A multifaceted approach aims to help providers navigate shortages of cisplatin, carboplatin and other anti-cancer drugs.
This past year witnessed what many experts have called the worst oncology drug shortage crisis in U.S. history. As of early December, the FDA listed 16 cancer drugs to be in short supply. Among those are cisplatin and carboplatin, two generic, platinum-based drugs that are prescribed for 10-20% of all cancer patients, according to the National Cancer Institute.
Platinum-based drugs, preferred for a wide range of cancer indications, are among the highest-value tools in the cancer-fighting armament. Yet what makes such medications so valuable also makes them vulnerable to shortages. The low financial margins can lead manufacturers to discontinue production, or to cut corners. An FDA inspection and subsequent closure of a production facility in India early this year cut the flow of cisplatin to the U.S. by about 50% and also affected carboplatin.
While these shortages appear to have peaked this summer, they persist.
To ensure that existing stocks of affected drugs deliver the greatest possible benefit, the American Society of Clinical Oncology (ASCO) issued guidance to cancer practices. Among the recommendations was increasing the interval between cycles and/or reducing the total treatment dose when clinically acceptable; minimizing or omitting shortage-affected drugs for recurrent drug-resistant cancers, so as to reserve them for curative disease; and selecting equally effective regimens that do not use shortage-affected drugs, when that’s an option.
For its part, Evolent has used several tactics this year to help conserve supplies of affected drugs while helping providers navigate the shortages with less friction.
These tactics include:
- Reducing drug waste through dose-rounding, an Evolent program that encourages providers to round to the nearest vial size within 10% of the ordered dose for eligible drugs. This step, which does not compromise drug efficacy or toxicity, prevents cases in which a single-use drug vial must be discarded after a small portion of its contents is administered.
- Easing the burden of authorizing alternative treatments to reduce risk of patient care delays. Our oncologists work directly with providers to authorize treatment plans that make the best use of available drugs.
- Expediting treatment requests by adding auto-approvals for appropriate non-platinum containing regimens, in those cases where platinum-containing regimens would typically be preferred.
- Consistently tracking drug shortages, and adapting as needed, to ensure our approaches reflect the reality on the ground. Evolent leverages reports from the FDA, American Society of Health System Pharmacists, and commonly used wholesalers to track drug availability and adjust processes as needed. For example, once shortages of cisplatin and carboplatin subside, auto-approvals for alternate regimens may be discontinued.
Given the severity of this year’s cancer drug shortages, the FDA has worked with manufacturers to boost production of affected drugs — or to restart production, in the case of those companies that stopped producing chemotherapies. Still, the U.S. remains highly dependent on overseas manufacturers for producing critical drugs. In late November, the Biden administration announced it was taking several steps to safeguard drug production networks, among others. Biden intends to leverage the Defense Production Act to make more essential medicines at home in the U.S. and prevent drug shortages, according to a White House fact sheet.
