{"id":1959,"date":"2012-12-19T05:00:00","date_gmt":"2012-12-19T00:00:00","guid":{"rendered":"http:\/\/www.policymed.com\/prescription-drug-shortages-crisis-abating-still-need-for-pricing-reform\/"},"modified":"2018-05-06T17:57:45","modified_gmt":"2018-05-06T12:57:45","slug":"prescription-drug-shortages-crisis-abating-still-need-for-pricing-reform","status":"publish","type":"post","link":"https:\/\/www.policymed.com\/2012\/12\/prescription-drug-shortages-crisis-abating-still-need-for-pricing-reform.html","title":{"rendered":"Prescription Drug Shortages: Crisis Abating – Still Need for Pricing Reform"},"content":{"rendered":"<p><span style=\"font-family: arial,helvetica,sans-serif;\">Some progress on drug shortages has been made over the last few months, due in part to manufacturing improvements.\u00a0 For example, <a href=\"http:\/\/www.fiercepharmamanufacturing.com\/press-releases\/genzyme-announces-return-full-supply-thyrogen-thyrotropin-alfa-injection\">Genzyme<\/a> said that a new plant was now producing all of the supply needed for its thyroid cancer treatment, <span style=\"text-decoration: underline;\">Thyrogen<\/span>.\u00a0 Supply had been spotty for about three years, but now biotech unit of Sanofi says it is producing enough of the drug to meet the needs of all patients.\u00a0 \u201cWe are grateful to the thyroid cancer treatment community for its ongoing patience and partnership,\u201d Alicia Secor, Genzyme\u2019s vice president and general manager of endocrinology, said in a statement.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">A Genzyme spokeswoman explained in an email that the drug went onto shortage lists as Genzyme worked through manufacturing problems after a virus was found at the Boston-area plant where the drug was filled and finished.\u00a0 A couple of other drugs, including <a href=\"http:\/\/links.mkt1985.com\/ctt?kn=196&ms=NDUzNzE1MgS2&r=MjQwNzYxNzc3MTAS1&b=0&j=MTMzMDg4OTA3S0&mt=1&rt=0\" target=\"_blank\" rel=\"noopener\">Fabrazyme<\/a>, Genzyme\u2019s treatment for the rare Fabry disease, were also interrupted.\u00a0 Genzyme began manufacturing Thyrogen at its new Framingham, MA, plant when the FDA signed off on it earlier this year. Fill\/finish is being handled by Hospira, she said.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Hospira, which has been at the heart of a number of drug shortages as it works through improvements to its manufacturing plants, also said it expects to soon have sufficient supplies to re-enter the market with <a href=\"http:\/\/links.mkt1985.com\/ctt?kn=237&ms=NDU1NTY2OQS2&r=MjQwNzYxNzc3MTAS1&b=0&j=MTMzMzIzMzcwS0&mt=1&rt=0\" target=\"_blank\" rel=\"noopener\">propofol<\/a>. The anesthetic is one of the drugs hospitals had turned to the large-sale compounder, Ameridose, for because it was hard to come by. Now Ameridose\u00a0has closed because of <a href=\"http:\/\/links.mkt1985.com\/ctt?kn=121&ms=NDU1NTY2OQS2&r=MjQwNzYxNzc3MTAS1&b=0&j=MTMzMzIzMzcwS0&mt=1&rt=0\" target=\"_blank\" rel=\"noopener\">FDA<\/a> issues, a move that may lead to a number of shortages.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">In another case, FDA allowed the manufacturer American Regent to sell a drug used during chemotherapy that was found to contain glass particles. \u00a0Doctors and nurses were <a title=\"The instructions.\" href=\"http:\/\/www.google.com\/url?sa=t&rct=j&q=&esrc=s&source=web&cd=4&ved=0CEQQFjAD&url=http%3A%2F%2Fwww.americanregent.com%2Fdocuments%2Fnews%2FwouIRLzwvIs%3D.pdf&ei=KsWjUOWaEsqu0AH0kYDoCA&usg=AFQjCNGqvwYBeZS7sKyGw56fLD0fVPr8xg&cad=rja\">instructed to filter the drug<\/a>, sodium thiosulfate, before administering it to patients.\u00a0 \u201cIf there wasn\u2019t a shortage, we would never allow a company to continue marketing\u201d in such cases, Dr. Sandra Kweder, deputy director of the FDA\u2019s office of new drugs, said. But \u201cpatients need it.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">FDA is also working with the Drug Enforcement Administration (DEA) to make exceptions with drug quotas so capable manufacturers can make extra supplies since many anesthesiology drugs in short supply are controlled substances.\u00a0\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">‘Repackaging’ doses in the operating room has been shown to increase the risk of infection in the past, but some clinicians may feel pressured to split up the larger vials of anesthesia drugs in times of shortage to maximize the number of patients who have access to care, Joel Zivot, MD, medical director of the cardiothoracic intensive care unit at Emory University in Atlanta, told <em>MedPage Today<\/em>.\u00a0 Many anesthesiologists have called for smaller packaging, though that’s been a challenge given it increases production costs on generic agents that are less profitable to begin with.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Food and Drug Administration (FDA) Commissioner Margaret Hamburg recently told <a href=\"http:\/\/www.nytimes.com\/2012\/11\/17\/business\/drug-shortages-are-becoming-persistent-in-us.html?_r=0\"><em>The New York Times<\/em><\/a> that while far from resolved, \u201cwe\u2019re in the midst of a period of really, very significant change that offers great promise for the future.\u201d\u00a0 NYT reported that only about 100 drugs have been added to the shortage list so far this year, compared with 221 when it peaked last year. \u00a0The FDA says that it has prevented the shortage of about 150 drugs this year by working with the industry to find supplies to avert a potential dearth of a particular med.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Nevertheless, \u201cthere are still dozens of drugs in short supply, forcing some patients to go without essential meds and forcing healthcare providers to make some tough choices.\u201d\u00a0 Much of the national shortage problem can be traced to production disruptions when drugmakers initiate improvements after the FDA has sent them warning letters. \u00a0A House subcommittee report earlier this year criticized the FDA for being too aggressive in that regard.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">\u201cFrom rural ambulance squads to prestigious hospitals, health care workers are struggling to keep vital medicines in stock because of a drug shortage crisis that is proving to be stubbornly difficult to fix.\u00a0 Rationing is just one example of the extraordinary lengths being taken to address the shortage, which health care workers say has ceased to be a temporary emergency and is now a fact of life.\u00a0 In desperation, they are resorting to treating patients with less effective alternative medicines and using expired drugs.\u00a0 The Cleveland Clinic has hired a pharmacist whose only job is to track down hard-to-find drugs.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">While shortages have been averted, when drugs become hard to get, they tend to remain hard to get, says Erin Fox, who tracks drug shortages at the University of Utah. Her group is keeping an eye on the supplies of 282 difficult-to-come-by drugs, she tells the newspaper. “The shortages we have aren’t going away–they’re not resolving,” she said. “But the good news is we’re not piling more shortages on top.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\"><strong>Compounding and Drug Shortages<\/strong>\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">In addition to these concerns, the deadly meningitis outbreak caused by contamination at a large drug producer could worsen the situation.\u00a0 FDA said that shortages of six drugs \u2014 medicines used during surgery and to treat conditions like congestive heart failure \u2014 <a title=\"The statement on Ameridose.\" href=\"http:\/\/www.fda.gov\/Drugs\/DrugSafety\/DrugShortages\/ucm324842.htm\">could get worse<\/a> after a big compounding pharmacy closed over concerns about drug safety.\u00a0 The pharmacy, Ameridose, shares some management with the New England Compounding Center (NECC), which is at the center of a meningitis outbreak that has <a title=\"The report.\" href=\"http:\/\/www.cdc.gov\/hai\/outbreaks\/meningitis.html\">claimed 33 lives<\/a> and sickened 461 more.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Methylprednisolone, the drug that has caused the meningitis outbreak, was not technically in short supply. \u00a0A brand-name form made by Pfizer is on the market. The cheaper generic kind ran out, however, because the two companies that make it, Teva Pharmaceuticals Industries and Sandoz, have all shipments on back order with vague information as to when they\u2019ll be available again. Some hospitals and clinics may have turned to compounding pharmacies for the drug to keep their costs down.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">\u201cCompounding pharmacies have fit a niche in terms of getting medications to patients,\u201d John Dombrowski, MD, chair of communications for ASA and director of the Washington Pain Clinic, told <a href=\"http:\/\/www.medpagetoday.com\/MeetingCoverage\/ASA\/35406?utm_content=&utm_medium=email&utm_campaign=DailyHeadlines&utm_source=WC&xid=NL_DHE_2012-10-19&eun=g339585d0r&userid=339585&email=adg5005@gmail.com&mu_id=5333437\">MedPage Today<\/a>.\u00a0 Steven Gayer, MD, professor of anesthesiology at the University of Miami, agreed that in times of shortage, \u201cthe correct answer is to find a compounding pharmacy.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Although compounders are focused on providing tailored drugs for specific patient needs, David Ball, a spokesperson for the International Academy of Compounding Pharmacists, confirmed that these pharmacies have been picking up some of the slack during shortages.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">\u201cCompounders have regularly been called on to make those medications that are commercially unavailable,\u201d Ball said. \u00a0They have access to raw materials, and with orders from patients — or from hospitals for specific patients — they can help disseminate drugs when they’re needed most.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Some of these pharmacies have even adopted a direct-to-consumer approach. The Professional Compounding Centers of America, which supplies compounders with raw materials, has a <a href=\"http:\/\/www.pccarx.com\/what-is-compounding\/compounding-for-drug-shortages\/\" target=\"_blank\" rel=\"noopener\">section on its website<\/a> that instructs patients how to find their local compounders if their medications are out of stock.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Consequently, FDA Commissioner Hamburg noted in a <a href=\"http:\/\/blogs.fda.gov\/fdavoice\/index.php\/2012\/11\/were-working-to-offset-ameridose-impact\/\">recent post<\/a> on FDA\u2019s blog that the agency is taking a number of actions to help address any shortages that may result from the supply of drugs affected by the Ameridose recall.<strong>\u00a0<\/strong><\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\"><strong>GPO\u2019s and Drug Shortages<\/strong>\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Despite this recent success, six members from the U.S. House of Representatives recently sent a <a href=\"http:\/\/markey.house.gov\/document\/2012\/letter-gao-group-purchasing-organization\">letter<\/a> to the Government Accountability Office (GAO) asking the agency to investigate \u201cwhether contracting practices by Hospital Group Purchasing Organizations (GPOs) are a driving cause of drug shortages that force hospitals and other providers to rely on compounding pharmacies.\u201d\u00a0 The letter was written by Representatives Edward J. Markey (D-Mass.), Henry A. Waxman (D-Calif.), John Dingell (D-Mich.), Frank Pallone (D-N.J.), Diana DeGette (D-Colo.), Anna G. Eshoo (D-Calif.).\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Markey said <strong>the investigation \u201cwill shed light on any possible linkages between drug shortages and reliance on compounding pharmacies and help address gaps in our oversight of this industry.\u201d\u00a0 <\/strong>\u201cWe look forward to GAO helping us understand the role General Purchasing Organizations play in avoiding, ameliorating, or contributing to the occurrence of drug shortages, and the role drug shortages play in hospital use of compounded drugs,\u201d said Rep. Waxman.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">GPOs are designed to leverage the purchasing power of their client hospitals to obtain the lowest prices for drugs and devices. \u00a0Virtually every hospital in the US is a member of at least on GPO and more than 70% of all hospital purchases are made through GPO contracts.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">However, a number of experts say that anticompetitive, exclusionary contracting by GPOs have \u201crigged the market\u201d in favor of a few manufacturers and distributors. \u00a0Current law allows GPOs to charge the drug manufacturer a fee that is based on a percentage of the total value of the purchase.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Some experts consider this a \u201ckickback\u201d that creates a perverse incentive structure, whereby the more the hospital pays for the products, the higher the kickback and profit for the GPO. \u00a0Shut out of the lucrative GPO contract and unable to make a profit, other manufacturers cease production and leave the supply chain more limited, fragile, and vulnerable to shortage.\u00a0 Such fees also drive down generic drugmakers’ profits on selling their drugs, diminishing incentives to continue production and potentially opening the door to shortages, according to the letter.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Angie Boliver, director of communications for Novation — one of the largest GPOs in the U.S. — told <a href=\"http:\/\/www.medpagetoday.com\/PublicHealthPolicy\/HealthPolicy\/35992\">MedPage Today<\/a> the drug shortage is complex and that the “notion that GPOs are responsible for drug shortages simply because they have negotiated prices too low is without logic or justification.\u201d\u00a0 \u201cThe reality is that hospitals will, and do, pay whatever amounts they have to pay in order to get life-saving drugs,\u201d Boliver said in a statement. \u201cIt is important to note that GPOs are negotiating against some of the largest and most powerful companies in the world. These companies are sophisticated businesses that are perfectly capable of negotiating contracts that will provide a reasonable profit margin.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Healthcare Supply Chain Association president Curtis Rooney said GPOs \u201cdo not have the ability \u2013 nor would it be in our interest \u2013 to force manufacturers into contracts that undermine their ability to deliver product.\u201d\u00a0 \u201cDrug companies regularly and quickly adjust pricing of GPO contracts when they experience shocks to production, and GPOs manage thousands of price changes annually, both increases and decreases,\u201d Rooney said, adding that “all hospitals can purchase off-contract.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">The lawmakers are asking GAO to investigate questions that include:\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-family: arial,helvetica,sans-serif;\">What market factors contribute to the reliance of hospitals and other healthcare providers on compounding pharmacies?<\/span><\/li>\n<li><span style=\"font-family: arial,helvetica,sans-serif;\">What impact have contracting practices by market participants such as manufacturers, distributors, group purchasing organizations, and providers had on competition and innovation in medical devices and drugs, access to medical devices and drugs, including an impact on drug shortages, and pricing of medical devices and drugs?<\/span><\/li>\n<li><span style=\"font-family: arial,helvetica,sans-serif;\">Do drug shortages drive hospitals and other health care providers to rely more heavily on purchases of drugs, including sterile injectable medications, from compounding pharmacies?<\/span><\/li>\n<li><span style=\"font-family: arial,helvetica,sans-serif;\">Do the incentives in the current GPO model lead to inflated prices for drugs and devices?\u00a0 Put another way, what is known about the competitive and budgetary impacts on both hospitals and the Medicare program that could result from eliminating the GPO safe harbor exemption from the Medicare anti-kickback statute?<\/span><\/li>\n<li><span style=\"font-family: arial,helvetica,sans-serif;\">What is known about the impact that GPO administrative fees have had on generic drug makers\u2019 financial condition, their ability to maintain and upgrade plant equipment, and their ability to conduct quality control?\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">\u201cThis initiative is a courageous step forward in addressing the foundational reasons behind both the tragedies caused by drug compounding and the broader issue of preventable drug shortages,\u201d said Peter J. Pitts, President, Center for Medicine in the Public Interest and a former FDA Associate Commissioner. \u201cThe anticompetitive manipulation of American healthcare by GPOs is an urgent topic for congressional action.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">\u201cThrough exclusive contracting, which has given GPOs effective monopolistic control of this industry, they have contributed to product shortages and disincentives for legitimate producers to manufacture and stock essential drugs,\u201d said S. Prakash Sethi, Ph.D., University distinguished professor, Baruch College, The City University of New York.\u00a0 \u201cAt the same time, they have given rise to unscrupulous manufacturers to produce and market substandard drugs and thereby expose the patient population to serious health risks.\u201d<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\"><strong>Causes of Drug Shortages<\/strong>\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Federal drug officials trace much of the drug shortage crisis to delays at plants that make sterile injectable drugs, which account for about 80 percent of the scarce medicines. \u00a0Nearly a third of the industry\u2019s manufacturing capacity is not running because of plant closings or shutdowns to fix serious quality issues. \u00a0Other shortages have been caused by supply disruptions of the raw ingredients used to make the drugs, or by manufacturers exiting the market.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">For example, a <a href=\"http:\/\/www.nytimes.com\/2012\/10\/18\/business\/drug-makers-stalled-in-a-cycle-of-quality-lapses-and-shortages.html?_r=0\">New York Times article<\/a> discussed how six of the major manufacturers of sterile injectable drugs have been warned by FDA about serious violations of manufacturing rules, and four of them have closed factories or significantly slowed production to fix the problems.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">While some industry observers and former plant employees point to plants reluctant to fix manufacturing problems, manufacturers reject descriptions of their factories as deteriorating and say they are investing hundreds of millions of dollars to make improvements.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">The \u201cGray Market\u201d is also exacerbating the drug shortage problem, where smaller distributors are marking up the prices on drugs in short supply.\u00a0 Capt. Valerie Jensen, RPh, associate director of the Drug Shortage Program at the FDA\u2019s Center for Drug Evaluation and Research, said during a panel at the ASA meeting that it\u2019s \u201cnot clear what, if any, laws are being broken\u201d in that process, and added that FDA is sending all gray-market reports to the Department of Justice.\u00a0 FDA has 11 employees dedicated solely to drug shortages.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Some people have accused the FDA of causing the shortages, saying overzealous enforcement and poor communication have led plants to close needlessly or to slow production. Others have cited economic factors, like market pressures and reimbursement policies that have set prices so low that some companies have stopped making certain drugs.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">An article from <a href=\"http:\/\/www.businessweek.com\/articles\/2012-10-25\/bloomberg-view-the-hidden-dangers-of-drug-shortages#r=com-s\">Businessweek<\/a> explained that in an \u201cordinary market, when one company\u2019s production lines shut down, competitors step in to meet demand. The generic injectable drug business is different in that it is greatly influenced by the practices of Medicare, the largest U.S. purchaser of health care.\u201d\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">As a Bloomberg Government study points out, \u201cMedicare rules from 2005 prevent reimbursement to providers for injectables and other drugs health-care workers administer from rising more than 6% above the average sales price, effectively limiting what drugmakers can charge. The cap has reduced suppliers\u2019 incentive to expand capacity when shortages happen.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">FDASIA, passed in July 2012, requires drug companies to notify the FDA six months in advance of anticipated problems that might lead them to shut down production of a drug.\u00a0 However, Ezekiel Emanuel, a former adviser to the Obama administration on health-care policy, recommended a change in the Medicare price controls\u2014to either raise the cap above 6% or, at least do so when a shortage develops.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Emanuel noted that \u201cStrict adherence to Medicare\u2019s price caps on injectable drugs may be penny-wise and pound-foolish. \u00a0And it stands in the way of ensuring Americans\u2019 constant access to safe drugs of every kind.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Echoing Emanuel\u2019s position, a recent <a href=\"http:\/\/online.wsj.com\/article\/SB10000872396390443524904577649612212591828.html?mod=dist_smartbrief\">article<\/a> written by Bill Cassidy, MD, a Republican Congressman from Louisiana, and Patrick Cobb, a practicing oncologist, also noted that drug shortages are being caused by the Medicare Modernization Act.\u00a0 While the legislation \u201chas lowered the cost of pharmaceuticals for seniors \u2026 it has in an increasing number of cases made them less available.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">\u201cBefore this legislation, providers of these pharmaceuticals received reimbursement proportional to the drugs’ average wholesale price. Among other changes, the new law also addressed concerns that the average wholesale price was often inflated above real costs and did not reflect actual market prices. Medicare began to reimburse providers at 106% of the average sales price of the drug over the previous two quarters of sales in lieu of the average wholesale price, so that average sales price corresponded to the sales price of a drug. This was intended to end abuse of the system.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">In response to the change in Medicare’s reimbursement system, many private insurance companies have switched to an average-sales-price-based reimbursement system. Manufacturers who previously had an overwhelming financial incentive to produce generic drugs now face minuscule profits or losses, in addition to government requirements to provide discounts and rebates on drugs for high-need populations. With much to lose and little to gain, many manufacturers continue to leave the market for these reasons.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">Almost all drug shortages have come about after their price has plummeted, and the problem is compounded by the fact that many generics have few suppliers.<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">The Affordable Care Act could make this already bad situation worse. Under this legislation, if Medicare expenditures exceed a predetermined amount, the Independent Payment Advisory Board is mandated to cut expenses. One of the few areas the board can cut is drug costs. This will move the market for pharmaceuticals further away from market forces\u2014and until market forces are acknowledged, drug shortages will persist.\u00a0<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\">\u201cWell-intentioned but ill-advised policy changes in the Medicare Modernization Act must be addressed immediately to ensure that lifesaving treatments remain available. This means Congress has to remove artificial price caps.\u201d<\/span><\/p>\n<p><span style=\"font-family: arial,helvetica,sans-serif;\"><strong>\u00a0<\/strong><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Some progress on drug shortages has been made over the last few months, due in part to manufacturing improvements.\u00a0 For example, Genzyme said that a new plant was now producing all of the supply needed for its thyroid cancer treatment, Thyrogen.\u00a0 Supply had been spotty for about three years, but now biotech unit of Sanofi […]<\/p>\n","protected":false},"author":1,"featured_media":9711,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[56],"tags":[1101],"class_list":["post-1959","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-shortages","tag-new"],"_links":{"self":[{"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/posts\/1959","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/comments?post=1959"}],"version-history":[{"count":1,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/posts\/1959\/revisions"}],"predecessor-version":[{"id":9716,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/posts\/1959\/revisions\/9716"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/media\/9711"}],"wp:attachment":[{"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/media?parent=1959"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/categories?post=1959"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.policymed.com\/wp-json\/wp\/v2\/tags?post=1959"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}