With no end in sight to the drug shortage crisis, hospital and health-system pharmacies have learned to rely on a variety of resources for information, ranging from the FDA’s drug shortage database to the record 323 current shortages reported by ASHP in the first quarter of 2024, to pharmacies’ own outreach to distributors and wholesalers.
“Shortage mitigation is one of the biggest issues we have facing us today,” said Paul Marcinkowski, the pharmacy purchasing manager for Thomas Jefferson University Hospitals, an eight-hospital multistate system with a flagship hospital in Philadelphia.
But there’s a limit to the intelligence that outside lists and services can provide, and personal outreach is time-consuming. That’s why Premier Inc., a healthcare improvement company with some 4,300 hospitals and health-system members, developed CognitiveRx, an add-on analytics tool that uses artificial intelligence, informed by purchasing data from its thousands of members, to predict shortages and alert users to other impending trends such as drug price increases.
CognitiveRx’s machine learning model scores individual drugs for vulnerability to going into shortage, said Shelley Scavo, the product director for pharmacy and supply chain at Premier. It evaluates numerous parameters, including:
- the number of manufacturers for a given drug;
- current shortage situations;
- fill rate patterns (the amount of product Premier’s members order vs. how much they receive); and
- the status of equivalent or alternative drugs, which may indicate issues with a particular active pharmaceutical ingredient.
“The model picks up signals,” explained Paula Gurz, Premier’s senior director of pharmacy contracting for generics and biosimilars. “These signals don’t always indicate that the drug is going to be short, but they provide insights as to what drugs could be problematic in the market.” Premier follows up with suppliers to ascertain whether the AI is detecting an actual shortage, “or instead something like a batch delay or a weather issue like the [2023] tornado that damaged the Pfizer plant in North Carolina,” Ms. Gurz said.
CognitiveRx presents weekly shortage alerts to its members and scores the top 200 drugs by name and relevant administration routes. “The interface also includes rank change from the previous week, which helps them understand trend lines,” Ms. Scavo said.
‘Like a Crystal Ball’
Since CognitiveRx launched in April 2022, Premier reports the tool has achieved an early detection rate of 76%, identifying more than 150 vulnerable drug-route combinations at least three weeks prior to the official shortage announcement. It’s currently being used by at least eight mid-sized to larger health systems encompassing more than 2,600 individual facilities, including Jefferson, which signed on in late 2022 when the system became a Premier member.
Mr. Marcinkowski said he likes the “my shortages” function because it allows him to identify facilities that have not received product or are experiencing other shortage issues. “I can see that hospital X has had a fill rate of 10% on a certain product, ordering 31 units but receiving three. That’s valuable to me; I look at that every single week.”
He added that the trend information provided by CognitiveRx is also useful. “[It allows] us to assess which potential shortages are mission critical and which are not. And it’s nice that I don’t have to go to 15 different places to find this information.”
Although useful, drug shortage lists alone cannot keep up with the fast-paced demands of healthcare. “Patient care doesn’t have the ability to wait 30 to 90 days for a situation to resolve,” Mr. Marcinkowski said. “This tool allows us to get ahead of situations.” For example, he said, when nystatin topical powder 15 g went on shortage, the 30-g formulation remained available. “We knew ahead of time to purchase additional product to get through that shortage. It’s like a crystal ball.”
When it comes to essential medications, “any additional information is huge,” said John Williamson, PharmD, Jefferson’s enterprise director for pharmacy shared services. “Even just three days’ advance notice of a potential shortage is very useful, allowing us to be proactive and fight for our patients’ needs.”
CognitiveRx’s drug pricing component is also helpful, Dr. Williamson said. “If we know that we can expect a particular drug to have a price increase of 6.3% within the next few months, let’s bring in more now and save on that increase in cost.”
CognitiveRx recently introduced a watch list feature to enable users to monitor specific drugs more closely, Ms. Scavo said. “At some point, users will also be able to configure it to alert them in certain circumstances—for example, if drug X jumps a certain number of positions on the shortage vulnerability list.”
The sources reported no relevant financial disclosures.
This article is from the April 2024 print issue.