Ron Autry, a Madera police sergeant, is caught in a prescription-drug shortage nightmare.
Autry, 52, was diagnosed with late-stage colon cancer at the end of July after a routine colonoscopy found the disease. Another test showed it had spread to his liver. His doctor prescribed four injectable chemotherapy drugs.
But at his first chemotherapy appointment in August, one of the drugs was not available. And at his second treatment, another drug couldn't be found. Autry couldn't miss another dose.
His doctor, Ravi D. Rao, was blunt, Autry said. "He said, 'the drug directly relates to how long you're going to live.' "
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A severe and growing nationwide shortage of prescription drugs is making it a struggle for patients to get the medications they need.
Doctors and pharmacists say drugs of all types can be hard to find. But, supplies of lifesaving cancer chemotherapy agents are at the top of the list.
Most of the cancer medications are generic, injectable drugs used for years with good results. "These are workhorse drugs that we use every day," said Rao, an oncologist at the Hematology-Oncology Med Group in Fresno.
On a day last week, Rao had five patients, including Autry, affected by shortages. "The last six months or so it's much more common and much more acute."
More than 178 drugs were in short supply in the U.S. last year, which was a record according to the federal Food and Drug Administration. And this year's shortage is expected to be greater.
Hospital pharmacists said, so far, they have averted major problems by locating a drug at another hospital or finding a substitute to prevent patients from going without treatments.
But it's a daily, time-consuming scramble. And the potential for switched drugs to not work as effectively and for delays in treatment to affect patients are growing concerns.
Reasons for drug shortages
Deciphering why a drug is in short supply can be difficult.
Production problems and quality issues, including recalls by the FDA, can be reasons. Limited raw materials and spikes in demand also can reduce inventory.
Some shortages can be tied to profit margins. Drug companies can't make as much money selling older, generic drugs as they can from newer, brand-name medications.
Often the older drugs get discontinued, said Valerie Jensen, program director for the Drug Shortages Program of the FDA's Center for Drug Evaluation and Research. The FDA cannot force a company to continue making a drug, she said.
A bill in Congress would require manufacturers to notify the FDA of supply shortages. Senate Bill 286, called the Preserving Access to Life Saving Medication Act, also would require the FDA to identify drugs vulnerable to a shortage.
The Generic Pharmaceutical Association said the industry has concerns about the Senate drug bill, including the potential release or sharing of proprietary information to competitors.
But the association is working to identify vulnerable drugs and address drug shortages, it said. And it has several recommendations for solving shortages, such as creating a government stockpile of active ingredients and raw materials and providing financial incentives to drug manufacturers to encourage production of medically necessary drugs and drugs that are in short supply.
Finding a way
Valley pharmacists and doctors have had to develop systems for handling shortages, which have become a daily occurrence.
Richard Sakai, director of pharmacy at Children's Hospital Central California, keeps more drugs on hand than he used to just a few years ago. "In my 30-plus years of pharmacy business, this is probably the worst it's been, and it doesn't seem to be getting any better," he said.
Drug shortages have become so widespread even the largest health organizations scramble to find medications.
At the Veteran's Administration hospital in Fresno one morning last week, Chief of Pharmacy Melissa Chase had five drug-recall notices on her desk.
Patients were notified and the VA began looking for suitable alternative drugs, Chase said. The VA health system has a vast network of buyers who share information and help each other in the hunt to find a drug, Chase said.
But it's frustrating.
"This is a lot of effort every day," she said. "It's hours of time to find these drugs."
And it can be costly. Last week, at Autry's third chemotherapy appointment, fluorouracil, the injectable colon-cancer drug missing at his second appointment, still wasn't available. But Rao had ordered Xeloda, an alternative pill form of the drug.
Fluorouracil, known at 5-FU, is an older, generic injectable drug that costs about $15 for a two-day infusion, Rao said, or $90 for a three-month supply. The pills are a lot more expensive, he said. "But at least we have an option."
The Autrys got a three-month supply of the pills. It cost $2,800, said Cris Autry. Insurance covered it, but their co-pay was $100.
The pill also has stronger side effects, which include mouth sores and skin peeling that Autry did not experience from the injection he had in August.
Autry said he is fortunate to have the pill and to have health insurance that pays for it -- but he is disgusted.
The stress from having cancer is enough. He shouldn't have to worry if drugs he needs will be on the shelf. "The whole thing has been bad," Autry said.
Rao said he, too, is frustrated. "We need to be able to practice medicine and be able to take care of patients without worrying if a drug is available."