Drug shortages and price hikes have become a critical issue in the healthcare industry. A recent example of this occurred when a shortage of intravenous fluids and injectable opioids ensued due to manufacturing delays in the areas affected by Hurricane Maria.

Another was when a drug used for toxoplasmosis, a parasite infection, had a 5,000% surge in price after a new pharmaceutical company acquired it. To address the effects of availability and affordability on the quality and safety of healthcare, physicians at Brigham and Women's Hospital published a new article in the Journal of General Internal Medicine to highlight the issues and recommend potential solutions.

By understanding the underlying causes, the incentives, regulations and new drug developments that the authors recommend could help to enhance competition and provide patients with reliable access to vital drugs.

For some generic drugs, the investigators state that the lack of competition stems from small market sizes, difficult regulatory requirements, and possibly unfair drug manufacturing practices.

Concrete solutions

"Healthy and appropriately regulated competition protect against predatory behaviors, such as companies taking advantage of monopolies to drastically raise drug prices," said first author Karthik Sivashanker, MD, Brigham and Women's Hospital. "It also ensures an adequate supply of medications by promoting manufacturing redundancy."

Concrete solutions are necessary, and the authors insist that the problems need to be addressed collectively. Some of their suggested solutions include:

1. Increasing incentives and modifying regulations to improve competition. Financial incentives should be considered to entice new companies to enter a small market, as should reduced regulatory barriers to avoid deterring new competitors. Increasing competition in this way spreads out drug manufacturing, which adds redundancy and protects against price hikes.

Reasonable drug price controls may also act as a safety net for when standard market mechanisms fail and may help curb the out-of-control rate increases in health care costs. It also aligns the United States with other industrialized countries successfully using price control strategies.

2. Redirect overinvestment in new drug development to the generic drug market to foster competition. The race to develop new, but rarely superior, drugs ultimately draws resources away from the high-value generic drug market.

3. Pivot from short-term survival mode to long-term organized response. Responses to crises tend to be short-term solutions and sometimes exacerbate a problem—like when hospitals build up reserves during a shortage.

4. Activate patients by talking about the big issue, rather than the situation. As trusted members of the community, healthcare employees must educate patients on issues relevant to their health.