Drug supply chain disruptions and outpatient medication shortages in the Veterans Health Administration, 2017-2020

We sought to describe how often and circumstances in which supply chain disruptions were associated with outpatient drug shortages within the Veterans Health Administration (VHA).

We conducted a descriptive analysis of VHA purchasing data for drugs used to treat chronic conditions for outpatients with a supply chain report from 2017 to 2020. In primary analyses, a VHA drug shortage was defined as a ≥ 10% absolute decrease in percentage of doses ordered that were filled by the wholesaler and/or a ≥ 10% relative decrease in total number of doses filled, comparing the 3 months after the reporting date with the 6 months before. We also examined longitudinal ordering and filling data over 12 months before and after the reporting date by whether the medication resulted in a shortage to VHA.

Of 64 medications with supply chain disruptions, 67% (n = 43) resulted in a shortage to VHA. Bivariable analyses did not identify covariates significantly associated with VHA experiencing a shortage. For medications with a shortage, dosage units ordered sharply increased over the 4 months before the reporting date, peaked at the reporting date (336.0%), and then generally decreased over the remaining 11 months. The monthly dosage units filled slowly declined leading up to the reporting date, dropped more quickly to 60% at two months post-reporting date, and then increased.

Among ambulatory-focused medications for chronic conditions, a high proportion of those with supply chain disruptions were associated with shortages to VHA. Sharp increases in medication ordering may serve as an early signal of shortages.