ph.D., and Walid F. Gellad, MD, MPH, all Pitt ; Inmaculada Hernandez, Pharm.D., Ph.D., from University of California, San Diego; and Joshua W. Devine, Pharm.D., Ph.D., from Des Moines University.

This research was supported by the Agency for Healthcare Research and Quality (R01 HS027985). Dr. Hernandez has received consulting fees from Bristol Myers Squibb and Pfizer, outside of reported work. Dr. Tadrous has received consultancy fees from Health Canada and Canada’s Drug Agency (CDA).