The world is currently suffering from a global shortage of certain prescription drugs, most notably in the US and the UK. Caymans busiest pharmacy at the Cayman Islands Hospital is significantly affected and has made the availability of its prescription drugs a priority to provide a continuous service for its customers wherever possible. Global concern Highlighting the global scale of the issue, the New York Times recently noted that despite efforts by the Obama administration to ease shortages of critical drugs, shortfalls have persisted, forcing doctors to resort to rationing or to scramble for alternatives.In the UK, the National Health Service noted that product discontinuations and shortages have been a problem for pharmacy managers and other healthcare providers for many years. In order to mitigate the problem in the UK the Pharmaceutical Services Negotiating Committee goes as far as issuing manufacturer contingency arrangements for pharmacies, should they run out of a particular drug brand. The contingency arrangement provides medicines from an identified emergency supply source, to pharmacies which experience severe shortages. Unfortunately, this facility is not available outside the UK.Colin Medford, Chief Pharmacist with the Cayman Islands Health Services Authority (HSA) provided insight as to how the pharmacy at the Cayman Islands Hospital is affected by the shortage.The HSA has been considerably impacted by drug shortages that are occurring in the US and UK which causes a trickledown effect here in the Cayman Islands as they are our largest direct and indirect suppliers, he confirmed. Contingency planning As far as possible, the Cayman Islands Hospital pharmacy purchases generic drugs; however there are some drugs (such as those with a narrow therapeutic index) which have to be name brands due to the consistency of product, Mr Medford advised. The HSA is also currently looking into purchasing from credible generic manufacturing source(s) which would ensure a better supply line in enhancing Caymans contingency plan.However, even with this in place manufacturers still encounter shortages, Mr Medford warned.The HSA orders larger quantities of prescription drugs than any other pharmacy on island and stock the widest variety of drugs, including a range of specialist medicines, Mr Medford said. These quantities can make it more difficult to obtain enough items if there are shortages, while on the other hand, smaller pharmacies would still keep enough stock due to the smaller size of their orders.Mr Medford said this is evident when orders are placed for 100 packages of an item, for example, and when they arrive only 20 are delivered.The balance can remain outstanding for months unless we manage to find an alternate supplier, he said. He added that there had been a challenge earlier this year obtaining IV solutions (mainly sodium chloride drips). This resulted primarily from the very bad winter flu season experienced in the United States.The high volume of patients we serve, combined with global shortages have made drug procurement very difficult, he said. Added pressures Furthermore, it should be noted that hospital drug purchasing is bound by annual tendered contracts awarded to suppliers, which somewhat limits the ability to widely source drugs independently or instantly as is done in the private sector, Mr Medford explained.The tender is a legal obligation which binds us to purchase drugs from specific suppliers annually. This means that we can only purchase outside of this contract when suppliers agree that they cannot locate items for extended periods. In these situations we seek the next best source, he said.In most cases the demand for medication is much higher at the hospital than in the private pharmacies, hence the reason for availability of the same drugs in these pharmacies when the Cayman Islands Hospital pharmacy is out of stock. However, if the hospital supplies are not replenished within a reasonable period, the private pharmacies could suffer shortages as well due to the increased patient demand, Mr Medford advised.We are aware of the necessity to maintain the health of our patients and try very hard to fill the gaps when shortages occur, he said. In some instances we will try to obtain whatever stock is available on the island, in order to facilitate patients who only use the government hospital and may not be able to afford paying cash for drugs. At times it is not always possible to do this and some patients are directed to the private pharmacies with the option of a refund for purchases made. In other instances we seek help from regional sources, which has proven to be very helpful. We never stop trying to obtain supplies and have been forced, in recent times, to add a number of companies as secondary sources when contracted suppliers are out-of-stock. Finding a solution The Cayman Islands Hospitals inpatient pharmacy keeps stock of all regular drugs used in the wards, which backs up the weekly ward stock. These supplies ensure that care on the units is largely unaffected by acute shortages and at times are enough for the outpatient dispensary to borrow small quantities for their patients.I am pleased to advise the situation has been gradually improving over the past few months, Mr Medford confirmed. All efforts are being made to have substantial drug quantities in stores for the hurricane season and these have already been ordered. This is especially true for the emergency medical shelters drugs. At this time it is difficult to say when things will get back to normal but the chief concern is to have adequate quantities of medicines for all patients from a consistent source(s).Mr Medford stated that the HSA tries its utmost to proactively keep necessary drugs stocked at all times, but when drugs are on a backorder, they do sometimes run out.The Health Services Authoritys CEO, Lizzette Yearwood, explained that the pharmacy ensures its source of pharmaceutical drugs is as broad based as possible.We source the drugs for our pharmacy from a number of different regions. This breaks down to approximately 75 per cent from the UK, 10 per cent from the US and the remaining 15 per cent from Puerto Rico, the Caribbean and Latin America, she said.Ms Yearwood said that the HSA does everything in its power to retain drugs on the shelf as needed, however some situations do occur when they lack a distributor with the products needed.Ms Yearwood said that the Health Services Authority makes the availability of pharmaceutical drugs an utmost priority for its patients despite the global challenges to supply.We appreciate our patients understanding of this ongoing global challenge, she said.