How Should Critical Medications Be Rationed During Shortages?

When any drug is in short supply, it must be rationed.Recent increases in the frequency of shortages require more rationing by clinicians.Most health systems have policies on managing drug shortages, but transparency of criteria according to which specific scarce medications should be rationed-and by whom-are rare.The COVID-19 pandemic offered several examples of clinical and ethical need to develop and implement clear, fair strategies for distributing medications in short supply.Lessons from the pandemic should inform strategies for managing drug shortages now and in the future.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM .Physicians should claim only the credit commensurate with the extent of their participation in the activity. Shortages Require RationingAt the time of this writing, the US Food and Drug Administration (FDA) listed 136 medications in shortage, ranging from inhaled albuterol solution to injectable vecuronium. 1 Even before the pandemic, it was not uncommon to see over a 100 drugs in shortage at any given time, but in recent years the state of drug shortages has become even more severe.Data from the University of Utah and the American Society of Health-System Pharmacists (ASHP) note that the number of ongoing and active shortages in mid-2023 is at a 10-year high. 2,3Products in short supply today include several standard-of-care chemotherapy agents, critical care medications such as intravenous hydrocortisone, important medications for attention-deficit disorder, and even common medications for diabetes. 2The most common reasons for drug shortages are quality deficits during manufacturing, as well as economic disincentives to produce low-cost but difficult-to-manufacture products. 4A comprehensive framework to improve the resilience of the medical product supply chain is available from the National Academies of Sciences, Engineering, and Medicine. 5But what should organizations do today, assuming shortages will continue to arise and could even become more common and severe?Most drug shortages are identified by a pharmacy department when an expected order does not arrive.The pharmacy team acts quickly to determine how long the stock on hand may last and what alternatives can be purchased.