Drug supply chain disruptions and outpatient medication shortages in the Veterans Health Administration, 2017–2020

We sought to describe how often and circumstances in which supply chain disruptions were associated with outpatient drug shortages within the Veterans Health Administration (VHA). We conducted a descriptive analysis of VHA purchasing data for drugs used to treat chronic conditions for outpatients with a supply chain report from 2017 to 2020. In primary analyses, a VHA drug shortage was defined as a ≥ 10% absolute decrease in percentage of doses ordered that were filled by the wholesaler and/or a ≥ 10% relative decrease in total number of doses filled, comparing the 3 months after the reporting date with the 6 months before. We also examined longitudinal ordering and filling data over 12 months before and after the reporting date by whether the medication resulted in a shortage to VHA. Of 64 medications with supply chain disruptions, 67% ( n = 43) resulted in a shortage to VHA. Bivariable analyses did not identify covariates significantly associated with VHA experiencing a shortage. For medications with a shortage, dosage units ordered sharply increased over the 4 months before the reporting date, peaked at the reporting date (336.0%), and then generally decreased over the remaining 11 months. The monthly dosage units filled slowly declined leading up to the reporting date, dropped more quickly to 60% at two months post-reporting date, and then increased. Among ambulatory-focused medications for chronic conditions, a high proportion of those with supply chain disruptions were associated with shortages to VHA. Sharp increases in medication ordering may serve as an early signal of shortages.