Issue link: https://beckershealthcare.uberflip.com/i/1546376
8 PATIENT SAFETY & OUTCOMES How 8 health systems are avoiding a repeat of the 2023 chemo shortage By Ella Jeffries and Elizabeth Gregerson C hemotherapy drugs cisplatin, carboplatin, oxaliplatin and ifosfamide are in shortage again, but five health systems are managing without the treatment delays and drug rationing that defined 2023. Shortages of the drugs have been straining hospital supply chains since June, with data showing some hospitals filling only 38% of ifosfamide orders and about two-thirds of cisplatin orders. e same drugs have been driving care disruptions, leading to "severe negative impacts" on patient outcomes, according to some oncologists. "is is our seventh or eighth wave of national shortage challenges in more than a decade in oncology pharmacy," Alexander Quesenberry, PharmD, pharmacy director at Memphis, Tenn.-based Baptist Cancer Center, told Becker's. Fortunately, Dr. Quesenberry said Baptist Cancer Center hasn't had to change how it allocates or schedules any of the four drugs, crediting the system's size and buying power — including direct accounts with manufacturers that let Baptist bypass the wholesaler and pick up drop-shipped or short-dated product directly when needed. Other systems' leaders have echoed similar situations. Elaine Huang, PharmD, associate chief pharmacy officer at Seattle-based UW Medicine, hasn't made broad changes, though her team is primed to act once inventory crosses a defined "shortage threshold." Kelley Curtis, PharmD, chief pharmacy officer at Boise, Idaho- based St. Luke's Health System, hasn't delayed treatment for patients needing cisplatin, carboplatin or oxaliplatin, and reports only minor disruptions on treatments requiring ifosfamide. Nilesh Desai, chief pharmacy officer at University of Miami Health System, has seen a handful of delays for new inpatient ifosfamide admissions, but no disruption to outpatient care. Wafa Samara, PharmD, vice president and chief pharmacy officer at Duarte, Calif.-based City of Hope, is watching inventory closely enough that intervention hasn't been necessary yet. Sourcing and substitution strategies Avoiding disruption to patient care has taken work, though. Baptist Cancer Center has started using Kyxata, a 505(b)(2) carboplatin alternative, for some patients — a shi Dr. Quesenberry said traces back to the economics driving the shortage cycle itself. Generic chemo drugs carry thin manufacturer margins, which is part of why supply cushions are so shallow to begin with. Reimbursement compounds it: Medicare's packaging threshold for outpatient oncology infusions doesn't separately reimburse anything priced under $140 a dose, so a $100 generic can go effectively unreimbursed. Because 505(b)(2) products can be priced above that line, they draw Image Credit: Adobe Stock