Those factors can add up in interesting ways: Many of the cheapest products tend to be manufactured in regions of India and China where they are inexpensive to produce, but the concentration of facilities creates an extra layer of vulnerability to problems such as natural disasters or political unrest.
Ms. Raghavendran said efforts to diversify the locations for production were important, but warned that bringing the manufacturing to the United States would not be the only way to fix the issue. She noted the recent bankruptcy of a U.S. generic drugmaker. The abrupt closure of Akorn Pharmaceuticals last month has been linked to the worsening of an albuterol shortage.
Witnesses also emphasized the need for more transparency into drug supplies. Policymakers are “flying blind” when it comes to the sources of critical ingredients, often referred to as A.P.I., or active pharmaceutical ingredients, Ms. Raghavendran said.
While the Food and Drug Administration gets some data on those active ingredients, the agency acknowledged to Senate staff that the data was not kept in a usable format, but rather “buried in PDFs within individual drug applications,” the Senate report says.
Erin Fox, an expert at the University of Utah who tracks drug shortages, said another gap in information was critical, as well: There is no data on drugmaker quality. Such information might be used to reward the most scrupulous suppliers and help them expand production. Yet while the F.D.A. “sees really clear quality differences between products and manufacturing sites,” the information is confidential and not available to drug buyers.
“There’s really no incentive for one company to do a better job,” Dr. Fox said. “If one company did do a better job, we have no way of knowing that.”
The matter deserves attention, she said: “Unlike other products, people’s lives are at stake.”
Dr. Shuman, the cancer surgeon, cited other troubling shortages, including of eye drops that “literally keep people from going blind that cost a few dollars a month.” He said patients with glaucoma who do not get the drops could be faced with surgery instead.
Those critical but cheap treatments in short supply point to a need for incentives or subsidies to companies that make them, Dr. Shuman said, given that “drug pricing structures are not always reflective of their value to patients.”
