SAN ANTONIO -- Lawmakers are trying to introduce new legislation that would require drug makers to notify the Federal Drug Administration in advance when there may be a shortage of critical drugs.
On any given day, hospitals right here in San Antonio have a list of many drugs that are in short supply. Now one shortage is touching cancer patients and causing life-threatening concerns.
On top of that, pharmacists are seeing outrageous markups on those drugs that typically sell for pocket change.
This drug shortage story is about supply and demand for some, but for Georgina Rodriguez, it's about life and death.
"I just feel so weak all the time, I'm so tired," Rodriguez said. She was diagnosed with leukemia 73 days ago. As if that weren't enough, her first treatment was delayed due to a shortage of the cancer-fighting drug, cytarabine.
"Within a few weeks I have to have it again, but I'm scared because there's a shortage," Rodriguez said. "What if I don't have it anymore? What am I going to do?
Doctors are doing what they can to help.
"What we do is try to is scrounge among all the pharmacists and all the hospitals in the city and try to calculate how much is remaining so we can ration it," Dr. Swaminathan Padmanabhan said. "We even use the last drop."
Dr. Padmanabhan at the Cancer Therapy & Research Center in San Antonio said someone should have seen this shortage coming.
"I don't think this should happen in the United States," he said. "We line up four or five people, so we can give them one after the other. So we have to do a lot of rethinking and creative ways of getting around this shortage."
While Dr. Padmanabhan would like to focus on practicing clinical medicine, he's often too busy, worried about logistics and planning. Now patients are feeling the pinch.
"I had to send a patient to Mexico, because in Mexico right across the border there's no shortage," Padmanabhan said. "The demand for cytarabine is high. There are only three makers in the U.S."
Two of the manufacturers report various production difficulties and the third company can't keep up. There are efforts underway to import the drug from another country, but that can't happen fast enough.
Celia Adams was diagnosed with leukemia last September. She's been waiting for two months to get one final life-saving treatment.
Only this drug can cure her; without it there is no cure. Doctors say she's been waiting too long.
"I feel at this point like my life is on hold. It's very frustrating," Adams said. "We shouldn't be put through this at all, myself and anyone in this situation."
Cytarabine has been around for more than 40 years. It's now a generic drug, but hospitals are paying almost $1,000 for a vial of 2 grams that would normally cost $15.
"These are things we simply either don't have or we have such a limited amount," said Mark Richerson, director of pharmacy at Christus Santa Rosa Health Care. "Even if one of our sister facilities asked for it we really couldn't give it to them."
Richerson says this is unprecedented and would not have happened 25 years ago.
Over the last two years he's seen a 300 percent increase in drug shortages and drug recalls. He says it seems things will only get worse.
"It's a question of safety -- public health and welfare," Richerson said.
Those third party wholesalers are part of what's called the gray market. They take advantage of the perfect storm by stockpiling the drugs and selling them for a high price.
"It's a free market so they can charge whatever it is they want," Richerson said. "It may be legal, is it ethical? We need to open up so there's more visibility to know what is this market? What is this process so that we can assure that the supply chain the quality of the products are there."
Pharmacies at hospitals do their best to manage drugs on the short supply list. News of a shortage should never reach the doctor and certainly not the patient.
"We're limping along doing what I think prudent folks do," Richerson said. "We try to make sure we use them judiciously. We try to use them in a way in which we eliminate any waste that can be avoided."
The FDA is in constant communication with the three companies that make cytarabine. A spokesperson says a light can be seen at the end of the tunnel.
"I don't think we deserve to die, because that's what we're doing," Georgina Rodriguez said. "We don't deserve to die just because of a medicine. We should all have the same price for the medication."
While the gray market is unofficial, it is legal. Only the Federal Trade Commission can put a stop the skyrocketing prices seen when certain drugs are hard to reach.