‘Too little, too late’: An investigation into medication shortages

With medication shortages worsening in Australia, serious questions are being asked about why this issue continues to worsen and why GPs are reporting an ongoing lack of communication.
 
The Therapeutic Goods Administration (TGA) has 410 current shortages listed for Australia on its website – with 71 anticipated shortages and 257 discontinuations.
 
The World Health Organization has recently reported 300 essential drugs as now in shortage worldwide.
 
It has been an ongoing issue for some time now in Australia – with the litany of recent shortages including pain management medication, antibiotics, hormone replacement therapy transdermal patches and HIV prevention drug PReP.
 
Last year, the shortage of diabetes medication tirzepatide (sold as Mounjaro) had GPs worried, while a separate warning from the TGA asked doctors not to initiate new patients on semaglutide.
 
Ozempic’s manufacturer, Novo Nordisk, also recently confirmed availability will continue to be limited until 31 December 2025.
 
The ‘Understanding the impact of medicine shortages in Australia’ discovery report, released late last year, revealed medical professionals and consumers believe current medicine shortage communication is ‘too little, too late’.
 
Surveying 800 people, including prescribers, pharmacists, impacted customers, and non-impacted customers, the report revealed significant angst among all groups about the consequences of such shortages.

It found 20% of consumers had waited one month or more to purchase a medicine in shortage or an alternative medicine.
 
Twenty per cent of consumers said they rationed their medicine to make it last longer, 14% did not purchase any medicine at all, 4% purchased a non-prescription medicine, and 2% went to hospital.
 
For individuals, the report said these shortages lead to increased dissatisfaction and frustration which reduces consumer credibility and trust in healthcare professionals ‘who in turn report higher rates of physical and verbal abuse’.
 
Clinically, it found shortages can compromise treatment outcomes and lead to adverse health outcomes, including disease complications, medication errors, adverse drug reactions, treatment delays, and inferior alternative medicines.
 
And economically, the shortage increases healthcare professionals’ workload and can result in higher out-of-pocket costs for consumers.
 
‘All cohorts find out about medicine shortages too late, and no one knows why it’s happening or how long it will last,’ the report reads.
 
‘Since the COVID-19 pandemic, medicine shortages management has faced additional challenges such as increased production costs and complex logistics, compounded by a lack of Australian domestic manufacturers.’
 
Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, told newsGP disruptions in the supply chain for medications are risking lives.
 
‘If the supply chain for certain insulins and diabetes medications becomes compromised it is critical for people who are very dependent on that for life and ongoing survival,’ he said.
 
Dr Deed said there are serious questions to be asked of the Federal Government and the TGA about how to both shore-up supply and to improve communication efforts to GPs.
 
‘That’s a high strategic issue that the Government’s never got its head around,’ he said.
 
‘I’m not certain that there’s a process to identify, classify and secure highly critical medications for the Australian population and their prescribers.
 
‘The communication process of supply chain disruptions is not coordinated and not systematically clear, so you might receive a communication for one thing, but you don’t hear about another.’
 
A spokesperson for the Department of Health and Aged Care told newsGP it is ‘actively monitoring this situation.
 
‘The Health Minister has agreed to the TGA further investigating improvements to the monitoring of medicine shortages and discontinuations, in order to reduce the impact of these supply disruptions on people in Australia,’ they stated
 
‘The initial focus of the TGA’s work is to update the medicine shortages regulatory framework to better meet public information needs.
 
‘This includes proposals to support TGA in receiving more timely information about medicine discontinuations that can then be shared publicly.’
 
But right now, Dr Deed said often he hears about shortages second-hand.
 
‘It’s often just from feedback from, say, a pharmacist who says it’s not available, even the patient saying “look, I can’t get this”,’ he said.
 
‘Are the politicians aware that this is such a huge issue? I’m not certain. Are the public aware? I think they are. But I think it needs to be brought out into the open, let the truth be told, at least then maybe some action might be taken.’
 
GP and women’s health expert Associate Professor Magda Simonis told newsGP this was also a significant problem in her practice.
 
‘This is one of those additional issues we have around health equity and access to medication for women’s health issues and we’ve been through this on so many occasions,’ she said.
 
‘I’ve had patients who’ve needed to get a copper IUD delivered from an interstate pharmacy because there’s a shortage on all fronts around sexual reproductive health needs for women.
 
‘That’s a significant oversight.’
 
The TGA launched its own investigation into medicine shortages earlier this year, which received 221 submissions in the consultation process.
 
‘A significant number of respondents from all stakeholder groups outlined the considerable time and resources it took for them to monitor and address medicine shortages and discontinuations,’ the TGA explained.
 
‘When a health professional prescribes a medicine, they often won’t know if it is available or in short supply, or where to find information about alternatives, especially if a medicine has been discontinued.
 
‘Medicine shortages are a wicked and complex policy problem.’
 
According to the TGA, more than 90% of medicines prescribed nationally are imported, and when there are disruptions in the global supply chain Australia’s geographical location doesn’t help.
 
Dr Deed said Australia’s remoteness from manufacturing sources was the ‘big issue’ here.
 
‘We’re very dependent on factors outside of Australian control,’ he said.
 
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