Drug shortage hits isles hard, new study finds

Hawaii has experienced the worst shortage of injectable cancer drugs nationwide, according to a recent study by the IMS Institute for Healthcare Informatics.

The Connecticut research organization found that the state had the highest year-over-year decline — 44 percent — in the volume of sterile injectable drugs currently in short supply. By comparison, the national average decline is 26 percent.

Hawaii is one of 13 states where the per capita supply of injectables — comprising more than 80 percent of those on the shortage list — fell more than 30 percent. The organization compared the average monthly supply of 168 products listed by the U.S. Food and Drug Administration and American Society of Health-System Pharmacists as of Oct. 7.

"We don’t have an evidence-based answer to know why Hawaii is the lowest," said Murray Aitken, executive director for IMS Institute. "It could be a geographic issue; it could be there have been some specific supply issues with wholesalers who serve the Hawaiian market. With a 44 percent decline, that is clearly having a disruptive effect on treatment of patients in Hawaii."

An estimated 6,000 Hawaii residents are diagnosed with cancer each year, and 2,000 die from the disease, according to the University of Hawaii Cancer Center, which didn’t have statistics on the actual number of people being treated for cancer or affected by the drug shortages.

Sen. Josh Green, a Hawaii County emergency room physician and chairman of the Senate Committee on Health, said he is asking the state attorney general to investigate whether the pharmaceutical industry is keeping its commitments to provide certain drugs to isle residents.

Green held an informational hearing last month at the state Capitol to see what can be done to address the problem, including administrative rules or legislation that would put pressure on pharmaceutical companies through the purchasing of drugs for about 500,000 Hawaii government workers, retirees, dependents and Medicaid recipients.

"As a very small state that’s isolated, our numbers are not going to tend to pencil out properly for profits, and very sadly, profits are a motivator in this industry," he said. "Every region has to be as important as the rest irrespective of how many patients or how many cases of a particular cancer there are. A state shouldn’t stand out with significantly worst access."

Besides cancer, injectable drugs — a small part of the overall pharmaceutical market — are also used to treat infection, cardiovascular disease, central nervous system conditions and pain.

An estimated 550,000 cancer patients nationwide were treated with at least one of the drugs on the shortage list, according to IMS.

"It is unconscionable that several pharmaceutical companies are turning their backs on Hawaii’s patients, especially those with cancer," Green said.

Key findings of the state-by-state report include:

» Drug shortages are highly concentrated. More than 80 percent are generic, while more than 80 percent are injectables.

» While there is a large number of suppliers, most medicines have only one or two suppliers. For instance, there are more than 100 suppliers of products currently in shortage, but more than half have only one or two suppliers.

» While the supply volume for many drugs is stable or increasing, there is substantial volatility among suppliers. Total monthly supply volume for products in short supply to health providers has grown 4 percent over the past five years. However, recent increased volatility in the month-to-month supply of these products by specific suppliers has resulted in disruption to providers.

» Supply volume has plummeted for 75 drugs. A subset of products has had supply declines of more than 20 percent.

IMS is urging the FDA or industry to create an "early warning system" for medicine shortages that include the identification of systematic risks and forecasts for long-term demand.