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Nearly a third of U.S. hospital pharmacists say they were forced to ration, delay or cancel treatments as drug shortages in the United States approach an all-time high, according to a survey released on Thursday.

The shortages are especially critical for chemotherapy drugs used in cancer treatment regimens, with more than half of the 1,123 surveyed saying they had to limit the use of such treatments.

The survey was conducted between June 23 and July 14 by the American Society of Health-System Pharmacists (ASHP), an association which represents more than 60,000 pharmacists and technicians.

The drugs in shortage include vital therapies such as steroids, cancer treatments and antibiotics.

According to the survey, while spikes in demand cause short-term scarcity such as for diabetes drug Ozempic, most severe and persistent shortages are driven by economic factors including extreme price competition among generic drugmakers.

“Purchasing at the cheapest price has led to a race to the bottom, which has basically disincentivized any investment in quality and manufacturing,” said Michael Ganio, senior director of pharmacy practice and quality at ASHP.

The number of U.S. drugs in shortfall – at 309 by the end of the second quarter – is already near a 10-year peak, according to the association, compared with an all-time high of 320 drugs.

“In some cases, there are no alternatives to the affected drugs, which puts patients at risk. This issue requires quick action from Congress to address the underlying causes of shortages,” said ASHP CEO Paul Abramowitz.

In June, the U.S. Food and Drug Administration (FDA) said it was seeking new suppliers to ease shortages of methotrexate, one of the most commonly used cancer drugs, building on its push to shore up two other scarce chemotherapy medicines. 

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