NCSD Releases First Known Survey of the Bicillin L-A Shortage Impact on Clinics

Contact: Elizabeth Finley, efinley@ncsddc.org, 919-749-7309

The National Coalition of STD Directors (NCSD), the association representing state and local health department sexually transmitted disease (STD) directors and staff, has conducted the first known survey on sexual health clinics’ experience of the worsening Bicillin L-A shortage.

The survey of more than 100 sexual health clinics is the first attempt to gather information on the scope of the shortage and demonstrates the urgent need for federal leadership to help clinics and other healthcare providers navigate the shortage.

Bicillin L-A Shortage Severity Survey Findings
August 16, 2023 – September 1, 2023

STI clinics are on the front lines of a worsening syphilis epidemic.

• 83% of clinics saw at least one patient for syphilis treatment or screening each day in the past three months.
• Collectively, these clinics estimate seeing more than 1,400 patients for syphilis treatment or screening each day.

The Bicillin L-A shortage is having a widespread and direct impact on sexual health clinics getting the drug they need for patient care.

• In the previous three months, 40% of clinics have attempted to order Bicillin L-A, but the drug was not available.
  • Unfilled orders are not a one-time occurrence. Two-thirds of clinics with unfilled orders have had their orders left unfilled 75% of the time.
• Pfizer has advised clinics that they may only receive partial shipments during the shortage. However, 72% of partial orders included less than half of the quantity of Bicillin L-A doses the clinic needed.

The shortage of Bicillin L-A is delaying or worsening patient care.

• 28% of clinics have already had to obtain Bicillin L-A from a nearby clinic or refer patients elsewhere, which delays treatment. Some clinics have also received patients referred by other clinics.

Stronger federal coordination on the Bicillin L-A shortage is needed to ensure clinics have adequate support and information to prioritize pregnant patients and provide adequate care to other patients in accordance with CDC guidelines.

• Only 58% of clinics have begun prioritizing Bicillin L-A for pregnant patients—in accordance with CDC guidelines for a Bicillin L-A shortage.
• In order to prioritize pregnant patients, clinics have been forced to use alternative treatments for others.
  • Clinics named additional negative consequences for patients receiving alternative treatments to Bicillin L-A, including difficulty covering costs, drug side effects, and the risk of not finishing a full course of treatment.
• “Outside providers and hospitals send their pregnant patients to us to start or complete treatment. Since we see more pregnant patients with syphilis than other clinics, I am worried about running out of Bicillin L-A.”

The shortage of Bicillin L-A is impacting clinic operations.

• 36% of clinics say the shortage has increased the time they must spend on administrative tasks like attempting to order Bicillin L-A.
• 33% of clinics have increased the amount of time they spend on patient follow-up.
• 30% of clinics have increased the amount of time they spend with syphilis patients.
• “We have spent a significantly greater amount of time finding alternative treatment at an affordable cost for each patient, we have to work with several pharmacies, find insurance co-pays and out of pocket amounts…”
• “We can provide [fewer] essential services. Our team provides all of the investigation for the county and region, so it has hindered a lot of our operations.”

About the Survey
The Bicillin Shortage Clinic Survey was conducted on August 16-September 1, 2023 and included categorical STI clinics, FQHCs, reproductive health clinics, AIDS service organizations, primary care providers, and other providers of STI clinical care.

Bicillin L-A is the only treatment for syphilis in pregnant people and the first-line treatment for nearly all syphilis patients. The Bicillin L-A shortage has seriously reduced the nation’s ability to stem the explosive growth of congenital syphilis, which rose 32% in 2021. Pfizer, the exclusive manufacturer of Bicillin L-A, estimates that it will not be able to supply enough Bicillin L-A to meet the nation’s needs until Q2 of 2024, at which point the shortage will have lasted for more than a year.

 Download the survey