Drug shortages aren’t new — but when they happen, members are left stressed and worrying whether they’ll have access to their medications. We spoke with Hannah Jang, Pharm.D, R.Ph, Clinical Pharmacy Manager of Horizon Blue Cross Blue Shield of New Jersey, about why shortages happen, and what you can do if one happens to you.

Why do shortages happen?
A shortage can occur with any drug. Here’s why.

There’s a problem with an ingredient. The majority of shortages, Jang explains, are caused by a faulty ingredient. If an ingredient turns out to be of questionable quality, the drug manufacturer will need to issue a recall – and just like that, there's a shortage.

A drug is discontinued. Sometimes a company will decide to stop making a particular drug. "We see this with older drugs," says Jang. "The FDA can't require them to keep making a drug they want to discontinue. So obviously that causes a lack of supply, and doctors will need to prescribe a competing brand."

Regulations can cause delays. There are a lot of safeguards in place to make sure that patients are getting safe medications. But the rules can cause snags. For instance, if a drug manufacturer is expanding, the company may open a new plant. Before that plant can produce drugs for consumers, it needs to be inspected and approved, and this delay can result in a shortage. Inspection can also cause production delays or stoppages for existing plants.

A surge in prescriptions. An unexpected increase in prescriptions for a particular medication can cause shortages.  Take for example ADHD drugs, such as Adderall.  ADHD drugs are harder to get because of a surge in prescriptions. A Washington Post article suggests that the cause may be the rise of telehealth during the COVID-19 pandemic. Previously, a prescription for controlled substances required an in-person visit to a doctor, but that requirement was waived during the pandemic – and is currently under review.

The drug is used “Off Label”. Using the drug for something other than its intended purpose could also cause supply disruptions. The shortage of Ozempic is an example of what happens when consumers engage in “off-label” use. This antidiabetic medication tends to promote weight loss as well, and it’s now sometimes seen as an easy way to shed a few pounds, regardless of diabetic status. “The manufacturer had a set amount they were going to develop, and did not expect the increase in demand,” says Jang. “Now everyone wants it, which is causing a backlog.”

What if I need a drug that isn't available?
Horizon directly engages pharmaceutical companies to get a better sense of shortage resolution timelines and to be provided updates in a timely manner. Horizon also will work with providers and hospital systems to share what alternatives may be available to prescribe in place of a drug in shortage to minimize member disruption. But if a pharmacy tells you they don’t have your medication in stock, and you need it as soon as possible, there are several steps you can take.

Call other pharmacies. The easiest solution is to get what you need from another pharmacy. This is where larger chain pharmacies have an advantage, in that they can call other branches nearby, or check an online database, to see whether there's a supply of your medication in your area. If your preferred pharmacy is independent, call other pharmacies in your area to ask if they have the prescription. When you find one, ask your pharmacy to transfer your prescription to the pharmacy that can meet your need.

Ask your doctor about other drugs. If you can't find a pharmacy that has the drug, call your doctor's office, explain that the prescribed drug isn't available, and ask about alternative drugs that are covered in the formulary. The doctor can write you a new prescription for a similar drug that you can take until the supply of the original is replenished.

Request a temporary exception. If there isn't a drug in the formulary that will work for you as a substitute, Horizon can temporarily approve an alternative. “Typically, we will monitor those,” says Jang. “If a request comes in for a drug that is not in the formulary, we will investigate. We’ll make a case-by-case exception and provide a short-term approval for the non-formulary drug.”

You or your physician can file a request for approval of a non-formulary drug by using the Formulary Exception form⁠⁠⁠⁠⁠⁠⁠. The request will be reviewed within 72 hours for a non-emergency case. If it's an emergency, the review will happen within 24 hours.

You can never be too informed about your prescriptions, how they're covered, and the resources you can access as a Horizon Blue Cross Blue Shield of New Jersey member. For more information on prescription policies, visit the Pharmacy & Prescriptions section of our online Education Center.