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Increased demand for drug treating rheumatoid arthritis causes shortages in Treasure Valley

After the FDA authorized hospitals to use Actemra on severe COVID-19 patients, health systems like St. Luke's have shortages.

BOISE, Idaho — Hospitals across the Treasure Valley have felt the impacts of shortages for certain drugs and medications. The most recent is the increased demand for a medication primarily used on people with rheumatoid arthritis pre-COVID-19. 

Back in June, the FDA granted Actemra (tocilizumab) an emergency use authorization for the treatment of hospitalized adults and pediatric patients. According to the FDA, the monoclonal antibody "was shown to reduce the risk of death through 28 days of follow-up and decrease the amount of time patients remained hospitalized."

"This medication traditionally doesn't have a lot of use in our hospitals but obviously with COVID patients, especially as we run into emergency standards of care, that use went off the charts for us," said Scott Milner, the senior director of pharmacy for St. Luke's Health System.

Milner said as the COVID-19 pandemic began, the Treasure Valley area hospitals learned there were going to be drug shortages. He said it forced them to quickly develop ways on how to handle it. 

He added the FDA's announcement in regard to Actemra gave them enough time to develop more ways on how to deal with the potential shortage in that circumstance.

In July, St. Luke's saw no limitations on the medication, but a month later that was no longer the case.

"Like with all of our drug shortages, we've pulled together a number of providers to help us understand," Milner explained. He said the health system has processes they follow, like figuring out ways how to ration the drug if needed, what are some alternate therapies, are able to delay certain patient starts on the infusion and more.

Milner told KTVB that at one point the health system did have to give some patients being prescribed Actemra alternate therapies but said they never had to stop a patient's infusion or delay a start. An "alternative therapy" has been approved and is equally as effective in treating a disease, according to Milner.

"I'm sure there is a patient or two that is offset by that, but at the same time, they were welcoming that we had a strategy to make sure patients were covered," Milner said.

Whereas St. Luke's saw shortages, officials from Saint Alphonsus Health System said they didn't.

 "We didn't normally keep a lot of that medication on hand and once things started becoming more prevalent in the use of it, we stalked up on what we were carrying and tried to be proactive and manage the drug supply that we had," said Lisa Thoroughman, the pharmacy director of Saint Alphonsus in Nampa. 

Thoroughman said all four of the hospitals pulled funds together to buy more of the medication. She explained each facility was able to share supplies with one another and make sure patients in need of the medication were taken care of.

Saint Alphonsus area physicians determined the criteria to use it outside of patients with arthritis 

"That way we were able to make sure it was used on patients that needed it the most," Thoroughman said.

While there may be a shortage of Actemra at St Luke's, Milner said there have other drugs shortages well beyond the pandemic. 

"Raw ingredients weren't being shipped from China, India and other places in the world and manufacturing, not only in the United States but abroad was limited," Milner said.

He added while drug shortages aren't going away, this particular shortage isn't related to typical circumstances which gives him hope this will not continue.

"This is more tied to the fact that we saw an increased spike in demand," Milner said.

While the demand is still pretty high, St Luke's has, for the most part, been able to keep up with it in supply but Milner would still say there is a shortage. More purchases are on the way to St. Luke's to help keep up.

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