At least once a week, my spam inbox contains mail from one or more online pharmacies, promising me a great price on a particular drug that is not medically necessary, nor is it meant to be dispensed to someone of my gender. Hospital pharmacies, in the business of dispensing medically necessary drugs to hospital patients, receive email from distributors with lists of drugs and prices, and also receive offers from so-called gray market distributors, unofficial sellers who are now taking advantage of drug shortages to resell scarce products at inflated prices.

In April 2011, the Premier Healthcare Alliance surveyed all of its acute-care membership, and asked them to submit examples of unauthorized offers to sell products in short supply. Over a two week period, they collected 1742 offers from 42 acute care hospitals, and tabulated the results. The largest markup they recorded was for Labetalol, a cardiology drug, at 4355%, but even sodium chloride concentrate was recorded as on offer at 2350% above normal.

The report warns that products obtained through the gray market may be stolen, counterfeit, or not handled properly, and recommends sourcing products from manufacturer-authorized vendors, or from other venders only when a pedigree for the product can be reliably determined.

Despite the risks, a report issued by the Institute for Safe Medication Practices found that about half (52%) of all respondents to their gray-market survey reported purchasing one or more products from gray market vendors during the past 2 years. Most (80%) of these respondents reported that their purchases had increased in the past 2 years as drug shortages have increased. According to the report, “Numerous respondents reported feeling pressured by physicians and hospital administrators to purchase medications from the gray market. Any resistance to the purchase, despite expressed risks, pegs the pharmacist as the ‘bad guy.’ Our physicians DO NOT want to hear that a drug is unavailable.”

At least some of the products on offer are entirely legitimate, but are being scalped to make a profit at the expense of hospitals that require the products to treat critically ill patients. Among the recommendations from ISMP for curtailing the gray market is that in the event of an anticipated shortage, manufacturers should be required to stop deliveries to wholesalers/distributors. This way, only direct accounts with hospitals, clinics, pharmacies, and other direct patient care providers will have access to the products at the contracted rate. The report also recommends stronger regulation and criminal penalties for gray market sellers, but the first step seems like a simple, easily implemented way of keeping the scalpers under control.

For related articles, see:

Drug Shortages Loom Large

Senator to Draft Legislation to Mitigate Drug Shortages