Recent IV shortages call for real fix, stakeholders say

YARMOUTH, Maine – A recent shortage of intravenous solutions underscores the need to address the fragile supply chain for infusion therapy solutions, says Connie Sullivan of the National Home Infusion Association. 

While flooding in September halted production of intravenous solution bags at the Baxter International plant in Marion, N.C., chronic shortages of IV solutions, enteral formulas and other products are an ongoing concern, she says. 

“This patient community has really been chronically hit with these shortages, having to have their formulations changed because we can’t get this or that product and it’s really exhausting for them to worry about whether they can get what they need,” said Sullivan, president and executive director of the NHIA. “And the impact to the industry, in terms of the cost to providers to absorb these secondary impacts, is enormous.” 

The NHIA, which created a resource center on its website that included conservation guidance, urged the U.S. Department of Health and Human Services in October to declare a shortage of IV solutions to, among other things, allow 503B compounding facilities to fill gaps in the supply chain; fast-track approval of products approved in the EU; and take steps to ensure allocations/distributions go to hospitals and pharmacies that use them for life-saving and medically necessary treatments. 

For home infusion providers, such shortages mean conserving inventory and, often, limiting new patient intake, says Greg Lopresti, CEO of Syracuse, N.Y.-based Upstate HomeCare. 

“It’s caused us to go into sort of an emergency preparedness mode and rationing mode, and having to look at our patients and prioritize them based on need,” he said. “We had a higher degree of on-hand inventory of fluids just to give ourselves a little bit of cushion. We had to put quite a few hydration-only patients either on a ration, depending on disease state, and our clinical pharmacy team works with the providers to determine which patients could be reduced or stopped altogether, because we had this (rationing of) our supply to our critical patients.” 

There is a light at the end of the tunnel. The U.S. Food and Drug Administration has begun authorizing imports of critical products from other countries and the Baxter plant has restarted production of certain products. But in the longer term, there needs to be wholesale reform, including from a payment standpoint, says Sullivan.  

“We’ve tried to put recommendations out to payers the last two years and a lot of the things we are recommending are to help them manage through shortage situations like this,” she said. “When there’s a disaster, they need to be able, (for example), send different product from a pharmacy that maybe isn’t part of the contract with that payer. We’re hopeful payers are listening. At the end of the day, it becomes a patient access issue.”