The ongoing shortage of many medications is generating not only considerable angst among physicians and politicians, but mushrooming gray market activity, as we have reported previously. And yet another survey reveals that shadowy offers and purchases are on the rise, along with an accompanying rise in price.
To be specific, purchasing agents and pharmacists at 549 hospitals were queried by the Institute for Safe Medicine Practices, a non-profit watchdog group, and 56 percent reported receiving daily solicitations from up to 10 different gray market vendors by phone, e-mail and fax. And 52 percent acknowledged by one or more meds from gray market vendors in the last two years. Not surprisingly 80 percent reported such purchases had increased in the last two years as shortages rose.
Meanwhile, 31 percent of small, critical access hospitals and 35 percent of community hospitals that purchased a gray market product in the past two years reported price mark-ups of 10 times or more the contract price - in other words, a 900 percent mark-up. And 53 percent from university hospitals reported pricing that high. Recently, the Premier buying cooperative for hospitals conducted its own survey and found similarly sky-high mark-ups for various meds (see this).
Of course, all this purchasing activity creates a conundrum. As one respondent told ISMP: ”You are hesitant to tell gray market vendors what you need because they will buy it all up if they find it, and then harass you (to buy it) for months afterwards.” But as one purchasing agent noted: ”Our physicians DO NOT want to hear that a drug is ‘unavailable.' "
While some states have enacted regulations requiring that the authenticity of all meds must be documented at the time of purchase, 50 percent of those surveyed in those states still reported buying meds on the gray market, and only 35 percent received the required documentation. Among all respondents, only 23 percent said they require documentation of authenticity from the gray market vendor before purchase. The percent of respondents who require such documentation was highest among university hospitals, at 35 percent, and hospitals in states with a pedigree law, also 35 percent.
The most common reasons that respondents gave for not purchasing meds from gray market vendors in the last two years were: 74 percent had concerns with authenticity, 66 percent expressed ethical concerns, 69 percent cited price and 58 percent listed concerns about the storage conditions prior to purchase.
And up to 12 percent said they were aware of a product authenticity issue, medication error or adverse drug event associated with the use of gray market products in the last two years. Most cited errors associated with using a different strength med than usual, issues with improper storage of drugs that must be refrigerated, sale of recalled or stolen products, illegal importation, questionable chain of custody, and sale of counterfeit products and placebos (you can read the ISMP newsletter here).