IV BRIEFING: Emergency Preparedness Coordinating Council January 18, 2018

IV fluids Issues Product lines impacted Product shortages and allocations are expected to continue for the next several months At a minimum, the next several weeks are critical, as manufacturing plants come back online Inventories are expected to begin to recover but are fragile Product availability changes from week to week and must be closely managed IV fluids (sodium chloride, dextrose, lactated ringers) Nutritional products (amino acids) Medication delivery (mini-bags, compounding bags) Large-volume irrigation fluids in bags Evacuated containers

IV Market Dynamics IV inventory levels remain very tight related to market consolidation Baxter plant maintenance shutdown deferred to Spring quality controls and FDA requirements production lines being shifted to meet critical demand recent natural disasters creates other temporary shortages (Braun and Baxter) Puerto Rico (Hurricane Maria) – Baxter – mini-bags and amino acids product allocations by manufacturers to committed customers in order to protect/manage inventory Mexico (earthquake) - Baxter sets California (wild fires) – Braun – all products - logistics planned plant maintenance resulted in a recent two-week shutdown (Braun) flu is now widespread (U.S. and NYS)

NYS Flu Report Source: health.ny.gov

NYS Flu Report Source: health.ny.gov

U.S. Flu Report Source: cdc.gov

Key Activities Regular updates and communications to C-suite/Supply Chain/Rx Advocacy efforts – FDA Office of Drug Shortages and Congress Regular meeting with FDA IV education and knowledge-sharing forum Letters to the FDA Create awareness of current shortages and impact Market overview Support for importation of product that meets U.S. standards (Baxter=Ireland, Australia) Conservation and Supply Chain strategies Accelerated review/approval Best practice networking forum Weekly status updates to monitor situation and provide member feedback

What can you do? Hospitals are strongly advised to develop proactive communication and education to leadership, nursing, medical staff, etc. hold regular meetings to review IV needs/delivery projections to develop/implement contingency plans. Meetings should include the following: create conservation strategies where clinically appropriate Hospital (Supply Chain, Rx, Nursing, etc.) develop alternative clinical therapies/approaches and substitute products Manufacturers Distributors Order full allocations implement centralized inventory control methods for critical products

Questions Jay Fligstein Sr. Vice President Acurity, Inc. O: (212) 258-5316 | C: (646) 831-1493 jfligstein@acurity.com www.acurity.com