Table 1.

Recommended strategies to mitigate drug shortages, avoid medication misallocation, and ensure the long-term quality and security of medicines

Strategy	Description
Strategies to ensure the adequate pharmaceutical supply and improve the long-term quality and security of medicines	•Consider medicines and their components as a strategic asset instead of a commodity •Improve tracking and forecasting of the antimicrobial supply chain •Create an Essential to National Security drug supply list that includes medications for which a supply interruption could cause an immediate risk to public health •Provide economic and policy incentives for the immediate restitution of pharmaceutical manufacturing capability to the nation •Strengthen the government oversight of drug manufacturers and overseas facilities •Improve testing of imported medications •Establish and maintain certain vulnerable pharmaceutical agents within the strategic national stockpile •Improve inventory management along supply chains
Strategies to mitigate drug shortages and avoid medication misallocation recommended by THRF-TAPO, Taiwan FDA, and Taiwan pharmacist professionals and associations	• For governmental agencies: - Establish appeal and referral pathways for patients who cannot fill the prescriptions - Establish the reporting and counseling system for adverse effects resulting from alternative drugs or therapeutics - Display a warning for medications being of a shortage concern on i-Cloud/electronic prescription records to inform clinicians and pharmacists - Implement a real-time, open tracking system for the supply-demand status to timely adjust distribution and allocation of medications - Reinforce the audit procedure to ensure the supply-demand balance of medications - Broaden the supply chains of essential medicines instead of having the pharmaceutical industry be dependent on only 1 or 2 countries - Increase domestic production of medicines to protect the supply chain and product availability from unpredictable global crisis events - Continue refining pharmaceutical administration and laws to perfect the systems of the distribution, allocation and dispensing of medications •For pharmaceutical companies: Recognize and strictly follow the rational drug allocation guidelines issued by Taiwan FDA •For hospital pharmacies: Avoid excess stockpiles of medications and serve as the satellite pharmacies between pharmaceutical companies and community pharmacies to enhance sufficient medications allocated to community pharmacies •For pharmacists and their associations: Step up to the plate and work more closely with relevant stakeholders to address misallocation of medications

Abbreviations used: THRF, Taiwan Healthcare Reform Foundation; TAPO, Taiwan Alliance of Patients’ Organizations; FDA, Food and Drug Administration.