Most of us never have to think about where our medicines come from, or worry that they might not be available when we need them.
The biggest inconvenience that we are likely to experience is the five or ten minutes that a pharmacist needs to prepare our prescription.
But in the last 18 months, thousands of NHS patients have been hit by some of the worst drug shortages ever registered in the UK – affecting everything from migraine pills to hormone replacement therapy.
Over the past 18 months, thousands of NHS patients have been hit by some of the worst drug shortages ever registered in the UK – affecting everything from migraine pills to hormonal replacement therapy
It is inevitable that Britain's impending exit from the EU has taken much of the blame. More border controls will, according to some, interrupt the flow of medicines from Europe. But is Brexit the real reason for the current pressure on medicines?
According to insiders in the pharmaceutical industry and healthcare experts, this is far from true. In fact something very ominous is playing. An exclusive study by The Mail on Sunday has yielded reports suggesting that drug wholesalers have deliberately withheld inventory. Why? A deeply cynical bid to raise prices, forcing NHS-funded pharmacies to pay hundreds of millions while patients are confronted for months on end without potentially life-saving pills.
A high-ranking source at one pharmaceutical company, who chose to remain anonymous, said: "It is not uncommon for wholesalers to withhold medication until the NHS agrees to pay a higher price for it. Then they suddenly have unlimited stocks. Pharmacists often complain about it. "With £ 17 billion in medicines that are already needed to keep Britain healthy, how can the NHS pay the extra money?
HRT plasters can run out within a few weeks
The shortage of common medicines has doubled since the end of last year. In October 2018 there were 45 scarce, but today this number stands at around 100, according to Health Minister Seema Kennedy.
Drugs that have attracted the most attention are hormone replacement therapy products, the life-changing treatment used by one million women every year.
Pharmacies are expected to no longer have Evorel skin patches in the coming weeks, one of the most commonly used medications.
Drugs that have attracted the most attention are hormone replacement therapy products, the life-changing treatment used by one million women every year
Makers Janssen says it is currently unable to deliver delivery data, but the deficits are expected to persist until mid-2020.
Another frequently reported deficiency is that of auto-injector adrenaline shooting for people with severe allergies. The shortage is in the most popular brand, EpiPen, which 250,000 patients trust. Pharmaceutical giant Mylan says production problems mean that it cannot meet all the needs of the UK.
The demand for rival brands has increased enormously, so that stocks are still depleted. Today, leading EpiPen manufacturers cannot meet the demand for devices with larger doses of 500 mg, putting thousands at risk.
There have been similar problems with amlodipine high blood pressure, candesartan for heart disease, anti-inflammatory drugs such as naproxen, sumatriptan for migraine and citalopram for anxiety and depression. So what's the matter?
Prices shoot with 7,000 percent
For brand-name medicines, such as Evorel and EpiPen, the problem is indeed one of the circumstances.
Chinese suppliers have encountered difficulties in making the glue used in HRT patches, and Meridian Medical Technologies, which makes EpiPen, is experiencing manufacturing problems.
However, the shortage of some branded medicines has boosted the demand for alternative, unbranded medicines that are exactly the same but cheaper. It is these generic drugs that have a more troubling problem.
About 85 percent of the drugs that are distributed on the NHS are now generic – GPs are actively encouraged to switch branded products to save money. And, like all medicines, the NHS pharmacists reimburse these when they order from wholesalers. Last year, the National Audit Office revealed shocking price increases for common generic drugs – some had risen by more than 7,000 percent in two years. It is intriguing that the NAO report found "a direct relationship" between price increases and the shortage of medicines.
According to some pharmacists, these shortages disappear miraculously as soon as the NHS has agreed to reimburse the eye water price
According to some pharmacists, these shortages disappear miraculously as soon as the NHS has agreed to reimburse them for the eye-water price.
A pharmacist who works in London said, "Medicines disappear and magically reappear once the price has risen dramatically."
Even wholesalers admit that this is the case. Rajiv Shah, director of pharmacy wholesalers Sigma Pharmaceuticals, told the journal Chemist + Druggist: "Contractors have reported that other wholesalers have drugs in stock to raise the price. Then miraculously when the NHS agrees with increased prices … wholesalers (start) telling them: "Stock is now available."
Pharmacists say they have had to reject patients because they cannot afford to buy drugs at the prices charged.
There is often a long wait before they are reimbursed by the NHS, which means that they will not be able to buy the medication in the meantime.
Increases cost the NHS an additional £ 315 million
When a pharmacy buys medicines from a wholesaler, this is reimbursed by the government through a system called the drug rate. It states exactly how many pharmacists can claim for medicines that they have delivered to patients.
If a wholesaler demands more than this amount, the pharmacy can request more money. Until the summer of 2017, the average number of monthly requests for extra cash was around 150. By the end of that year, it was nearly 3,000 requests per month for nearly 100 different medicines.
As a result, the number of concessions granted by the government has more than tripled.
Who pays for our pills?
Drug manufacturers sell drugs to the 2,000 wholesalers in the UK, who in turn sell them to pharmacies and hospitals.
The prescription costs that are paid by patients go to the NHS.
Sometimes it only covers a fraction of the total costs. The part of the prescription that the pharmacist keeps will then act as an invoice. It is sent to the NHS by the pharmacy or hospital and the costs are reimbursed. The amount depends on the amount agreed in the government rates document.
This contains the prices that the NHS pays for each prescription of each medicine. If the stated amount is lower than the wholesale demand, the NHS may agree to temporarily reimburse the higher price.
The NAO said the increase was unprecedented and the Health Service cost an additional £ 315 million in 2017-2018, leaving many local health authorities in the red.
In its report, the NAO said: "The margin between the purchase and selling prices of wholesalers has unexpectedly increased. The Ministry of Health and Social Care could not fully explain the reasons for the increase in wholesalers' margins and the NHS will not be able to recoup these expenses. "It also noted that the price increases were drastically greater than those of the wholesaler manufacturer. And it warned that" price manipulation "and" collusion "among the 2,000 drug suppliers could not be excluded.
Since 2016, the Competition and Markets Authority has attracted three pharmaceutical companies due to unfair price increases. One concerned a company called Concordia, which increased the price of liothyronine – a drug used to treat slow-acting thyroids – by 6,000 percent in the ten years to 2017.
Another case concerned Accord Healthcare (now called Actavis), a company that supplied the NHS hydrocortisone tablets to treat adrenal problems. Prices for small doses of the drug increased by an astounding 12,000 percent over the eight-year period to April 2016 – an increase that the government referred to as "excessive and unfair."
The Healthcare Distribution Association, which represents drug wholesalers in the UK, recognizes that drug distributors are required by law to ensure appropriate and continuous delivery of medicines to pharmacies.
Executive Director Martin Sawer estimates that generic drugs save the NHS around £ 100 million a year. But he says "prices will fluctuate" and refers to the supply chain of these essential drugs as "a commodity market."
Life-saving medicines are now unaffordable
Organizations representing pharmacists are annoyed. Ravi Sharma, the director of England at the Royal Pharmaceutical Society, says that hundreds of community pharmacists are struggling: "I work in a pharmacy and spend at least one or two hours every day solving problems in the supply chain.
"It takes a lot of time to help patients."
And GP Farah Jameel, who prescribes the head for the British Medical Association, says the problem has undoubtedly worsened in recent years. She says: "I have definitely noticed an increase in the number of medicines that we are short of. Some, but not all, patients can switch from one drug to another that works in a similar way. But this requires time and resources, which raises additional questions for doctors and pharmacists. & # 39;
Several pharmacists say they should ration medication. The Committee for Pharmaceutical Negotiation Services says it receives an unprecedented number of calls from pharmacists who are unable to pay for or locate certain life-saving medicines, and wants drug suppliers to explain why
Several pharmacists say they should ration medication. The Committee for Pharmaceutical Negotiation Services says it receives an unprecedented number of calls from pharmacists who cannot afford or locate certain life-saving medicines, and wants drug suppliers to explain why.
On its website it says: "When pharmacies are unable to purchase products at set prices, they may want to challenge suppliers to explain why their prices are so high." The National Pharmacy Association also asks for answers about why the wholesale rates are & # 39; massively disproportionate & # 39 ;.
Professor Lesley Regan, president of the Royal College of Obstetricians and Gynecologists, wants government intervention.
She says: "We must ensure that these companies are accountable – first give us an explanation of what the problem is and especially the timelines before they are resolved."
When approached for comment, Warwick Smith, of the British Generic Manufacturers & # 39; Association, the body representing all UK drug wholesalers, said: & # 39; Drugs are good like all others. With more than 2,000 companies licensed to distribute medicines, it's hard to oversee them all. & # 39;
The health ministry said, "We have established procedures to deal with drug shortages and we work closely with our partners to help prevent shortages and minimize risks when they occur."
DR ELLIE CANNON: I have never seen such a crisis
My inbox is bursting with e-mails, which almost all ask about medication.
From migraine tablets and blood pressure pills and from analgesic creams to antibiotics for urinary tract infections, the list is endless.
I now also see it in general practice for the first time in a decade.
The only option for GPs is to spend hours researching alternative drugs that are just as effective.
This not only takes valuable time away from our ten minutes with the patient, but it lets them soak without their vital pills. Otherwise they have to settle for an alternative that can cause unpleasant side effects.
Some politicians and stakeholders claim that there have always been shortages, but they are mistaken.
Both myself and my colleagues have never known anything like this.
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