"I've never seen anything like this": High demand fuels drug shortages

Ongoing shortages of life-saving and essential drugs have largely been tied to the fragility of drug supply chain, but the flip side of the economic equation driving the scarcity — demand — is also a growing problem.

Why it matters: The U.S. has been experiencing its worst year for drug shortages in a decade, with Sanofi and AstraZeneca's new RSV shot for infants as the latest high-profile example.

• Demand-driven shortages in the last year have also hit popular drugs used for weight loss, ADHD medications and antibiotics.

What they're saying: "A year, maybe two years ago, I would have said, 'No, demand shortages aren't really a thing.' But then with ADHD [drugs] ... and the amoxicillin ... and Ozempic would call me a liar," said Michael Ganio, a senior director at the American Society of Health-System Pharmacists, which keeps a running tally of drugs in shortage.

• Those are just some of the latest examples of why the drug shortage issue is so complex, Ganio told Axios.
• In the case of the ADHD drug Adderall, a surge in behavioral health care as the Drug Enforcement Agency cracked down on bogus prescribing created a perfect storm. But the drug has also suffered from ongoing supply shortages due to manufacturing delays.

Between the lines: Ozempic and other diabetes medications that are used for weight loss are drawing consumer demand that's hard to compare, Bradley Nelson, senior director of clinical services for RxBenefits, told Axios.

• "In 20 years, I've never seen anything like this," Nelson said.
• High-risk diabetes patients are competing against patients with obesity for these drugs, creating tough choices for prescribers.
• The key, Nelson said, will be deciding who should be first in line.

The intrigue: The influence of social media and mass media is also contributing to surging demand, ASHP's Ganio said.

• He noted an article about minoxidil, the active ingredient in Rogaine, in the New York Times last year. There was an immediate jump in prescribing for the once-obscure drug following the story, according to a study published in JAMA Network Open in May.
• "I think it's an interesting new twist on the drug supply chain," Ganio said. "Any public attention on a particular treatment can increase demand more than what we would expect."

The bottom line: Boosting how much buffer stock providers keep on hand could help alleviate some of the drug shortage problems when demand surges, Ganio said.

• Medicare recently considered such an idea, but it backed off after stakeholders raised questions about the cost and effectiveness of its proposal.
• "We always expect that the next shipment is going to be enough to get us through to the next, and that goes all the way up the supply chain," Ganio said. "It's just an unexpected demand increase, but a buffer inventory would allow time for manufacturers to respond."