North Carolina Families Struggle Amid Drug Shortages

Parents across North Carolina are grappling with the severe impact of a growing national drug shortage, particularly of prescription medications like ADHD treatments. The shortage is taking a toll on families, disrupting daily life and creating financial burdens.

Kerry Caskey and her two teenage sons are among those feeling the strain. All three take ADHD medication, and the shortage has deeply affected their ability to manage their condition effectively.

“There are different shortages with different medications, and we take different medications,” she explained. “We all have an issue with the medicines that we take.”

Data from the American Society of Health-System Pharmacists (ASHP) and the University of Utah Drug Information Service reveal an alarming reality: the United States is experiencing the highest number of active drug shortages on record. These shortages span multiple categories, including central nervous system stimulants, antimicrobials, hormone agents, intravenous fluids, and even chemotherapy drugs.

In North Carolina, families struggled throughout 2023 as pharmacies faced mounting challenges in meeting demand. Insurance companies often exacerbate the issue by only covering generic versions of medications like Vyvanse and Focalin, leaving families with limited options.

“It’s gotten better for some of the drugs,” said Melissa Illig of White Oak Pharmacy. “As far as Vyvanse, that has been a huge problem, especially since most of the insurance companies want to cover the generic, but we can’t get the generic.”

For families like Caskey’s, the rising costs of out-of-pocket medication add another layer of stress.

“We pay $371 for a 30-day supply, so multiply that by three, and that’s what I’m paying every month for our medication,” she shared.

Illig noted that relying on out-of-pocket payments is not a sustainable solution, but for parents like Caskey, the necessity outweighs the expense. Without the medication, her oldest son is unable to function in his daily life.

“When I don’t have [my oldest son’s] medication, I get very worried. He can’t drive, he can’t work [and] he can’t go to school if he doesn’t have that,” she said. “It’s not just a school-day medication. It’s these kids’ lives, and they depend on this to help them function.”

The drug shortage crisis is the largest the nation has seen in over a decade. ASHP and the University of Utah Drug Information Service began tracking shortages in 2001. The previous peak occurred in 2014, with 320 drugs in shortage. However, the numbers have climbed steadily since 2021, reaching a record 323 drugs in active shortage during the first quarter of 2024.

“It’s long past time to put an end to drug shortages,” wrote Paul Abramowitz, ASHP’s CEO, in an April 11 blog post.

“All drug classes are vulnerable to shortages,” he continued. “Some of the most worrying shortages involve generic sterile injectable medications, including cancer chemotherapy drugs and emergency medications stored in hospital crash carts and procedural areas. Ongoing national shortages of therapies for attention-deficit/hyperactivity disorder also remain a serious challenge for clinicians and patients.”

ASHP maintains a comprehensive drug shortage database based on reports from healthcare professionals, patients, and manufacturers. This list often exceeds the number recognized by the FDA because it accounts for broader impacts on healthcare providers and patients.

While increased demand can drive shortages, underlying factors such as manufacturing issues, supply chain disruptions, and discontinuations are more common culprits. The average drug shortage lasts about 18 months, but more than half extend beyond two years, according to government data.

Earlier this year, the U.S. Department of Health and Human Services (HHS) released a white paper proposing strategies to address these issues. Key recommendations include fostering collaboration between manufacturers and hospitals, improving market transparency, and incentivizing resilient supply chains.

However, not all aspects of the HHS proposal have been well-received. ASHP expressed concerns about proposed financial penalties for hospitals unable to meet compliance requirements, noting that many lack the resources to implement the suggested changes.

“We all know that managing shortages isn’t enough and is not a sustainable solution to the worsening crisis,” Abramowitz emphasized. “Much work remains to be done at the federal level to fix the root causes of drug shortages.”

Illig remains optimistic about the potential benefits of generic medications becoming more widely available.

“It’s a cheaper alternative, and once the generic is released, it should be provided to the patient because it’s equivalent, but it’s not available, so that’s a problem,” she said.

However, Caskey pointed out that generic options are not always a viable solution for everyone.

“The generics are not one-to-one for the brand,” she noted. “I have had people in my group who have said generic Vyvanse doesn’t work for them, even if they can find it.”

For families across North Carolina and beyond, the drug shortage crisis underscores the urgent need for systemic change. As parents continue to navigate the challenges of availability and affordability, many feel they are at the mercy of insurance companies and an unreliable supply chain.

With continued advocacy and collaboration between stakeholders, there is hope for progress in mitigating drug shortages and easing the burden on families. Until then, parents like Caskey are left to navigate an unpredictable landscape, doing whatever it takes to secure the medication their families rely on to thrive.