Photo courtesy of Dr. Tony Johnson
The rationing of normal saline and other intravenous fluids is generating concern from veterinarians who rely on fluid therapy to support circulation in anesthetized patients. Fluids also are used to treat shock, dehydration and other medical conditions.
Human hospitals and veterinary practices are having a tough time stocking up on what’s basically pharmaceutical-grade saltwater, used for everything from hydrating patients to mixing medications.
Supplies of 0.9% sodium chloride injection (normal saline), a cornerstone of human and veterinary health care, have diminished since late last year due to a combination of recalls, weather-related distribution delays and increases in demand resulting, in part, from a nasty cold and flu season.
Now insiders say rumored price increases by Hospira Inc., one of three major manufacturers of normal saline in the United States, has sent medical professionals, veterinarians included, scrambling to stock up.
It's creating a hoarding situation that's depleting the saline supplies of distributors such as MWI, Patterson Veterinary Supply and Henry Schein Animal Health, forcing them to “allocate,” or ration, product. The tight saline market also is impacting supplies of other intravenous solutions, with access to Lactated Ringer’s, Plasma-Lyte and Normosol-R diminishing as medical professionals vie to scoop up saline alternatives.
Veterinarians say they are feeling the pinch. Dr. Edith Marshall of Houston relayed a note from her practice manager on a message board
of the Veterinary Information Network, an online professional community:
"I was notified late yesterday that we will not be able to get Norm R from Abbott for awhile. They are holding off shipment of product until sometime in July so they can raise the price. They say they are losing money on fluids so all fluids will be increasing significantly."
Dr. Kim Buck of San Antonio stated the same.
“I make the orders at work,” she wrote last week on VIN. “To order any LRS, saline or PlasmaLyte from MWI, I had to call a sales rep and could only order two boxes of each. All fluids are on allocation.
“They are trying to prevent people from hoarding fluids, causing a shortage,” she added.
The U.S. Food and Drug Administration (FDA) first alerted medical professionals to saline shortages in January, when production delays due to recalls and fresh scrutiny by regulators of the nation's manufacturing plants collided with cold and flu season, causing demand for saline to outstrip supplies across the country.
“We are working with the three manufacturers of these products, Baxter Healthcare Corp., B. Braun Medical Inc., and Hospira Inc., to help preserve the supply of these necessary products,” the agency said in a news release.
Regulators followed with two more alerts
announcing that the FDA would try to mitigate the shortage by temporarily allowing the importation of saline from Norway and Spain.
“While the shipments described above will help reduce current disruptions, they will not resolve the current shortage of 0.9% sodium chloride injection. Preventing drug shortages is a top priority for the FDA, and we are doing everything within our authority to improve access and alleviate this shortage,” the agency said in April.
Officials with Baxter and Braun did not respond to VIN News Service questions about the companies’ current supplies of saline. Hospira spokesman Dan Rosenberg said the company has "maximized production."
"Hospira is making as much product available as possible by producing at full capacity, because we understand the criticality of saline products to patients and healthcare providers," he said by email. "... Much of the increased demand we're seeing comes from customers who don't typically order IV solutions from us and are unable to obtain these products from their previous suppliers."
Rumors, however, are circulating that Hospira is about to double or triple prices on normal saline — speculation that one industy insider believes is more to blame for current supply woes than true medical demands.
"The company believes they can sell fluids at a much higher price point," he said, speaking on condition of anonymity because his employer has business ties to Hospira. "They’re not saying they predict a lack of fluids or deficiency. They are making a business decision to raise prices.”
Rosenberg did not respond to questions about whether a price hike on saline is in Hospira's future, and it's unclear whether competitors Baxter and Braun would follow Hospira's lead.
Nevertheless, the prospect of high-priced saline is causing panic, the industry insider said.
“If customers used to buy one case a month, they’re now trying to buy three dozen cases,” he said. “Once word gets out that the price is going up, in the veterinary space, people start stocking up.”
That’s when distributors start rationing product.
“There’s really nothing veterinarians can do other than take a deep breath,” he advised. “Things will get better.”
It’s unclear if and when saline price hikes will occur. If so, the additional costs could be passed on to consumers. FDA officials say they have no control over pricing; that’s the Federal Trade Commission’s (FTC) domain.
The VIN News Service could not immediately reach FTC officials.
Megan Bensette, spokeswoman for the FDA Center for Veterinary Medicine, confirmed that the manufacturing shortage of saline has eased since regulators publicly addressed the topic in April.
“We are continuing to closely monitor the situation,” she said by email.