Hospitals are dealing with a shortage of sodium bicarbonate, a drug whose active ingredient is essentially the same one that cooks know as baking soda. Healthcare providers, which need the drug for uses that include heart surgery and chemo, are having to ration it right now because of supply issues reported by its primary producers, Amphastar and Pfizer.
“As I talk to colleagues around the country, this is really a problem we’re all struggling with right now,” Mark Sullivan, the head of pharmacy operations at Vanderbilt University Hospital and Clinics in Nashville, Tennessee, told the New York Times.
Providence Hospital in Mobile, Alabama, had to postpone seven open heart surgeries because of the shortage, officials told the newspaper.
Amphastar is indicating it now has some supply available, but Pfizer said in a “Dear Customer” letter last week that it will be late June to sometime in August before it can provide clients with the simple but essential drug. It will be August into next year before it will have full recovery of supplies of some doses. In an email, a spokesman said the shortage is due to issues with a third-party supplier but not the API supplier.
Shortages of low-priced, stable drugs like sodium bicarbonate and saline solution have become a fact of life for hospital pharmacies. Often with just a few suppliers, if one has supply chain issues, increased demand can quickly overwhelm the inventories of other producers.
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In fact, Pfizer said in its letter last week, the shortage of sodium bicarbonate is one of eight it is dealing with right now. Also in short supply are Bicillin, labetalol hydrochloride, sodium acetate, calcium chloride, dextrose, atropine sulfate and epinephrine.
Pfizer told clients that the causes of individual shortages vary but the majority are due to three main factors: manufacturing, distribution, and third-party supplier delays.
Because of the supply-and-demand factors involved, when hospitals can get their hands on product from other producers, it comes at a much higher cost. That is what happened several years ago when a shortage of saline solution, another common but essential hospital product, plagued hospitals. In that case, however, hospitals got suspicious because there were a number of producers and ever-rising prices didn’t solve the supply issue. Some complained that producers were also tying sales of infusion supplies to availability of product.
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This all led to a congressional hearing and a federal investigation, with evidence now being heard by a federal grand jury. Baxter International, B. Braun and Hospira, now owned by Pfizer, are the major suppliers of saline. Pfizer and Baxter have reported that employees have been subpoenaed to testify before the grand jury. The companies have vigorously denied collusion and pointed to their efforts to increase supplies when the shortage materialized.
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In the matter of the current shortages, Pfizer said that it has a “dedicated team focused on addressing these delays” and has taken eight steps to speed the recovery of supplies, including allocating some medicines to minimize stockouts, increasing production at key injectable plants and qualifying alternative third-party suppliers who meet the company’s standards.
As for hospitals awaiting supplies, it is more of the same, Kuldip Patel, the associate chief pharmacy officer at Duke University Hospital in North Carolina, told the Times: “It’s not like we haven’t been here before.”