SILVER SPRING, MD — VA is not immune to the effects of drug shortages, and even small problems in the drug pipeline can have serious effects on the department’s ability to get the right pharmaceutical to the right patient, VA officials said at a recent public hearing.
The hearing, organized by FDA, brought together health officials, public and private, to discuss the growing national drug-shortage problem, which has been experienced most strongly with injectable drugs such as chemotherapy drugs, parenteral nutrients and anesthesiology drugs.
Effects of Shortages in VA
More than 258 million outpatient prescriptions are written by VA physicians every year, with 82% of those going through the department’s Consolidated Mail Outpatient Pharmacy (CMOP) system. VA has urged veterans to go through this system, consisting of seven physical plants across the U.S., because of its high accuracy and efficiency. That efficiency, however, also compounds the effect of any delays.
“We have an efficient system that’s very sensitive to the supply chain,” explained Vincent Calabrese, PharmD, associate chief of VA Pharmacy Benefits Management Services (PBMS). “Anything that impacts that chain can have an effect on patient care.”
Patients usually request a prescription as soon as they need a refill, Calabrese said. For the CMOP system to work efficiently, it must have the prescription filled and out the door within 48 hours. If the CMOP cannot fill the order because it does not have a drug in stock, the order is cancelled and sent back to the originating medical center.
“Then that facility is faced with the workload of having to fill it and, potentially, have to find a source,” Calabrese said.
Drug shortages also have had profound effects on inpatient practices in VA hospitals. Calabrese cited shortages in anesthesia drugs, particularly, succinylcholine, as one example. Anesthesiology chiefs at VA hospitals have had to issue guidance to their staff to come up with alternative therapies, such as rocuronium, and develop strategies to conserve supplies. This includes reserving succinylcholine for emergency use or when no other options in the guidelines are appropriate.
While implantable devices have shown promise in reducing rehospitalization for heart failure (HF), VA researchers sought to determine if options that are less expensive and non-invasive would have comparable results.
Legislation to prevent VA from outsourcing creation of its drug formulary and to require more input from medical professions is being considered in Congress.