Drug shortages are a pain - but there's not much we can do about them

Everyone agrees that medication supply shortages are a pain.

The current shortage of two HRT patch brands will mean plenty of hassle for affected women, more doctor visits, and thousands of extra conversations with pharmacists. 

Replacement products may be less suitable clinically, and medication substitution will increase confusion and the likelihood of dosage error.

The problems of shortages are obvious, but it’s not at all clear what can be done to prevent them. In fact, it’s difficult to even pinpoint who is responsible for their prevention — and who should pay.

One way of reducing the potential for shortages is for a buyer to stockpile. In the US, this is increasingly being done by private hospitals and the giant health insurers. 

But in Australia, the cost would inevitably fall to the federal government, at the expense of other health budget items.

We do this occasionally with medications prone to running out in extreme circumstances such as infectious epidemics. 

Even then, we get it badly wrong: the $200 million Tamiflu stockpile was widely considered wasted when subsequent research revealed the drug shortened symptoms by just half a day, without reducing complications or hospitalisations.

Stockpiling is inefficient, expensive, and impractical in most circumstances.

So should the obligation fall to the manufacturers? Again, we have to be careful what we wish for.

Obliging a private company to produce a product necessarily entails punishing them financially if they get it wrong. For example, making this a condition of PBS listing.

The fine would have to exceed the year-round cost to the company of creating a buffer by continually producing more stock than required.

In essence, this just shifts the stockpiling costs to the manufacturer, which they would pass back to us.