# The broken drug supply chain: The impact of COVID-19 on drug shortages and Veteran health

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: Few of the drugs Veterans take as a cornerstone to prevent and treat disease are produced
domestically; the majority of medications consumed in the U.S. are produced in foreign facilities. Thus, the drug
supply chain is global and susceptible to disruption due to unanticipated events, such as the 2019 Coronavirus
pandemic (COVID-19).
Significance: However, little is known on the frequency of drug shortages causing medication treatment gaps
and subsequent impact on adverse clinical outcomes. This is especially true in the outpatient setting, where
the majority of drug shortages occur.
Innovation and Impact: The research is innovative by conducting formative work on: 1) the impact of the pan-
demic on drug supply and outcomes, 2) differences in shortages in VA priority groups, 3) incorporating stake-
holders to inform methods, 4) direct involvement of VA operations and an expert panel of federal partners, and
[unique access to operations data.]. The majority of Rx use and drug shortages in VA occur in outpatients, but
prior research on drug shortages has focused on inpatients. We will also evaluate the impact of drug shortages
by race, ethnicity, age, location, and co-morbidities. The results obtained here will guide VA policy-makers in
the identification of the most effective policies to address this growing problem.
Specific aims: 1) Determine the impact of the COVID pandemic on the drug supply chain in VA; 2) Assess the
impact of drug shortages on outpatient medication treatment disruption in the VA; and 3) Determine the asso-
ciation between drug shortage-related treatment disruption in outpatient prescription refills and serious adverse
clinical outcomes.
Methodology: Drug supply chain issues will be identified through U.S. reporting systems (e.g., FDA). We will
leverage VA data for the quantity of drugs ordered and supplied nationally using VA purchasing and outpatient
prescription data. For each drug potentially used in the outpatient setting with a reported supply chain issue,
purchase changes will be assessed monthly pre- (2017-2019) and during the pandemic. Aim 1 will use inter-
rupted time series (ITS) analyses to test whether the incidence of supply chain issues triggering a decrease in
supply increased after pandemic start. Aim 2 will identify outpatient drug shortages leading to treatment disrup-
tion using ITS and structural break models. Aim 3 will define cohorts based on the indication for drugs with
identified shortages using a time to event analysis with entropy balance weighting to evaluate if adverse out-
comes (hospitalizations, death, emergency/urgent care) were greater for patients using drugs affected by short-
ages (the exposed group) compared to unexposed controls.
Next steps and Implementation: Dissemination will be guided by an expert panel comprised of VA operational
partners, other federal partners and experts in drug supply and shortages. The quantitative results will be as-
similated with the expert pane...

## Key facts

- **NIH application ID:** 10804626
- **Project number:** 5I01HX003519-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** KJ Suda
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-04-01 → 2027-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10804626

## Citation

> US National Institutes of Health, RePORTER application 10804626, The broken drug supply chain: The impact of COVID-19 on drug shortages and Veteran health (5I01HX003519-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10804626. Licensed CC0.

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