In Search of an Alternative to Imported Drugs

If there had been any uncertainty, the COVID-19 pandemic has made it clear that our country’s strong reliance on imported drugs—particularly as medication costs continue to soar overall—is a precarious strategy from both a supply chain and safety standpoint. HealthTrust is heeding this message by helping expand member access to proven alternatives at more competitive prices.

Most drugs sold in the United States are produced outside the country, according to the World Trade Organization. Experts say this fact verifies that drug integrity is just as vital as sourcing an array of options that save money. International supply chain disruptions related to the pandemic also resulted in shortages of some medications.

“If we import medications, it can increase competition and result in better pricing for patients,” says Haley Peel, PharmD, BCPS, Director of Clinical Pharmacy Member Support at HealthTrust. “I support competition and better pricing, but it’s important to have visibility into the drug supply chain in order to ensure quality medications reach the patients. Importing medications complicates the process and could increase the risk of adulterated drugs entering the supply chain. If you have no insight into what you’re consuming, the integrity of the supply chain is a big concern.”

David Blazo, RPh, VP, Pharmacy Services at Franciscan Alliance in Mishawaka, Indiana, agrees: “It’s probably a national security risk to have active product ingredients (API) for mission-critical drugs being manufactured in countries outside of the United States, such as China,” he says.

A matter of safety & cost

Several egregious examples of drug price gouging and quality control lapses since the turn of the new century have raised awareness among consumers, healthcare leaders and legislators about the importance of alternatives to imported drugs. According to Peel and Blazo, these examples include:

The death of more than 80 patients in 2008 from adulterated heparin manufactured in China, which the Food and Drug Administration (FDA) determined was intentional to cut production costs.
Daraprim, a drug long-considered the standard of care for treating a life-threatening parasitic infection, skyrocketed from $13.50 to $750 per tablet overnight in 2015, after a Switzerland-based company acquired the rights to produce it (as reported by The New York Times).

At Franciscan Alliance, the prescriptions that could most often benefit from alternatives to imported drugs are high-use generic injectables and older drugs that are off-patent, but mission-critical, says Blazo. These include heparin, the antibiotic cefazolin and the heart drug isoproterenol.

“Sometimes drug manufacturers bidding for multiple, large GPO [group purchasing organization] contracts bid below their own costs of manufacturing,” Blazo explains, “and when they win that bid, they find themselves alone in the market and increase prices. It’s a situation that repeats itself over and over.”

Pointing to solutions

Lawmakers have attempted to address drug cost and integrity problems with various forms of recent legislation, Peel says. Notably, the Securing America’s Medicine Cabinet Act was introduced by Congress in March 2020. The bill aims to establish a National Centers of Excellence in Advanced Pharmaceutical Manufacturing to train future workers to research and implement these technologies and also spur pharmaceutical companies to bring drug manufacturing back to the United States.

HealthTrust’s key effort in this realm has been creating the SIMS (Supply Interruption Mitigation Strategies) program to help ensure both a high-quality and reliable supply chain of medications. Among other efforts, the program requests detailed supply chain information from partners and incorporates the information as part of the contracting evaluation, explains Peel.

“We also look at FDA inspection history and focus on the viability and sustainability of vendors’ supply chains prior to contract pricing discussions,” Peel explains. “Our members can enter into an agreement with the manufacturing partner so they can mitigate supply swings on critical products and obtain a market-competitive price.”

This process ultimately has the patient at the center. “Quality is first and foremost,” Peel adds.

For more information, visit the SIMS & Drug Shortage Strategy Center on the Member Portal.