POSC224 Drug Supply Chain Disruption: Retrospective Analysis of Substitution Procurement Agreements in a University Hospital Structure

ABSTRACT

Objectives: Between 2013 and 2019, the number of pharmaceutical supply chain disruptions declared by industry in France had been threefold increased. The covid-19 crisis amplified this rise including in 2020. Substitution procurement agreements (SPA) are formalized to overcome pharmaceutical shortages. These agreements are set up with costs to be paid by the defaulting holder. During the crisis, this additional cost was not charged to the defaulting suppliers. The aim of this study is to analyze retrospectively the development of supply chain disruption between 2016 and 2020 in our hospital structure and to quantify their impacts. Methods: Each SPA is analyzed type of shortage drugs, substitute medications, amount used, disruption delays and financial impacts. Results: Between 2016 and 2019, 257 SPA are established including 68% of generics and 58% of oral solid forms, for an average period of time of 191 days [1 – 1026]. A 30% raise of SPA is observed between the first 6 months of 2019 and 2020 but the increase provides primarily from injectable medication (48%).The substitute drug unit prices excluding tax are always higher, this additional median annual cost represents 1 140 701€ between 2016 and 2019, and 2 617 626 € in the first half of 2020 (for a annual drug budget of around 1 billion euros). Conclusions: The covid-19 crisis increased the injectable drug shortage due to increased activity in intensive care unit. There is a correlation between low prices and medicine shortages. The additional cost is high for our institution, due to the fact that defaulting suppliers have not been requested to support the medication cost differences. This suggests that some drugs unit prices should increase in the future as it is already the case for immunoglobulins.