Frustration over gray-market drugs lingers throughout nation.

A lthough President Obama issued an executive order last October directing federal agencies to deal with the ongoing drug shortage and to look into the price gouging taking place in the so-called gray market ( see J. Natl. Cancer Inst. online Jan. 23, 2012), frustration continues to build among oncology professionals trying to meet patients ’ needs. Meanwhile, little coordination seems to exist among federal agencies ( see sidebar). JNCI interviewed various pharmacists, oncologists, and cancer center directors about their experiences with the drug shortage and the gray market. Although anecdotal and not necessarily representative of all situations, these interviews provide selective snapshots of the diffi culties of obtaining drugs in short supply. One such expert is David B. Wilson, R.Ph., oncology pharmacy manager and oncology pharmacy residency director for St. Luke ’ s Mountain States Tumor Institute, which consists of seven nonprofi t hospitals in Idaho and is part of the NCI Community Cancer Center Program. As a Disproportionate Share Hospital, the institute is eligible to purchase medications at the same cost as government entities, such as the Veterans Administration. Wilson said the ongoing drug shortage is routinely discussed with St. Luke ’ s purchasing group and executive leadership, and he has found that manufacturers have been trying to stop the shortage and meet patient demand. “When we are getting down to our last few days ’ supply of cisplatin, leucovorin, or Taxol [paclitaxel] and are faced with having to start calling patients and cancel their appointments, we contact the manufacturers, and they ’ ve been able to come through for us.” Wilson said that for ordering by computer, the drug may be listed as on backorder, but following through with contacts can often help uncover a stash to meet patients ’ needs. He recalls that the hospital ’ s purchasing agent had once been contacted by a gray-market distributor offering paclitaxel at 10 times the market cost, but St. Luke ’ s decided not to buy it because the drug ’ s pedigree could not be established. George W. Sledge, M.D., BallveLantero Professor of Oncology and professor of medicine and pathology at Indiana University ’ s Simon Cancer Center and immediate past president of the American Society of Clinical Oncology, told JNCI during the recent San Antonio Breast Cancer Symposium that he had been successfully treating a metastatic breast cancer patient with liposomal doxorubicin (Doxil). “It was the only drug that was keeping her in remission, and then one day I had to tell her that the drug was no longer available,” he said, adding that he actu ally had received a call from his insti tution ’ s pharmacist while in San Antonio to let him know that a single dose had been located. Sledge admitted that he had no idea about the drug ’ s cost but was glad to have it for his patient.