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Implementation Aspects of a Medicines Shortage Policy Tool: Evidence from Australia's Serious Scarcity Substitution
Jack Janetzki1, Lisa Kalisch-Ellett2, Nicole Pratt2
1School of Pharmacy and Biomedical Sciences, College of Health, Adelaide University, Adelaide University North Terrace, Adelaide, SA, 5000, Australia. Jack.Janetzki@adelaide.edu.au.
Drug Safety
|July 2, 2026
Summary
Serious Scarcity Substitution Instruments (SSSIs) helped limit medication decreases during shortages. However, SSSIs were less effective when many substitute medicines were also unavailable.
Area of Science:
- Pharmacoeconomics
- Health Services Research
- Drug Utilization
Background:
- Medication shortages significantly disrupt patient access to essential medicines.
- Australia implemented Serious Scarcity Substitution Instruments (SSSIs) in 2021 to allow pharmacist substitutions.
- The impact of SSSIs on medicine utilization remains unexamined.
Purpose of the Study:
- To evaluate the effectiveness of SSSIs in mitigating medicine shortages.
- To assess if SSSIs meet patient medication needs during scarcity.
Main Methods:
- Retrospective cohort study analyzing pharmacy claims data.
- Examined utilization of 12 medicines with active SSSIs.
- Calculated percentage change in dispensed defined daily doses per 1000 population per day.
Main Results:
- Utilization decreased for 10 of 12 medicines post-SSSI implementation.
- Eight medicines experienced utilization decreases of less than 20%, indicating SSSI success.
- SSSIs were less effective when numerous permitted substitutes were also scarce, showing larger utilization drops.
Conclusions:
- SSSIs appear successful in limiting medication consumption decreases during shortages.
- SSSI effectiveness is diminished when a high proportion of substitute products are also unavailable.
- Further research is needed to optimize SSSI strategies during widespread drug scarcity.
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