Drug shortages, price spikes affecting care

The young male patient had a diagnosis of chlamydia.

Fran Beall, a nurse practitioner in Athens, prescribed a seven-day supply of doxycycline, a dependable antibiotic that’s long been generic and inexpensive.

Shortly thereafter, a pharmacist called Beall and asked if she could prescribe another antibiotic for the young man, because he had no insurance.

“Why?” Beall asked. “He can’t afford $5?”

“It’s not $5,’’ the pharmacist replied. “It’s $157.’’

Beall called another pharmacist she knew. The cost there was $135. “There’s a big shortage of doxycycline,’’ the pharmacist told her.

Those high prices for doxycycline hyclate stunned Beall, who has been a nurse practitioner for 38 years. She told GHN that for a long time, the drug was easily available and typically cost $4 or $5. In fact, she said, “just a year ago it was even free at the local Publix pharmacy.”

Doxycycline is not the only drug in short supply. Shortages of dozens of critical drugs have persisted in the United States in recent years, with manufacturing problems cited as a major reason. Some of the drugs in limited supply include anesthetics, chemotherapeutic agents, antibiotics, painkillers and intravenous solutions.

The Athens doxycycline episode, though, also illustrates the opaque pricing of drugs, devices and medical procedures. The health care system provides very few simple ways for consumers to compare costs before they obtain a service or drug.

Doxycline is used to treat many different bacterial infections, such as urinary tract infections, acne, gonorrhea, chlamydia and periodontitis (gum disease), as well as the tick-borne illness Lyme disease. The drug is also used to prevent malaria.

In May, concerned about the shortage of doxycycline, Sen. Susan Collins (R-Maine) called on federal drug regulators to take immediate action. She was joined by Sen. Amy Klobuchar (D-Minn.). Both Maine and Minnesota have high incidences of tick-borne illnesses.

This summer, the CDC advised that because of the continuing shortage of doxycycline, the drug should be used only for conditions that have no alternative treatments. The Atlanta-based health agency urged that use of the increasingly scarce drug be limited to treatment of rickettsial infections (a category of bacterial infections), prevention of Lyme disease after a tick bite, and prevention and treatment of malaria.

The agency also noted that there are alternatives to doxycycline for treating sexually transmitted diseases and Lyme disease, and that providers “should use clinical judgment in making treatment and prophylactic decisions.’’

Doxycycline manufacturers attribute the drug shortage to scarce raw materials and to supply and demand, although not all manufacturers could provide reasons for the shortage, the American Society of Health-System Pharmacists (ASHP) reported, according to the American Dental Association.
Bona Benjamin of ASHP told GHN on Monday that doxycycline availability has improved. So has the overall drug shortage problem, she added, partly because of new congressional legislation that has required manufacturers to report a shortage is imminent.

The effect of a limited drug supply on patients can be significant, Benjamin said. When a shortage of anesthetics occurred, she said, “patients had to cancel or postpone surgery.’’

The doxycycline shortage has boosted revenues of at least one manufacturer, Reuters recently reported.

Hikma Pharmaceuticals said it expected total revenue to rise 20 percent in 2013, up from its previous forecast of 17 percent.

Two generic manufacturers recently stopped making doxycycline, Benjamin noted.
She said the high pharmacy price could reflect the fact that only the brand-name version of doxycycline was available, or it could simply reflect market supply and demand.
Jim Bracewell of the Georgia Pharmacy Association said that a drug price “can go up astronomically” because of supply problems.

Beall, a former president of the Georgia Nurses Association, said she wound up prescribing another antibiotic for the chlamydia patient, one that cost about $25.

Now, she says, another form of doxycycline is available, costing about $40.

Still, Beall wonders about the effect of such price hikes. “That increases health care costs for all,’’ she said.

http://chronicle.augusta.com/news/health/2013-10-21/drug-shortages-price-spikes-affecting-care?v=1382369163