# Global Medication Shortages: A Comprehensive Report (2021-2024)

## Executive Summary

Medication shortages represent a critical global health challenge affecting both developed and developing nations.

This report examines the scope, causes, and impacts of medication shortages between 2021-2024, with particular focus on life-saving medications for chronic conditions.

The analysis reveals that shortages are widespread, multifactorial, and require coordinated responses from governments, healthcare systems, and pharmaceutical industries.

## Scope of the Global Medication Shortage Problem

### Geographic Impact
Medication shortages are a worldwide phenomenon affecting:
- **Egypt**: Experiencing 30-40% drug shortages, particularly impacting chronic disease medications including diabetes, cancer, endocrine, and cardiac drugs
- **Botswana**: Health facilities reporting shortages and delayed delivery of drugs and medical supplies since Q4 2020/2021
- **Italy**: Ongoing monitoring by

# Global Medication Shortages: A Comprehensive Report (2021-2024)

## Executive Summary

Medication shortages represent a critical global health challenge affecting both developed and developing nations.

Title:

Content: Chairman of Wafd Party
Dr. Abdul Sindh Yamama
Chairman of the Board of Directors
Dr. Ayman is an accountant.
Editor-in-Chief
I'm sorry.
My grandfather, Zainuddin.
Chairman of Wafd Party
Dr. Abdul Sindh Yamama
Chairman of the Board of Directors
Dr. Ayman is an accountant.
Editor-in-Chief
I'm sorry.
My grandfather, Zainuddin.
Smuggling burns drug stability
Libya and Sudan are the main destinations.
And the profits are huge.
Deficiencies include stents, heart medications, diabetes, pressure, and tumors.
It is an undeniable fact that the Egyptian pharmaceutical market is experiencing a crisis of shortage of some vital items on which citizens depend mainly, and at all levels, which exacerbated the suffering of patients in public hospitals affiliated to the government, which receive subsidized medicines at low prices, so that the so-called alternative class becomes a citizen ’ s refuge, to get the necessary dose of medicine, to alleviate his health suffering or save his life.
At a time when it is assumed that more than 90% of medicines are manufactured in Egypt, citizens' complaints about the lack of many medicines and medical supplies in the markets and hospitals are escalating to the extent that deputies submitted a number of requests for briefing through the deputies, stressing that the crisis lies in the raw material itself and imported in dollars.
And the pressure.
Thyroid and sugar.
The main reasons lie in the importation of 95% of raw materials in addition to the presence of “smuggling brokers ” whose mission is to smuggle Egyptian medicine to neighboring conflict countries, especially Libya and Sudan, in order to sell it abroad at exorbitant prices, and to reap huge profits, according to some pharmacists and specialists. In addition to Sudan ’ s import of Egyptian medicine in hard currency, especially with the licenses of Egyptian medicine compared to others and the stopping of factories in neighboring countries because of their conflicts.
According to Ali Abdullah, head of the Egyptian Society for Pharmaceutical Studies (an NGO), the lack of medicines and their disappearance from the local market is a real crisis in case of smuggling, such as insulin, tumors, anesthesia, surgical supplies, serums and vaccines.
The shortage of hard currency in Egypt is also one of the reasons for the disappearance of medicines.
Mahfouz Ramzi, head of the Pharmaceutical Manufacturing Committee at the Cairo Pharmacists Syndicate, pointed out that there are organized gangs that smuggle medicine to countries of conflicts and wars, explaining that “most operations are conducted through land border roads, and the Egyptian Drug Authority is responsible for inspecting companies, factories and any pharmaceutical institution, to ensure that medicines produced in Egypt are in the normal sequence until they reach pharmacies. ”“ Some smuggling professionals deal with drug stores, where they buy large quantities of medicines, take advantage of discounts on them, and then smuggle them abroad to take advantage of the price difference. ”
The Executive Director of the Egyptian Center for the Right to Medicine, Mahmoud Fouad, confirmed that "the drug stores have turned into an illegal business and a back gate for drug smuggling and expired drug trade, as most of them are not licensed and sold without invoices, and are not subject to the umbrella of the Ministry of Health, in addition to the lack of health standards required to practice the profession of pharmacy, after some stores are run from apartments away from the eyes of the Ministry of the control bodies. 90% of its owners are not pharmacists. ”
“Are these stores registered with the Ministry of Health?
And are they subject to pharmaceutical inspection or from the Drug Control and Research Authority? ”, stressing that most of the small pharmacies in the villages “do not have the ability to buy medicine from distribution companies, which makes them resort to buying from stores after agreeing on specific facilities and periods for payment, ” pointing out that“ popular medicines in Egypt are the most smuggled abroad. ” From 250 pounds ($8 at the official exchange rate).
According to Dr. Ashraf Hatem, Chairman of the Health Committee in Parliament, it is a social responsibility, and priorities must be set, and all parties sitting together may help to solve the crisis, in light of the apparent shortage of a number of medical drugs, and his demand that the Drug Authority publish periodically and daily alternatives to the missing medicines in the absence of the original medicine. In addition, the pharmaceutical industry continues to operate and produce.
For all this and for the continuation of the crisis of drug shortage it was necessary to search and investigate the causes and solutions!
During the meeting of Gamal al-Laith, Chairman of the Chamber of Pharmaceutical Industry at the Federation of Industries, in the presence of Minister of Health Dr. Khaled Abdel Ghaffar, the Governor of the Central Bank, Hassan Abdullah, and others, he sent letters of reassurance to the Egyptian people about the existence of a solution to pump the needs of the market of foreign currency to end the shortage of medicines. Or psychologically for the patient.
He said: « The medicines that suffer from the shortage, some of them are sugar drugs and other drugs tumors and drugs of the glands and heart, drugs related to chronic diseases, which is now being secured, and we as factories work with a stock of raw materials enough for 4-6 months, and this stock reached only weeks, and therefore we are now in the stage of risk, and therefore the government began to move ».
He added that the health sector is supported by the provision of foreign exchange resources to provide all needs according to a plan to deal with such circumstances, stressing the importance of full coordination between the unified purchasing authority and the pharmaceutical industry room as well as pharmaceutical companies to face any problems related to the shortage of supplies, medicines and medical consumables.
As well as a detailed presentation on the commitments implemented and not implemented in the period from June 2023 to January 2024, with regard to the provision of (medicines, medical supplies, laboratory supplies, devices, raw materials and packing materials), and the Minister was briefed on the results of the mechanisms established with the Central Bank of Egypt to pay the obligations in foreign currency to meet the demands of the health care sector.
In the end, the official spokesman stressed that the shortage of drugs does not exceed 15% and the drugs directed to tumors are at the forefront of the shortcomings because of their close link to the currency and what faces the supply chains, otherwise all drugs and within them are compatible... The complaints are due in their entirety to the lack of knowledge of citizens with the trade names of medicines.
In addition to the above, a severe shortage of anesthetic drugs, dental pening drugs, nephrology and recovery drugs, which will cause a real disaster that threatens the conduct of surgical operations for patients, and thus increase the waiting lists in hospitals and the occurrence of complications for patients that may result in loss of their lives.
The head of the medicine division of the Federation of Chambers of Commerce, Ali Ouf, revealed that a request will be submitted to the Egyptian Drug Authority early next week to move the prices of 1,500 items in light of what he described as developments in the situation and rising costs.
He pointed out that « the need to raise the wages of workers in the pharmaceutical sector to compensate them for the cost of living and therefore must raise salaries so that they can live in the current conditions and the sector will bear the increase of salaries at the expense of cost and raise the minimum insurance ».
On the shortage of medicines, Amin al-Dabraki, one of the dealers in the pharmaceutical market, said that the main reason for the crisis is the lack of active substances imported by companies.
This is mainly due to the dollar crisis, in addition to the withdrawal of some financial companies from the Egyptian pharmaceutical market.
On the inability of the Ministry of Health to move the prices of medicines with the movement of the exchange rate, he said that the solutions are the intervention of the state by providing a fixed customs dollar for pharmaceutical companies, while moving the prices of medicines, in addition to starting factories to produce active substances inside Egypt.

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Content: The real reason for the Children’s Tylenol shortage

After two years of lockdowns, colds are back and consumers are likely hoarding. ‘We’re seeing increases in demand that are running close to 20 to 40 per cent.’

Kim Mackay has resorted to giving her 11-year-old son expired children’s Tylenol desperate to ease his pain.

The 44-year-old mother and her husband scoured the aisles of at least 10 pharmacies in Vancouver and Burnaby in British Columbia in search of the pain medication for their child’s pancreatitis but could not find the product on shelves.

After friends, also on the look out, came back empty-handed, Mackay posted a plea for help on Facebook.

“I managed to get some expired Tylenol from somebody, and another person had gone down to the U.S. in the last month and brought back a big pack of Tylenol so I have that too,” Mackay said, adding that she currently has enough medicine for another week or so. After that, she’s resigned to repeating her search.

“It has been stressful on top of my child’s illness but I’m grateful for the people who have helped,” Mackay said.

Drugstores nationwide have been grappling since May with supply shortages of over-the-counter medications for children containing acetaminophen (also known by the brand name Tylenol), and ibuprofen (Advil) due to heightened demand and supply chain constraints.

“After two-years of social distancing, kids, adolescents, even young adults are getting exposed again to regular viruses,” said Dr. Sumon Chakrabarti, an infectious disease physician in Toronto, adding that a resurgence of colds and flus was expected after lifting COVID-19 restrictions.

“Kids normally would have a certain level of immunity when they’re being exposed to viruses. But we’re seeing a general increase and kids getting sicker than they normally would have because of the last two years of social distancing,” said Chakrabarti.

Supply of pain relievers for children has been especially impacted by unprecedented demand driven by an uptick of cold and flu viruses as well, treatment for milder COVID-19 symptoms is impacting the supply, according to the Ontario Pharmacists Association.

“We have seen higher transmission of respiratory illnesses such as coughs, colds and COVID-19 since the relaxation of public health precautions,” said Jen Belcher, vice-president of the Ontario Pharmacists Association. “Manufacturers have been unable to keep up with the high demand for all these products,” she added.

The Retail Council of Canada, which deals with supply chain issues on behalf of retailers across Canada, said overall demand is outpacing production for children’s cold and flu medications.

“Retailers are experiencing rolling shortages,” said Retail Council of Canada spokesperson Michelle Wasylyshen. Staffing shortages at the manufacturing level are also impacting production, she added.

These drug shortages are primarily consumer-driven, said Anthony Fuchs, a spokesperson for Food, Health & Consumer Products of Canada, the national trade association representing Canada’s food, beverage and consumer goods manufacturer which includes pharmaceutical company Johnson & Johnson Inc., the maker of Tylenol, as a member.

While there are staffing shortages among all members, they “have not been identified to me by companies making these types of products as an issue,” said Fuchs. “These companies have increased production of the products that they’re providing but particularly when it comes to children’s medication, we’re seeing increases in demand that are running close to 20 to 40 per cent above historical highs,” Fuchs said.

When asked about shortages, Johnson & Johnson confirmed that it is continuing “to experience increased consumer-driven demand.”

“We are taking all possible measures to ensure product availability,” the email said.

Dr. Rupert Kaul, director of the division of infectious diseases at the University of Toronto, said demand could also be spiking because people are stock piling the drugs.

In August, Health Canada in a twitter post urged Canadians not to buy more acetaminophen and ibuprofen medications for children than necessary to prevent drug shortages.

“It may well be that people are panic-buying children’s Tylenol in the same way we were panic-buying toilet paper at the start of the pandemic without any true increase in use,” Kaul said.

He pointed out that acetaminophen can be made in certain pharmacies on-site, so there isn’t any worry that drug stores will run out of it, he said.

“If we can rein in any panic buying, it will reduce the pressure on those supplies so the people who need them will be able to access them,” Kaul said.

Ghada Alsharif is a Toronto-based staff reporter for the Star. Reach Ghada via email: galsharif@torstar.ca
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Content: Hospitals spanning England face critically low levels of intravenous paracetamol - as a national shortage of the popular painkiller runs on. Paracetamol administered via an IV is the safest and most effective drug to give patients who are in post-operation pain - but staff at one hospital trust in particular have been told to pull the plug on the drug from anaesthetic rooms immediately.

The shortage of IV paracetamol is expected to run into November at earliest, with a Department for Health and Social Care spokesman blaming 'capacity constraints with a manufacturer' as the cause. One hospital worker detailed how deeply worried they were at the shortage - citing how it is much more effective than the orally consumed version.

They said: "It is deeply worrying. We use IV paracetamol because tablets taken orally are only 30% effective. Given by IV it is a potent and direct drug and it restricts pain very quickly."

Read more: Doctor warns that silent pandemic 'scarier' than Covid-19 is already killing a million a year

It is reported by The Mirror that they went on: "The alternatives are oral morphine, which is very slow-acting, or nonsteroidal anti-inflammatories such as ibuprofen and aspirin, which can have negative side effects such as bleeding and allergic reactions."

Drug shortages have become a global problem, worsened by the recent Covid pandemic, the ongoing war in Ukraine, the energy crisis and record levels of inflation. Last winter, France completely culled the internet sales of paracetamol products in a widespread shortage blamed on a Chinese export ban on raw materials.

In Great Britain meanwhile, it is Brexit which is primarily blamed for making matters worse. This is because drug imports from the EU - which historically make up two thirds of the National Health Service's supply - are at their lowest ever levels since leaving.

The health department’s spokesman, said: "Guidance has been issued to the NHS advising on how to manage the issue and we are working with those in the supply chain to resolve this as soon as possible."

Labour’s shadow health minister, Liz Kendall, said: "Concerned staff and patients will understandably be seeking reassurance that the pain relief they need is available. The Government must spell out the urgent steps being taken to resolve the shortage."

It comes after a Covid Inquiry heard that a lack of nurses left the NHS and Great Britain vulnerable to the pandemic - with the infection control lead at the Royal College of Nursing telling of a national shortage of PPE due to a lack of planning for an airborne virus.

Rosemary Gallagher, the RCN’s professional lead for infection prevention and control, explained: "The resilience of the health and care workforce is absolutely essential in order to be able to deliver health care services that meet the public's needs. We know that we went into the pandemic with a significant shortage, about 50,000 nurses short.

"That immediately put us at risk when we needed to surge capacity to support patients at home and in hospitals."

The intervention came the same day that a damning international study warned that Britain has fewer nurses than other developed nations.

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Content: Minister of Health: There is no shortage of medicines and supplies and we are working on rationalization and rationalization
Wednesday ، 26 October 2022 05: 11 PM
Dr. Khaled Abdel Ghaffar Minister of Health
Noor on
Leave a comment and read the comments of the readers.
Dr. Khaled Abdel Ghaffar, Minister of Health, stressed that there is no shortage of medicines and medical supplies, pointing out that there is a global shortage as a result of a shortage in supply chains due to the failure of factories to operate with the same efficiency due to Coronavirus.
He added at the ministry level that we transferred the financial commitments to the Unified Procurement Authority in order to be able to get everything we need, adding: "We are working on rationalization and rationalization in light of the global shortage in supply chains and coordinate on a daily basis with the Drug Authority to review all medicines."
In response to the demands of some deputies to allow medical staff to take vacations in accordance with the Civil Service Law, the Minister of Health asked how the situation is evaluated and there is a shortage of doctors in health institutions and allow vacations, saying: "The need to work is first of all, wondering how we have a shortage and at the same time open vacations, stressing that 50% of the force that we complain of inadequacy will not exist."
He pointed to the formation of a higher committee with all specialized professors to review the treatment protocols, pointing out that if the treatment protocol is changed, it is done without prejudice to the treatment received by the patient.
This came during the comment of Dr. Khalid Abdul Ghaffar, Minister of Health in the plenary session of the House of Representatives on the requests for briefing, questions and discussion, which amounted to nearly one hundred surveillance tools today.
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Title:

Content: Lack of medicines in MOH hospitals and accumulation of indebtedness Repercussions / solutions
3 hours ago
Dr. Naeem Malkawi
The problem of shortage of medicines in Jordanian hospitals requires quick and effective attention and intervention, as providing medicines to patients is one of the foundations of quality health care and one of the most important strategies of the Ministry of Health, however, the shortage of medicines in many hospitals leads to health, economic and social challenges that threaten the quality of health care and patient safety.
The budget of the Ministry of Health of medicines, vaccines, vaccines and medical consumables for this year 2023 was estimated at 103.75 million dinars, where the actual for the past year 2022 was 93.8 million dinars.
The question is, how did the Ministry of Health accumulate such a large indebtedness in the item of medicines to reach 300 million dinars for pharmaceutical companies?
And why last week was the debt of 2019 cleared and deducted estimated at 50% of the debt for that year?
This means that there is still a delay in the payment of dues for companies for the years 2020, 2021 and 2022 in addition to eight months of the current year 2023, and this brings us to a range of reasons and challenges:
1.
The aim of the Ministry of Health was to reduce the bureaucracy of procedures and overcome the complexity of procurement references in hospitals and health directorates in the governorates and not to obtain price and discount preferences, but the results indicate a defect in the management and mechanism of dealing with the strategy of unified and central procurement, despite the margin for hospital administrations to use the power of direct purchase in cases of necessity.
2.
Preparation of sub-budgets for hospitals: Evidence shows that there is a problem in the preparation of sub-budgets for hospitals and the main budget of the Ministry of Health with regard to the item of medicines, which is due to the lack of accurate and sufficient data on the number of patients and hospital needs of medicines, and the lack of accurate forecasting of future needs.
3.
Delays in the review of financial claims and invoices between the Ministry of Health and the hospitals on the one hand and the pharmaceutical companies on the other hand, is one of the most important reasons behind the accumulation of indebtedness, and this negatively affects the liquidity of the pharmaceutical companies and hinders them from providing a sustainable service in adhering to the procedures of supplying medicines according to schedule.
4.
Lack of coordination and communication: There may be a lack of coordination and communication between hospitals, the Ministry of Health and pharmaceutical companies, which complicates the supply and distribution of medicines and increases the chances of delays and the depletion of medicines from hospitals in the absence of an effective policy for stock management and the time required for stock adequacy.
5.
Focusing on the trade names of certain drugs from specific production sources and not adopting the protocol of writing the scientific name for the prescriptions of patients.
6.
One of the reasons that may be major and important at the same time is the funding aspect and the lack of the necessary allocations or use them in other aspects other than medicines to fill a deficit or emergency during the use of budget items due to the scarcity of available liquidity. Medication.
Lack of medication can lead to:
1.
Threat to patient safety: Lack of medication puts sick people at risk, as this can lead to delays in receiving necessary treatment or the unavailability of vital drugs, putting their lives at risk.
2.
Economic Implications: The lack of medicines entails additional economic costs for the health system and patients.
Medical cases may be referred to other medical centers or private hospitals, increasing pressure on other MOH budget items.
3.
Pressure on health care workers: Health care workers are under pressure as a result of dealing with patients affected by drug shortages and repeatedly facing their inquiries and complaints.
4.
Social repercussions:
Increased anxiety and stress: A lack of medication can lead to an increase in anxiety and stress among patients and their families, as they live in uncertainty about the availability of the necessary treatment.
Lack of medication can affect the level of trust in the health system among citizens, who may feel that the system is unable to provide them with adequate health care.
Increased costs and social burdens: Some patients may have to incur additional costs to obtain drugs from other sources outside hospitals, affecting their financial and economic status.
After all this narrative there must be ways to overcome these dilemmas:
1.
Preparation of budgets scientifically and professionally: Hospitals should develop more accurate standards for the preparation of sub-budgets for medicines, through the analysis of previous data, estimation of future needs and other scientific and methodological foundations in the preparation of budgets and commitment to apply them accurately.
2.
Improve coordination and communication between parties: Coordination between the Ministry of Health, hospitals and pharmaceutical companies should be strengthened through the establishment of structured mechanisms for information exchange, review of invoices, and completion of claims, and not delay them.
3.
Implementation of fiscal reforms: The Government and the Ministry of Health should implement fiscal reforms that provide funding to cover this important item and pay dues in a timely manner, reduce bureaucracy in the financial audit process, and proceed with payment procedures within the timetable mechanism agreed in the tender terms.
4.
Achieving social responsibility: The government and pharmaceutical companies should adopt a social responsibility towards patients by providing these drugs and reducing their prices in the market to make them more accessible to patients while relieving part of the pressure and burden on hospitals.
Addressing the problem of drug shortages in government hospitals requires comprehensive cooperation between all concerned parties from government, Ministry of Health, hospitals, drug suppliers and patients.
To provide medicines on a permanent basis and to ensure the provision of high quality health care to the Jordanian patient.

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Content: Global News
The World Today – Staphylococcal Bacteria in the UK
The lack of drugs is causing a wave of controversy.
You are now following the news of the Staphylococcal Bacteria in the UK.
The lack of drugs is provoking a wave of controversy from the World News section, and now we leave you with the full details.
Mohammed - Abu Dhabi on Wednesday 7 December 2022 09: 22 AM - An official in the pharmaceutical sector in Britain, warned of the shortage of penicillin drugs and antibiotics used to counter the spread of the bacteria Staphylococcus "A".
Zeeshan Rahmani criticised the UK health ministry for being "out of touch with reality" after it floated proposals to give antibiotics to children in schools to help ward off the threat of the Staphylococcus A bacterium.
Rahmani added: "There is no stock of penicillin at all," according to Sky News.
Rahmani ’ s comments came amid concerns that some parents are using old antibiotics in their homes to treat their children.
In the same context, the President of the Royal Pharmaceutical Society Thoron Govind, warned of the danger of self-diagnosis of staphylococcal infection, and urged parents to seek medical advice about the appearance of any symptoms on their children.
Govind warned that old antibiotics should be eliminated because they pose a risk to children if given in the wrong dose.
The Drug Shortage Crisis
Nine children in the UK have died from an outbreak of Staphylococcus A, an infection that is usually mild and easily treatable with the antibiotic amoxicillin.
A type of bacteria known as iGAS has spread this year, especially in those younger than 10 years old.
The National Pharmaceutical Association has confirmed that there is a sharp rise in demand for some antibiotics, including those used to treat staphylococcus in children.
A statement issued by the association said: "Pharmacies are forced to work hard to obtain stocks of these antibiotics, and some varieties are temporarily unavailable."
The statement added: "Wholesalers have informed us that most antidote items will be secured soon, but we cannot give an exact date."
“Pharmacists will continue to work with local GPs to help citizens get the medicines they need as quickly as possible, which can sometimes lead to prescription changes. ”
The Ministry of Health commented.
Health Minister Maria Caulfield said an inter-party briefing had been held for MPs on the infection and denied there was a shortage of antibiotics.
- Caulfield stressed that "we want to reassure parents if their children have symptoms, general practitioners are ready.
Public health officials proactively go to schools where injuries are recorded. ”
The British official said: “There is no shortage of antibiotics.
"We want to reassure people about this and we are monitoring the situation on a daily basis."
Colin Brown, deputy director of the UK ’ s Health Security Agency, told Sky News that there are “long-term guidelines that enable health protection teams to assess the situation in schools and nurseries to consider prophylactic treatment with antibiotics for either a group of children in particular classes, a nursery or an entire school. ”
After the deaths of at least nine children across the UK, Brown reiterated that there was no evidence to suggest a change in Staphylococcal strains "ie" made them more severe.
We hope that we have succeeded in conveying the full details of the "Staphylococcus" news in Britain..
The lack of medication is causing controversy.
In God ’ s care and protection.
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Content: How natural language processing can help relieve the healthcare worker shortage

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Tashfeen Suleman, CEO, CloudMedx

  • The WHO predicts a shortage of 18 million health workers by 2030.
  • A new survey shows the “biggest pain points” affecting these workers: increasing use of tech can add even more layers of documentation.
  • Healthcare workers want to spend more time caring directly for patients, and less on paperwork. Natural language processing (NLP) is a game changer. It can take over a lot of this work, freeing healthcare personnel to spend more time on direct care.

Across the world, fears are rising about a lack of nurses, doctors, and healthcare technicians in the coming years. The World Health Organization predicts a shortage of 18 million health workers by 2030.

There was already a shortage before the COVID-19 pandemic, but the last few years have exacerbated the problem. Experiencing burnout, exhaustion and mistreatment, many in the sector, especially nurses, have quit their jobs. But there are also other reasons for the shortage as well. For example, in the United States, many doctors are reaching retirement age just as the population of elderly people is expanding – meaning more people will need healthcare from fewer providers.

In addition to attracting young people to careers in medicine, other solutions are needed. One of these is to put new, emerging technologies to good use. But this is a very difficult challenge in healthcare. Unfortunately, the sector has a history of bringing in technologies that are meant to help but end up making things more complicated.

Tech as relief and burden

A new global survey of healthcare workers shows how concerned they are about this. A large majority (70%) say they believe digital health technology will enable positive transformation. But virtually the same number (69%) say these technologies will present a “challenging burden.”

I’ve seen this problem in action for years. The most prominent example involves electronic health records (EHRs). These were meant to improve care and make things much more efficient. And while they have brought benefits, they have also increased the amount of time healthcare staff have to spend dealing with documentation.

One study found that time spent on direct patient care dropped by more than 8 percent at one center. Another found that nurses perceive a high workload due to all the documentation. In a survey published in March, U.S. physicians were polled about the “documentation burden” presented by EHRs. Majorities said they’re spending too much time on documentation, and that it’s reducing the time they have for patient care. And one-third said they’re spending two hours or more completing documentation outside of work hours each day.

It shouldn’t be this way. Technologies can be designed to handle more administrative tasks so that healthcare workers spend more time in direct patient care. The more we relieve the documentation burden, the more patients can get the attention they need.

The potential of NLP

Natural language processing is a technology focused on helping machines process information as humans do. Several companies have been working to apply this to the world of medicine.

When doctors and nurses need relevant information from a patient’s healthcare records, they should not have to go digging through long lists of information collected over the years. Instead, technology should be able to read through all the text and automatically pull up relevant information for a patient’s treatment. One study published in 2020 found that specifically designed algorithms could do so with 96% accuracy.

Similarly, healthcare providers should be able to speak into their phones or other devices and have the information they provide automatically entered into healthcare records through NLP. When a patient comes into an emergency department complaining of certain symptoms, NLP can help pull up relevant information from the patient’s records – for example, a family history that could show the patient has an elevated risk for a heart attack. So doctors and nurses would see that information automatically pop up when they open the patient’s file.

Of course, there is always a possibility of machine errors, just as there are possibilities of human errors. It’s important to have healthcare personnel look at the information and doublecheck it. But there’s no need for them to spend extra time finding the information in the first place – just as they should not have to scroll through long forms with lots of text fields in order to input information. Technology should do all that for them.

There are also other ways to use NLP. For example, this technology has been built into AskSophie, a tool in which people can describe symptoms they’re having in order to learn about patients with similar ailments and what’s causing them.

Serving the needs of healthcare workers through technology

NLP is just one tool that can help relieve burdens on doctors and nurses and strengthen global healthcare for the future. Artificial intelligence can help deliver a more holistic approach to health by showing government and healthcare leaders the social determinants of health that must be addressed in different areas. Algorithms can help predict patient flow so hospitals have a better sense of how much staff they’ll need at any moment. And companies are developing new ways to monitor patients in need from afar. The possibilities are endless.

The key is to incorporate the needs of healthcare workers in the development of new technologies. The more people are freed to spend time caring for patients and avoiding burdens of documentation, the more people will join and stay in the healthcare field. This will make the global health outlook only stronger.

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Content: BONELA calls for axing of incompetent medical supply officers

  • Says shortage of medicines is a matter of life and death
  • MoH blames it on COVID-19

GAZETTE REPORTER

The Botswana Network on Ethics, Law and HIV/AIDS (BONELA) has called on President Mokgweetsi Masisi to fire incompetent officers for their failure to procure medicines and drugs for public health facilities.

The Assistant Minister of Health and Wellness (MoH), Sethomo Lelatisitswe, recently told Parliament that public health facilities were running short of medicines and condoms, saying the situation was being addressed.

According to BONELA, the situation got worse after the outbreak of COVID-19.

In an interview with The Botswana Gazette this week, the Executive Director of BONELA, Cindy Kelemi, said those responsible for the dearth of drugs and medicines should be fired.

“There is a serious shortage of medicines,” Kelemi said. “Whether you are talking about hypertension medication or anti-retroviral drugs, there are shortages. This is a concern for us because BONELA exists to ensure that the right to health is made a reality in Botswana.”

“The question we often ask is what the ministry is doing to address this, especially for people in hard-to-reach areas? We have always maintained that we have not explored fully our procurement potential, including looking at the private sector.”

She added that in addition to medicines and drugs, condoms are also in short supply at public health facilities. “We have had condom shortages since last year and we were informed that logistical problems were preventing distribution of a donation through the US embassy,” she said. “Central Medical Stores must understand that this is a life and death situation.”

Kelemi expressed hope that the budgetary vote for MoH being the largest, medical supplies to public health facilities will be replenished.

“But we had this problem even before COVID-19,” she noted. “This goes to show that we can throw money at a problem when there are underlying problems.”

The Chief Public Relations Officer at MoH, Dr Christopher Nyanga , has acknowledged the shortage of medicines and drugs at public health facilities but blames it on COVID-19 slowing down production and delivery timelines.

“Health facilities in Botswana and across the world have been experiencing shortages and delayed delivery of certain drugs and medical supplies,” Nyanga said.

He added that the problem has become more pronounced since the last quarter of the 2020/2021 financial year.

This report examines the scope, causes, and impacts of medication shortages between 2021-2024, with particular focus on life-saving medications for chronic conditions.

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Breaking The Rules Of Healthcare: Overpaying For Drugs That Underachieve

Since this time last year, the U.S. Food and Drug Administration (FDA) has granted approvals for 42 new medications. The press releases for these drugs would lead a reasonable person to conclude that a pharmaceutical revolution is underway—that the drug industry is ushering in a brave new era of medical advances.

The truth is far less flattering. Despite enormous hype and dozens of new medications flooding the market each year, major pharmaceutical breakthroughs are exceedingly rare. The overwhelming majority of “blockbuster” drugs represent minimal (if any) improvement over existing treatments.

This is not because drug companies lack the scientific knowhow, research capabilities or dollars to deliver lifesaving medications.

Instead, drug-industry innovation has been stifled by an unwritten rule in healthcare; one that has guided nearly all pharmacological research and development (R&D) efforts of the 21st century.

The rule: Maximize drug profits by minimizing the risk of failure

In the previous century, before the term “wonder drug” was hyperbolically applied to every new FDA-approved medication on the market, drug companies almost always swung for the fences.

Consider the countless lives improved and saved by the true wonder drugs of the 20th-century.

Like insulin, discovered in 1921 to treat diabetes. Or penicillin, the infection-fighting antibiotic derived from mold in 1928. Or mechlorethamine, a 1940s weapon of chemical warfare turned cancer-fighting agent now used in chemotherapy drugs. Or the life-saving psychiatric medication chlorpromazine, now known as Thorazine, created in 1951. Or birth control (approved by the FDA in 1960), or statins that reduce heart-disease (like Lipitor, patented in 1985) or the HIV/AIDS treatment zidovudine (better known as AZT, 1987).

For each of these medications, the research and development (R&D) process was intense and time-consuming. The go-to-market costs were massive with the potential to bankrupt the underwriting drug companies involved.

But despite the expenses and risks, pharmaceutical leaders were driven then by an intrinsic desire to save lives. As George Merck put it in 1950 near the end of his 25-year run as Merck CEO: “We try never to forget that medicine is for the people. It is not for the profits. The profits follow.”

In the 1980s, that outlook shifted. Newly elected president Ronald Reagan pulled back government regulations, which sent the stock market soaring. Pharmaceutical shares skyrocketed more than 950% over the next 12 years.

By the 1990s, outsized CEO salaries and exorbitant drug prices had become the norm. The focus of the industry swung from saving lives to increasing shareholder value. Drug companies wanted to maximize prices while minimizing drug-development risks. They succeeded, and drug spending in the United States took off.

To spotlight the difference, consider that from 1960 to 1980 prescription drug sales remained fairly static as a percent of U.S. gross domestic product, consuming just 5% of all medical costs. Between 1980 and 2000, however, sales tripled. Today, prescription drug expenditures exceed $460 billion a year, accounting for 16.7% of all healthcare dollars spent.

The smoke and mirrors of drug pricing

Pharma leaders love to trumpet how expensive and time-consuming it is to bring a new drug to market. They collectively assert that ever-rising prices are needed to “cover accelerated investment in researching and developing new and better medications to protect Americans.”

That message has found a receptive audience among patients. Today, 68% of Americans believe that the cost of R&D is “a major contributing factor” to high drug prices.

The data tell a different story about where the money goes. One report found that 9 of 10 top drugmakers spend billions more on marketing than R&D. Another investigation noted that 80 cents of every $1 in prescription drug sales go to something other than R&D—be it profit, overhead, taxes, etc.

To be clear: Drug companies are not struggling to make ends meet or afford the cost of R&D. In fact, a 2019 analysis found that drugmakers could afford to lose $1 trillion in sales and still be the nation’s most profitable industry sector.

Maximizing revenue by minimizing risk

Two recent FDA approvals—Aduhelm, the first new Alzheimer’s medication in over two decades, and Trodelvy, a targeted treatment for aggressive breast cancer—demonstrate that drugmakers aren’t living up to their potential, despite the high prices and industry hype.

The companies behind Aduhelm and Trodelvy have issued a combined total of 70 press releases (34 from Biogen and 36 from Gilead) about their respective flagship drugs.

Notwithstanding the sheer quantity of promotion, neither drug will have a meaningfully positive impact on the lives of people with Alzheimer’s or breast cancer.

Look at Aduhelm. Two years before its approval, Biogen halted testing amid inconclusive and concerning results. In trials, the drug wasn’t shown to preserve intellectual function for patients. But rather than abandoning the medication or pausing to invest in additional R&D, the company filed for accelerated approval, which the FDA granted against the cautions and protests of its scientific advisory committee.

Upon approval, Aduhelm was projected to earn upward of $112 billion in annual sales with an initial price tag of $56,000 (five times greater than its estimated value)—a maximal profit projection for a drug with minimal value. This controversial drug and its accelerated pathway to approval have congress taking a closer look at the FDA. And for good reason. Since 1992, nearly half (112) of the 253 drugs given speedy approval have not been proven to extend longevity or improve quality of life.

And then there’s Trodelvy, a key drug in Gilead’s oncology portfolio. It was invented by Immunomedics, Inc., which Gilead purchased for $21 billion (one of more than 30 cancer drugs Gilead has acquired in the past five years).

Priced at over $2,200 per vial, a 21-day cycle of the new breast-cancer treatment costs $16,000 and contributed to an 11% revenue increase for Gilead in 2021 (leading to a $19 million bonus for the company’s CEO).

So, is Trodelvy worth the price? A company press release boasts a 49% reduction in the risk of death for patients who take the drug.

That figure is misleading at best. In studies, the medication extended median overall survival to 11.8 months compared to 6.9 months in the control group. The “statistically significant survival benefit” noted in the press release makes it sound as if patients taking the drug beat their cancer. In reality, they died less than five months later than patients who took standard chemotherapy.

When we zoom out and look at the 90-some new oncology drugs approved by the FDA this century, the average gain in life expectancy is a mere 73 days. Much of that time is spent in pain, dealing with debilitating side effects while being isolated from loved ones.

By following the rule of maximizing profits at minimal risk, pharmaceutical companies now routinely price and promote minimally effective drugs as if they were lifesaving medications.

Even the highly effective Covid-19 vaccines—the most celebrated innovation of the 21st century—were brought to market with minimal risk. The federal government paid for much of the underlying development costs through decades of NIH-funded research and minimized the risks to companies by fronting $18 billion as part of “Operation Warp Speed.”

Breaking the drug-industry’s unwritten rule

For drug companies, the lure of charging high prices ($2.1 million in one case) and generating huge profits (more than any other industry sector) distorts research priorities. As a result, pharmaceutical companies ignore many of the biggest areas of clinical need.

Consider antibiotics, a drug category that remains extremely under-researched and underfunded. Public health officials agree that antibiotic resistance undermines our entire modern medical system. Nationwide, drug-resistant bugs are becoming a growing threat, putting millions of lives at risk. That is, unless drug companies can discover the next generation of treatments.

But there’s a problem: Antibiotics are usually prescribed for a short 10- to 14-day course, generating only a tiny profit. Thus, identifying a new class of antibiotics is (financially) risky and nowhere as profitable as the drugs currently garnering the most interest—like cancer drugs, which can be priced at $120,000 to $150,000 a year regardless of efficacy.

Right now, more than 600 cancer drugs are being tested for clinical use. Meanwhile, there are no breakthrough antibiotics on the horizon.

For the past two decades, life expectancy in the United States has stalled. Our nation needs better, safer, more effective medications. But drug companies won’t develop them until the industry inverts its focus: not on minimizing risk but on maximizing its impact on human lives.

Americans won’t be able to afford those drugs until another rule of the drug industry is broken: the rule governing how drug companies price their newest medications. That will be the focal point of the next article in the Breaking The Rules Of Healthcare series.

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Content: Shortcomings Creon, confirmations from Aifa and the company: “Difficulties until the end of 2025”

#Shortcomings #Creon #confirmations #Aifa #company #Difficulties

Rome, 30 January – The situation of shortages on the pancreatic enzymes market, reported in recent days by the singer Fedez and ended up on the pages of newspapers, TV news and information sites, it had been addressed by AIFA since last autumn, when – after a discussion with the owner/sales licensee (Viatris Italia Srl) and in agreement with the same – the the national regulatory agency had issued an information note aimed at healthcare professionals which clearly represented the terms of the problem. The drug – which replaces the functions of the pancreas when compromised and is necessary for patients to assimilate food – began to register significant shortages on the distribution circuit in autumn 2023.

Due to production problems/high demand for pancrelipase-based medicines Creon 10,000, Creon 25,000 and Creonipe 35,000″ explained AIFA in the note dated 25 October 2023, “they are currently distributed on a contingent basis; this situation will presumably continue until 12/31/2025. The shortage is not due to safety or quality issues and has already been communicated to the regulatory authority in accordance with current legislation”.

AIFA therefore invited healthcare professionals to prescribe these drugs “only for authorized indications, to inform patients already undergoing treatment also in order to avoid hoarding phenomena and to prescribe Creon 10,000 and 25,000 e Creonipe 35.000 only if strictly necessary, in the minimum effective dose, and if for the indication in question there are no valid therapeutic alternatives or if, for patients under treatment, it is not possible to switch to other medicines. This is to ensure that the available packaging, as limited, is used for indications for which the medicine cannot be replaced”.

The difficult situation has not seen any improvement since then but, in the meantime, reports of patients seeking the drug have multiplied, and Fedez has acted as spokesperson for this in recent days. On the problem – after the clarifications of Minister Schillaci in question time in the Senate in recent days, the undersecretary also spoke yesterday Marcello Gemmato (in the picture). who in a statement to Adnkronos wanted to remind you that “AIFA allows healthcare facilities to import similar medicines authorized abroad. In addition to this, I invite pharmacies, if they cannot find the drug from the usual suppliers, to place the order directly with the manufacturing company”.

“The situation has been under the attention of the Ministry of Health and the Italian Medicines Agency for some time, in constant dialogue with the manufacturing companyand to manage its supply in the area so that the therapeutic continuity of the medicine for citizens is guaranteed as much as possible” then reiterated Gemmato, who wanted to point out how the issue of the unavailability of some drugs in our country has been “one of the issues that I wanted to address, already in the first months as undersecretary, through the establishment of an ad hoc table to deal with all issues regarding access, availability and sustainability of pharmaceutical goods for citizens”.

Viatris itself, the company that holds the authorization to market and distribute Creon pancreatic enzymes in Italy, also intervened on the issue, requested by telephone from Ansa. “We are in daily contact with the manufacturing company to mitigate supply difficulties and reduce the impact on patients” company representatives told the agency, confirming the difficulty in supplying Creon. Which, however, they explain from Vatris, are due “in high demand globally” and not, as some initially hypothesized, “to issues of quality, safety or effectiveness”. In any case, the situation does not yet seem to be resolved. Indeed, as already announced last October, Viatris has confirmed that “difficulties in supply could continue until 12/31/2025”.

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The analysis reveals that shortages are widespread, multifactorial, and require coordinated responses from governments, healthcare systems, and pharmaceutical industries.

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Content: Nationwide Adderall shortage impacting area pharmacies in the Panhandle

Published: Oct. 19, 2022 at 5:07 PM CDT|Updated: 19 minutes ago

AMARILLO, Texas (KFDA) - The Food and Drug Administration has declared a nationwide Adderall shortage and the Panhandle is feeling the affects.

The FDA blames the shortage on manufacturing delays.

Health experts say a shortage in stimulant medications is actually not a rare occurrence.

“The amount of medication that is produced is limited and regulated by the government, so there have been other years where towards the end of the year in particular, we start to struggle with supply issues. In this case, however, while that does seem to be probably one of the contributing factors, the other issue we’re facing, at least what we’re hearing about it right now, is that the manufacturing delays have been an issue and some of that has been secondary to the labor shortages,” said Dr. Carolyn Lentsch-Parcells, pediatrician and assistant professor at Burnett School of Medicine at TCU.

Martin Tipton Pharmacy is being impacted by this shortage.

“We’re having to order from various manufacturers right now, not our normal manufactures just because we cannot get them from our normal ones,” said Mark Vogler, Martin Tipton Pharmacy.

Fortunately its patients have been able to get their needed medication, just a different brand.

Amarillo Pharmacy is also being impacted, saying the drug has been back ordered for the past two months.

The Amarillo Pharmaceutical Care Center at Texas Tech Physicians is also seeing a back order on one of the strengths of the drug.

“The drug company manufacturers short-acting and extended-release, for example. So, a pharmacist, in this situation, will work collaboratively with the patient’s provider to find an available strength and dosage to meet the patient’s needs until the original strength becomes available again,” said Amarillo Pharmaceutical Care Center at Texas Tech Physicians.

Dr. Lentsch-Parcells acknowledged this may be an uneasy time for those depending on Adderall, especially with the end of the semester and holidays approaching. She encourages you to reach out to your providers.

“There are various strategies that we will sometimes use to help our patients get the best care possible, while we are trying to ride out the shortage, so that might be changing dosage or using dosage forms that are available to replace their typical medication,” said Dr. Lentsch-Parcells

She emphasizes not to make any changes to your medications without speaking to your providers first.

Pharmacy chains, like CVS and Walgreens, both confirm they are seeing intermittent supply issues with the generic form of the drug.

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Millions of Americans Can't Afford Their Prescription Drugs. Now What?

As the cost of medication soars, patients are turning to online coupons and financial assistance programs.

When 27-year-old Savanna Braun changed jobs last December, she had more to worry about than meeting co-workers and adapting to an unfamiliar schedule. A new job meant different insurance, and that meant jumping through hoops to get approval for her lifesaving prescription drugs.

With insurance coverage, which costs her around $5,100 a year, she pays an extra $960 annually for medications to treat her severe asthma, psoriatic arthritis and depression. Those pharmacy benefits soften the bill -- without insurance, she'd be looking at a staggering $200,000 a year.

As basic expenses increase, soaring prescription drug prices are eating up an even larger portion of household income. Over just the last year, prescription drug prices rose at an average rate of 31.6%, with some increasing up to 500%, according to a recent Department of Health and Human Services government report. Americans, who pay the highest prices in the world for prescription drugs -- two to three times more than people in other countries -- are finding any way possible to get around the entangled pharmaceutical industry.

Exorbitant prescription drug costs disproportionately hurt lower-income households, particularly the uninsured and underinsured populations (9% and 23% of US adults, respectively). Black, Latino and Native American people are less likely to have health insurance and more likely to face cost-related barriers to treatment, according to the Commonwealth Fund, a nonprofit focused on health policy reform. Without insurance, patients are forced to sacrifice their medications for more immediate needs, such as housing or food. Those who are reliant on prescription drugs to manage their chronic conditions can often accumulate medical debt

Almost a third of the US adult population, including those with insurance, can't take their prescriptions because they can't afford it, according to Frederick Isasi, executive director of the health advocacy group Families USA. The crisis has damaging consequences: Nearly three in 10 adults end up skipping doses, cutting pills in half or not filling their prescription, resulting in long-term health complications. Others get desperate -- as many as 8% of American households have purchased medications outside the US to get a lower price.

But there are far less risky workarounds. Some patients score significant cost savings by opting for generic medications, requesting alternative medication from their providers or even switching pharmacies. Others who are financially vulnerable turn to advocacy organizations, sliding-scale health centers or patient assistance plans. And many turn to third-party sites like GoodRx, NeedyMeds.org or, more recently, Mark Cuban's Cost Plus Drug Company to cost-compare medication prices, get coupons and save at the register.

When drug costs stand in the way of patient health

Braun had her first run-in with high-cost medicine when she was 3 years old. After she had a life-threatening asthma attack, her doctors said the best treatment was an adult-only prescription. The insurance company didn't want to cover a drug that wasn't approved for her age group by the Food and Drug Administration, though it eventually gave in.

Controlling her asthma soon became a whirlwind of nebulizers, inhalers and steroids, all of which cut into her family's budget. Every time her father changed jobs, she had to wait months until his benefits kicked in, and the bureaucratic obstacles to get her meds began again.

With the 2010 enactment of the Affordable Care Act, Braun's family could no longer be denied insurance coverage or charged more for her preexisting condition. But a few years later, after Braun was diagnosed with psoriatic arthritis, she struggled with trying to find the right medication, and most of them took months for insurance to authorize. Her list of tested drugs read like a pharmaceutical representative's brochure: Methotrexate, Humera, Solara, Remicade and Xeljanz. When her asthma worsened, her pulmonologist told her to take Xolair, but insurance initially denied her, saying she needed to have less lung function to warrant its use.

When Braun turned 26, she got kicked off her parents' insurance plan and lost coverage for all her medications. For months, she was stuck relying on her doctor's samples to keep her symptoms at bay. Not having access to her specialized drugs and treatment set her back. "I was losing lung function rapidly," Braun said, noting that she now has permanent lung damage from not being able to control her asthma. Braun was constantly worried about ending up on a ventilator in the hospital without insurance coverage. "I was pretty scared for my life," she said.

When insurance obstacles stand in the way of patient health

Julie Whitehead, 52, who has bipolar disorder, tackles similar insurance hurdles, which take a huge toll on her mental health. In 2015, Whitehead's doctor prescribed a new mood stabilizer, Abilify, but her insurance company balked. At the time, Abilify didn't have a generic option, so it would cost her $1,000 a month out of pocket.

Because Whitehead couldn't afford the hefty price tag, she was prescribed a different medication, Geodon, for her bipolar disorder. But after six months taking it, she became suicidal. "I had been in a good place for five years, and then I was hospitalized," Whitehead said.

In 2020, Whitehead's doctor wanted to change her medication to Latuda, which required prior authorization. Prior authorization requires a lot of time-consuming paperwork, and if doctors agree to do it, they often charge for it. Whitehead had to wait three months for a green light, and in the meantime she struggled to pay out of pocket for Latuda, which cost more than her monthly Social Security disability check. Luckily, Whitehead's husband had enough income to help her cover the cost. But the process made her angry -- she was trying to "forestall a medical catastrophe," and wasn't allowed to because of an insurance denial.

Today, Whitehead pays around $200 a month for her 11 prescriptions under her husband's insurance plan. "It's one thing to be without insurance and have to depend on Medicaid and Medicare Part D," she said. "But to pay a king's ransom for insurance and for it to still not cover what you need, that's in some ways worse."

A David versus Goliath fight

As many as 28% of adults end up having to take a prescription that isn't covered by their health insurance, and 13% have had a prescription medication dropped by their health insurance plan, according to a survey conducted by GoodRx Health. In 2016, Americans spent some $66 billion total for out-of-pocket retail prescription drugs.

Additionally, many pharmaceutical companies place the drugs that treat chronic diseases such as diabetes, asthma, HIV/AIDS and hepatitis B and C in higher specialty tiers with greater out-of-pocket prices. People of color are disproportionately impacted by these types of serious illnesses and health conditions, making such drug-tier policies openly discriminatory, according to the National Academy for Health Policy.

Disputing a denial from an insurance company for an important medication takes time and effort -- it also requires a certain amount of financial literacy and tools, which aren't generally accessible to historically disadvantaged groups. Some patients never try negotiating with or appealing to their providers or insurance companies on costs.

Vulnerable consumers going up against the pharmaceutical behemoth is a David and Goliath fight, according to Isasi. From 2000 to 2018, 35 pharmaceutical companies reported a combined $11.5 trillion in revenue. With so much in profits at stake, the pharmaceutical industry focuses its lobbying efforts on keeping drug prices high and reducing its competition by gaining monopoly power through patents.

While pharmaceutical companies claim that high drug prices are needed to cover research and development, a recent study conducted by an international team of researchers showed no association between pricing policies and R&D investments. Drug companies set the price, regardless of how much it costs to make the medication. "It's usually a half a penny, or one cent, to actually produce that drug," Isasi said. "Why is it that a drug company can charge whatever they can get away with?"

Alternative paths to obtaining affordable medicine

The debate over prescription drug prices has for decades taken center stage in congressional hearings and among lawmakers. The recently passed Inflation Reduction Act has an extremely limited provision allowing Medicare to annually negotiate prices with pharmaceutical companies on 10 pricey medications, starting in 2026. It also caps out-of-pocket prescription drug costs at $2,000 for those with Medicare Part D drug plans, but not until 2025.

A multitude of organizations focus exclusively on pushing common-sense reforms and achieving policy changes to lower the price of prescription drugs. But until there's a monumental overhaul to the global pharmaceutical industry, there are a few government-based solutions that help medically underserved populations obtain lifesaving medication. For example, Federally Qualified Health Centers offer a sliding scale for certain drugs, and the federal 340B program allows certain hospitals and clinics to buy discounted outpatient prescription drugs for low-income and uninsured patients.

The next step, according to Isasi, is for patients to check if they qualify for Medicaid, through the website. Though eligibility income levels are very low, the expansion of Medicaid in 39 states has helped many financially vulnerable households cover the cost of prescription drugs. And Medicare patients age 65 or older can try applying for the Extra Help federal program to get their medicine at a very reduced, income-adjusted rate.

Patients can also try looking for coupons, rebates or price comparisons online. GoodRx offers discount coupons for all FDA-approved medications, both brand name and generic, regardless of insurance status. If there isn't a GoodRx coupon available, the site will offer a coupon from the manufacturer to bring down the price, or show options for similar medications that may be more affordable, according to co-founder Doug Hirsch. Patients can present a GoodRx coupon to the pharmacy immediately, and the price is better than an insurance copay more than half the time, said Hirsch.

The Cost Plus Drug Company, launched by the billionaire Mark Cuban, is a new online pharmacy that slashes prices on generic prescription drugs. A recent study in the Annals of Internal Medicine, co-authored by Harvard Medical School fellow Dr. Hussain Lalani, found that Medicare could've saved $3.6 billion in 2020 if it purchased 77 prescription medications through Mark Cuban's company. Uninsured and underinsured patients get the biggest benefit from using Cost Plus, Lalani said. But patients should look elsewhere if they need a brand name or clinician-administered drug, or if they need their generic medication immediately, since generics from Cost Plus come through the mail.

Read more: How to Get Cheaper Prescription Medicine With Cost Plus Drugs

Then there's NeedyMeds.org, an organization started in 1997 by Dr. Richard J. Sagal, which assembles roughly 40,000 patient-assistance programs for people who can't afford medication and health care costs. It's a free, nonaffiliated information outlet, and visitors to the site are anonymous. Sagall said it receives up to 15,000 daily users looking for low-cost clinics, prescription savings, rebate programs and more. The organization also gets up to 6,000 calls a month to its toll-free hotline from patients seeking resources.

Sagall, a former family physician, said he's helping more people through the website than he ever did in private practice. "Our ultimate goal is to go out of business for lack of need," said Sagall. "I don't see that happening in the near future."

## Scope of the Global Medication Shortage Problem

### Geographic Impact
Medication shortages are a worldwide phenomenon affecting:
- **Egypt**: Experiencing 30-40% drug shortages, particularly impacting chronic disease medications including diabetes, cancer, endocrine, and cardiac drugs
- **Botswana**: Health facilities reporting shortages and delayed delivery of drugs and medical supplies since Q4 2020/2021
- **Italy**: Ongoing monitoring by