OBJECTIVES: The number of pharmaceutical supply chain disruptions is increasing these last years in France. To prevent the consequences of shortages, our university hospital structure establishes substitution procurement agreements (SPA) with an alternate supplier. The defaulting holder pays the overcost. However if this one is regarded as not responsible for the shortage, the overcost is borne by the hospital. The aim is to analyze retrospectively the SPA contracted in our hospital between 2019 and 2021.

METHODS: Each SPA is analyzed: type of drugs, disruption delays, amount used, defaulting and suppliant holder’s prices, and financial impact.

RESULTS: Between 2019 and 2021, 221 SPA have been established, with a constant average around 70 SPA per year and an average period of 155 days [1 – 934]. The SPA included 75% of generics and affected mainly oral solid forms except in 2020. This rise in 2020 provides primarily from injectable medications (45%) used in intensive care units as drugs of nervous system. Indeed, sedative and anesthesic drugs represent 70% of the overcost. The substitute drug price rose on average by 270%. The SPA contracted in 2019 represent an overcost of 1 406 585€ exclusively paid by defaulting holders. This cost has been twofold increase in 2020 (hospital: 3 007 000€ and defaulting holders: 793 000€) and reduced to less than 1 million euros in 2021 (hospital: 432 000€ and defaulting holders: 388 000€), for an annual drug budget of around 1,1 billion euros.

CONCLUSIONS: The covid-19 led to an increase of injectable drug shortages and an important financial impact for the hospital. However, a stabilization of the number of SPA is observed these last years. This can be explained partly by French legislation. Indeed, since 2021, pharmaceutical companies are required to maintain a safety stock for all medicines of major therapeutic interest.