In the past six years, Marcus Zavala watched as several drug shortages emptied his shelves at Perrone Pharmacy. Founded in 1952 by Paul Perrone, the independent, family owned retail pharmacy is a Fort Worth fixture just off the Camp Bowie traffic circle.
As chief pharmacist officer, Zavala understands the ups and downs of pharmaceutical manufacturing. Still, with every shortage, he tries not to worry. Each wave only lasts a while, he said.
But this time is different.
Since 2022, Perrone has been experiencing shortages for its most in demand drugs: Amoxicillin, Children’s Tylenol, Ozempic, Percocet and Adderall, an ADHD medication.
Perrone Pharmacy is not alone — other locally owned, independent pharmacies also are struggling to meet patient needs amid drug shortages. Some are finding solutions by compounding their own versions of name brand medications.
Chain pharmacies ‘have the buying power’
For the past eight months, Hall’s Pharmacy has been placed on backorder lists for the same medications that elude Perrone. Its biggest backorders: Ozempic, Adderall. The pharmacy is also seeing a shortage of Trulicity, which is used for patients with Type 2 diabetes.
Ozempic, originally a treatment for people with diabetes, has seen an uptick in usage this year among weight-loss patients. Now, doctors are prescribing patients off-label Ozempic amid shortages.
Novo Nordisk, the pharmaceutical company behind Ozempic, has gained about $7 billion in profit in just the first six months of this year — up 32% from the same period in 2022, according to CNN. Novo Nordisk is also selling a higher dose of Ozempic under a different name: Wegovy.
With the school year back in session, parents are contacting Hall’s for refills on Adderall and other ADHD medications for their children. The pharmacy places patients on waitlists.
Every day, the pharmacy’s staff checks for updates with its primary vendor, McKesson, but haven’t seen any restock updates. When the pharmacy does receive new shipments of Adderall, residents receive it based on whoever joined the waitlist first.
“Since we are a specialty pharmacy, we need to have these medications on time,” Haritha Pingili, registered pharmacist at Hall’s, said. “It’s very frustrating.”
Both Perrone Pharmacy and Hall’s Pharmacy contact doctors and nurses to provide alternative medications for patients. Some of Hall’s patients who are regularly prescribed Trulicity, are switched to Victoza for the time being.
However, switching to alternative drugs creates a separate problem.
“It cascades a shortage with other medications, too, because you’re diverting all of it to these other meds,” Zavala said.
On North Riverside Drive, A&P Pharmacy is also left with no choice but to place patients on waitlists, Sejal Dasondi, A&P owner and lead pharmacist, said. As patients grow increasingly frustrated, the pharmacy has to transfer patients to large chain pharmacies, including Walmart, Walgreens and CVS.
By doing so, A&P Pharmacy loses more and more customers, Dasondi said.
While larger companies are also facing shortages, when drug manufacturers restock, the chains get first shot on bulks of medications, Zavala said.
“They have the buying power,” he said. “Any stuff that’s in shortage, they get priority. They’re also these huge, giant corporations who can buy half a warehouse (of medications) at a time.”
Pingili has worked for both corporate and independent pharmacies and recognized a stark difference in operations. Independent pharmacies don’t have the luxury of being able to contact other chain locations for additional products, she said.
“When you’re independent, it’s very difficult because every problem you have, you have to find the solution yourself,” she said. “It’s not like you can reach out to someone and they’ll take care of it. We have to survive against competition.”
What is causing drug shortages?
Drug shortages across the U.S. are caused by manufacturing, quality problems, delays and discontinuations, according to the Food and Drug Administration.
As of Sept. 5, there are 136 drugs currently in shortage.
Click here to view the Food and Drug Administration’s complete list of drugs currently in shortage.
Some drug manufacturing plants have struggled to bounce back and others have shut down completely following the COVID-19 pandemic.
From 2021 to 2022, drug shortages increased by nearly 30%, according to the Senate Committee on Homeland Security and Governmental Affairs.
Since October 2022, Tarrant County has seen a shortage on name brand Adderall. That same month, the FDA announced that Adderall shortages stemmed from manufacturing delays and production issues at Teva, a drug company that produces both generic and brand-name versions of the drug.
Other manufacturers, including Epic Pharma LLC continue to produce Adderall, but there is not enough supply to meet the demand in the U.S.
In February, Illinois-based Akorn Pharmaceuticals, which was responsible for producing 75 generic drugs on the market, filed for Chapter 7 bankruptcy and closed its doors.
Following Akorn’s closure, all of its drugs had to be pulled from the market. The company was one of two U.S. suppliers of liquid albuterol, which is used to treat asthma and RSV in children.
“When [Akorn] went out of business, that line of drugs went nonexistent,” Zavala said. “It takes time for other drug companies to get their machinery ready to make or replace whatever company got sold or went out of business. Drugs are not protected by anything.”
The shutdown forced other plants and pharmacies to pivot, Zavala said.
‘Adapt as it comes’
Going into the fall, some independent pharmacies don’t see an end to the drug shortages — all some can do is be prepared to adapt.
To ensure continuous customer support, Perrone Pharmacy has invested in providing a full-service experience to keep residents coming back.
“When I train new techs, I tell them that [customers] can go to any pharmacy around here,” Zavala said. “We’re not always going to have affordable prescriptions, so we have to sell them on us.”
Perrone and Hall’s Pharmacy are also meeting patient needs by producing generic drugs in their own compounding labs.
What are compound drugs?
Compounds are customized medications created for specific needs of each patient. The customized medications are used when a commercially manufactured medication is not available or patients cannot tolerate commercially available drugs. Compounds work the same, they are just not the name brand.
Trained pharmacists and technicians dilute existing medications and mix powders with bases. Injectable drugs can also be compounded.
Still, the physical and chemical properties of each ingredient must be considered in order to prepare a safe medication. To be able to produce compounds, pharmacies must receive a separate license. Compounding labs are regularly inspected.
One medication Perrone is currently compounding is a generic version of Ozempic.
“I’m hoping that everything stabilizes out here for 2024,” he said. “But I don’t think it will be for Ozempic, they’re way too far behind. It’s always going to be one thing or another all the time. We’ve learned to adapt as it comes.”
Meanwhile, A&P Pharmacy is going to continue riding out the wave — hoping the business’ shelves restock soon.
“Mainly we are hoping they supply the demand,” Dasondi said. “That’s all you can do.”
David Moreno is the health reporter at the Fort Worth Report. Contact him at david.moreno@fortworthreport.org or via Twitter.
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