Drug supply chain issues more likely to result in shortages in U.S. than Canada

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Reports of drug-related supply-chain issues were 40 per cent less likely to result in drug shortages in Canada versus the United States, according to a new study from researchers at the University of Toronto and the University of Pittsburgh, published today in JAMA.

The analysis looked at drugs that had reports of supply-chain disruptions between 2017 and 2021 in both countries and found that within 12 months of an initial report, nearly half resulted in drug shortages in the U.S. versus about one-third in Canada. There was also a consistently lower risk of shortage in Canada at each month of follow-up.

“Drug shortages cause real disruptions in patients’ lives, often resulting in interrupted or delayed treatment,” said senior author Katie J. Suda, Pharm.D., M.S., professor at the University of Pittsburgh School of Medicine and associate director of the Center for Pharmaceutical Policy and Prescribing. “We can learn from other countries that are having success in mitigating the effects of drug shortages on patients.”

The researchers used supply chain issue reports drawn from the U.S. Food and Drug Administration, the American Society of Health-System Pharmacists and Health Canada. They then compared these reports to actual drug usage in both countries, defining a drug shortage as a decrease in monthly purchased units of at least 33 per cent relative to average units in the six months before the report.

“The pharmaceutical supply chain is global, and every single person who touches a drug is essential, from manufacturers to port workers to pharmacists.”

Most reports of supply-chain issues were due to manufacturing or shipping problems. However, one-quarter of the U.S. reports did not specify a reason. Generic drugs accounted for 95 per cent of reports in both countries, and sole-sourced drugs made up one in five.

“The pharmaceutical supply chain is global, and every single person who touches a drug is essential, from manufacturers to port workers to pharmacists,” said Mina Tadrous, Pharm.D., PhD, and assistant professor, Leslie Dan Faculty of Pharmacy, University of Toronto. “Shocks to the supply chain will happen, and it’s important to cooperate internationally to develop strategies for minimizing disruptions for patients.”

Lessons from Canadian response to drug shortages

While the paper did not explore the reasons behind the differences in drug shortages in the two countries, the authors note that Canada has more cooperation between regulatory agencies, health systems, public payers and other important players like manufacturers and wholesalers. Canada also uses its pharmaceutical stockpile mechanisms to address drug shortages, whereas the U.S. stockpile is for acute events, such as terrorism or mass casualty. The authors also said policymakers should consider incentivizing the manufacture of generic drugs with lower profit margins.

“These findings show us that how a system responds or is set up to respond can potentially make a difference in the frequency of drug shortages, indicating there might be an optimal way to respond,” said Tadrous. “This type of analysis can help us tease out what might be working better and provide an opportunity to help shape future policy and reduce the impact of drug shortages for people.”

Read the full press release from the University of Pittsburgh.

Additional authors are Katherine Callaway Kim, M.P.H., Scott D. Rothenberger, Ph.D., Tina B. Hershey, J.D., M.P.H., Lisa M. Maillart, Ph.D., and Walid F. Gellad, M.D., M.P.H., all of Pitt; Inmaculada Hernandez, Pharm.D., Ph.D., of the University of California San Diego; and Joshua W. Devine, Pharm.D., Ph.D., of Des Moines University.