Dr. Benjamin: From 70 to 267 in 5 years.

Where do you think we are going to be in the next couple of years?

Dr. Benjamin: Well, there is good news. There are only 97 new shortages right now, and last year at this time there was many more. I cannot give you the number, but I can find it if you needed it. We are encouraged by this downward trend of new shortages in the first six months since the President signed the bill into law. We hope it keeps up and we would like to see it be doing a little bit better than that. We would like to see shortages go down to the past levels; we usually maintained around 40 or 50 and that was kind of a low, steady level. As I said, quality problems happen and people take care of them, but we will be monitoring to see what happens when all of the legislation that has to do with shortages is implemented. We hope it will help. When shortages occur pharmacists and physicians get together and they try to develop prioritization protocols that make sure that the most needy patients get the scarce supply. So, this essentially is rationing.

How do you make this decision?

Dr. Benjamin: It is done usually with the hospital ethics committee, the medical staff, and pharmacy. It is a very difficult decision. It is similar to what you do with solid organ transplant. Who gets the kidney? Who gets the heart? Who gets the lungs? I mean, it is a very difficult decision. It has been quite stressful for all the care providers involved and certainly mostly for the patients.

Do the patients know that they are on a certain list when they hear about a shortage?

Dr. Benjamin: What we have heard that practitioners are doing is whenever a patient’s drug is in shortage and there is an alternative therapy or the patient will have to get a lesser dose or the patient will have to skip maybe a cycle of his drug, the physician and pharmacist, either or both, can discuss this with the patient and tell them what the potential effect on their care might be, how it might affect the outcome of their disease, and what we are going to do now moving forward. We have heard that patients have really been drawn into and engaged in their own care and in these decisions.




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