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Coronavirus crisis highlights weak links in supply chain for widely-used medications

The Trump administration announced Tuesday that it has made a deal with a new company to manufacture generic medicines and pharmaceutical ingredients needed in the coronavirus fight, according to published reports.

The $354 million four-year contract, awarded to Phlow Corp, is meant to protect the nation’s supply chain when it comes to ingredients that are primarily made in China and India.

The announcement comes in the wake of concerns about medicines in general — not just those needed for COVID-19.

But what about your regular medications? Have you had trouble filling your prescriptions?

An April study by National Community Pharmacists Association (NCPA) found 90% of neighborhood pharmacies have experienced some drug shortages since March 1.

The survey found shortages of albuterol inhalers, hydroxychloroquine, azithromycin and other drugs in high demand since the outbreak.

It makes sense that there was a run on hydroxychloroquine, for example, after President Trump touted that the drug could be a weapon in the coronavirus fight.

But other medications faced higher demand as consumers worried about having enough of a supply to treat chronic conditions.

Pharmacy experts say we’ve been seeing some problems in the supply chain because of the United States’ reliance on China and India for many of the “active pharmaceutical ingredients,” or API, used in common medications.

“There is such a heavy reliance for the active ingredients for commonly used medicines like blood pressure medication and penicillin,” said Douglas Hoey, the chief executive officer of the National Community Pharmacists Association (NCPA). “India at one point was going to stop the exportation of 26 active ingredients they were making because they wanted them for their own country’s use.”

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Pharmaceutical companies rely so heavily on overseas supplies as a matter of profit.

“Like a number of industries, the overseas market has been able to provide products for less,” said Chad Worz chief executive of the American Society of Consultant Pharmacists.

He said while much of our supply chain for medications is closely held inside the United States, many of the ingredients are not.

Other shortages have been not been caused by a lack of ingredients or an uptick in demand, but because some overseas manufacturers haven’t met safety standards set by the Food and Drug Administration.

Worz said medications like the antacids ranitidine and famotidine, and high blood pressure medication valsartan “have all had safety issues likely the result of poor manufacturing practices in other countries.”

“This has, in turn, led to a cascading shortage in medications that could replace them like losartan and nizatidine, to name a few,” Worz said.

HOW CAN WE FIX THIS?

The pandemic has exposed some issues in the system that need to be addressed going forward, experts say.

But this isn’t the first time we’ve seen concerns, said John Beckner, a pharmacist and senior director of strategic initiatives with NCPA.

“A number of years ago there were only a couple of manufacturers for the flu vaccine — this was at the time of the H1N1 epidemic — and one manufacturer got shut down for unsanitary practices which left only one manufacturer on the market so there was a shortage of vaccines,” he said. “If you only have two companies making a particular product that’s in great demand, you’re going to run into problems.”

Becker said there are some states — but not New Jersey — that are looking at allowing pharmacists to do “therapeutic substitutions” for medications if there is a shortage of a drug without having to call the prescriber.

Worz said his group is supporting legislation on both the federal level and in some states that would allow pharmacists to test for strep, influenza and COVID-19.

“Pharmacists are the most accessible health care provider and the ability to order, test, inform and triage people to the right place — back home, the doctor, the hospital — is the most efficient way to hold down an outbreak,” Worz said.

On Tuesday, Gov. Phil Murphy announced expanded coronavirus testing at pharmacies in the state. He said the attorney general and the Division of Consumer Affairs has “authorized the more than 18,000 licensed pharmacists in the state to administer FDA-approved or authorized COVID-19 tests to their customers.”

No prescription will be required, the governor said.

But when it comes to medication prescriptions, consumers can take steps to make sure they don’t run out of needed medications.

For example, if you’re on a 30-day supply of medication, ask your physician for a 90-day supply, said Adam Warner, marketing professor and director of the Market Research Center at Seton Hall University.

Another possible solution on the business and government side would be to create some sort of centralized database that collects patient caseloads so manufacturers and practitioners “can be a little smarter about supply,” Warner said. Think of how a pharmacy today can track how many oxycontin prescriptions a person fills across different locations. A national database along those same lines, but for all medications, doesn’t exist, he said.

Warner says he believes pharmaceutical companies will shift gears and “get (key active ingredients) where they can,” he said.

“Maybe they shift some of the active ingredient processing to the United States, but we haven’t seen it yet,” he said.

Worz said we need to be able to produce more of our “strategic assets” here in the United States and have more capacity to produce what we need during emergencies.

“Medications have not traditionally been considered strategic assets and the time has come for us to take a close look at what our capabilities need to be in ongoing production of our medications and our ability to ramp up when needed,” he said. “In addition, we need to be sure our agencies, like the FDA, have the authority to reject medications that come from places that they cannot inspect.”

Hoey agreed that increased domestic production, or at least increased deals with our trading partners who are not foreign adversaries, would go a long way.

“Just like we wouldn’t buy all our submarines for a military operation from China or from Russia, why would we rely on them so heavily for our prescription drug supply?” Hoey said.

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Karin Price Mueller may be reached at bamboozled@njadvancemedia.com.

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