Copyright © 1999 Nando Media
Copyright © 1999 Scripps Howard News Service
By LEE BOWMAN
(April 19, 1999 11:57 p.m. EDT http://www.nandotimes.com) -
If the millennium bug bites, will there be enough medicine to go around? Patients, pharmacists, drug makers and everyone in between are pondering whether stockpiling prescription medicines ahead of possible computer breakdowns come Jan. 1 is prudent. And they worry that significant hoarding will create shortages even before the computers are put to the test.
In Waterloo, Iowa, pharmacist Bob Greenwood said the period between Thanksgiving and New Year's Eve is always one of the busiest times of the year for druggists anyway because many patients who have met their insurance deductibles seek to stock up on medications that will cost them less out of pocket.
"I'm discouraging customers from trying to get ahead too much because I think we'll have enough to go around," Greenwood said. "I usually keep a one-month supply, although with generics, I'm able to stock up to six months of many drugs."
Still, Greenwood is wary that shortages might affect some of his critically
ill patients, so he's planning to have extra supplies of a few critical
drugs. "I've got five transplant patients, and I'll probably order an extra
month's worth of anti-rejection agents for them, for instance."
Pharmacists are among the most intensive users of computers in the health care industry, with an estimated 99 percent of all prescriptions dispensed using at least one computer system.
"In any given pharmacy, there may be different systems to track sales
and inventory and maintain patient profiles, check for drug
interactions, track prescription refills and maintain patient records, as well as file claims for insurance coverage," said Richard Carbray, a spokesman for the American Pharmaceutical Association, in testimony before a Senate special committee on Year 2000 problems.
Officially, the drug industry says it is, or will be, fully operational
when computer calendars flip to "00." "We anticipate no interruption in
the supply of medicines due to Y2K problems at our member companies," said
Alan Holmer, president of the Pharmaceutical Research and
Manufacturers of America.
He added that meeting the challenge also depends on "other links in the supply chain." The industry is spending more than $2 billion to correct software flaws in computers and other equipment.
But Holmer added that "hoarding and stockpiling by patients could create a greater threat to the supply of medicines than any computer glitch." In Leesburg, Va., pharmacist Steve Roberts has aggressive Y2K plans in the works, testing and upgrading equipment, with a backup plan to keep serving customers in the unlikely event of a system collapse.
He worries about the effects of stockpiling, but said that "for me to feel safe about things, and realistically what we can afford to stock up on, is an additional one-month supply of medications. We'll review the drugs by class, and stock up on what people can't live without - things like antibiotics, insulin, cardiac drugs and asthma inhalers. If the problems last longer than a month, it's going to be chaos."
Affordability is key. For many people with a chronic illness, drugs are a big part of the budget every month, even if part of the cost is covered by insurance. And most insurance plans, including Medicare, won't pay for more than a month's supply at a time.
Joel Ackerman, executive director of RX2000 Solutions Institute in Edina, Minn., which is helping health care organizations correct Year 2000 computer problems, urged the Senate committee to support legislation that would permit "a one-time exclusion for Medicare or health plans allowing patients to receive a 90-day supply of medications instead of a 30 day supply at the end of 1999."
But the proposal has drawn little enthusiasm from insurers or the drug industry, which fear such a step would only exacerbate shortages. The alternative, Ackerman said, is possible rationing of some drugs. In that case, he said, "some stockpiling is prudent."
No one has a magic number for how much to have on hand, though the International Association of Emergency Managers recommends 30 days' worth of medications along with a seven-day stock of food and water. In Kokomo, Ind., pharmacist Don Moore said so many of his customers work for high-tech companies and are on insurance plans that curb early refills "that this just hasn't been an issue so far. I did have one man come in last week whose wife was so upset about being able to get her drugs, she sent him down to talk to me about it personally." "I may be wrong, but I don't think we're going to have that much to worry about from this," Moore said. Still, he admitted that he's checked around with wholesalers in his area to make sure he or his employees could reach warehouses if the supply system were to break down.
Drug companies and wholesalers are watching for any unexpected surges in demand for particular drugs but haven't detected any trends that would indicate widespread hoarding. Companies are updating contingency plans to get around bottlenecks that might develop, just as they did during the 1997 UPS strike.
"Even if a big surge in demand is detected, there's not a whole lot of excess capacity in most plants, nor in the raw materials that go into most drugs," said PhARMA spokesman Jeffrey Trewitt.
So far, though, few Americans seem inclined to stuff the medicine chest.
"Even though there's been some news coverage of this, I can't recall
any customers discussing it with me," said Joe Smith, owner of The Medicine
Shoppe in Falls Church, Va. "It's a little early yet to tell, but I think
some combination of insurance restrictions and maybe some
rationing steps at some level will keep this from being too much of a panic.
"Of course, around here a 2-inch snow forecast is all it takes to empty
the shelves of bread, milk and toilet paper, so I'm sure we're going to
have one of the busiest Decembers we've ever had."
Lee Bowman covers health and science for Scripps Howard News Service
and can be reached at BowmanL@shns.com.