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Features
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1/9/2012
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John D'Arcy: Cutting short drugs supply problems
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The current stock shortages are becoming the bane of pharmacists’ life. The current level of shortages is not only leading to frustration but seriously compromising the resilience of the supply chain and putting patient care at risk, says Numark managing director John D'Arcy...
Whilst any supply chain will suffer from periodic shortages, the current difficulties are exacerbated by the introduction of manufacturer-led Direct to Pharmacy (DtP) and Reduced Wholesaler (RW) arrangements in response to a rapidly changing market.
The erosion of manufacturing margin associated with a tightening Prescription Price Regulation Scheme (PPRS), the increasing number of patent expired products and dwindling pipelines of new products is forcing manufacturers into need-to-control costs. At the same time, manufacturers need to deal with the impact of parallel trade on local markets.
Alongside DtP and RW is the “system” of quotas which causes the greatest hassle, frustration and inconvenience for pharmacists in attempting to fulfil their supply obligations. These are imposed unilaterally by manufacturers with no transparency in informing customers the rationale for setting quota levels.
The combined effect of DtP, RW and quotas is to reduce the availability of stock in the market, whilst simultaneously reducing choice and competition. And the consolidation within the manufacturing sector, coupled with the reduction in the number of wholesalers, has reduced the flexibility in the market for dealing with stock shortages.
At a time when pharmacists are being required to do more to enhance patient compliance with prescribed medicine regimes, they are instead being forced into wasting precious time in sourcing products in short supply. As a consequence, the NHS (and the taxpayer) ends up paying for medicines that are wasted and we lose out on the wider objectives of NHS policy.
Difficulties
Patients are having to make more visits to a pharmacy for owings and pharmacists are spending more time explaining to patients, and prescribers, the difficulties associated with getting hold of affected products.
This undermines both patients’ and prescribers’ confidence in the system. In some cases, prescribers may change the treatment in favour of a product more readily available. This, of course, means patients are being given a second choice of treatment which could in some cases mean a sub-optimal therapy. In extremis, patients may be denied condition critical therapies.
In an attempt to solve the problem, supply chain stakeholders have developed practical and sensible guidance toward a solution. But the general perception is that things have, if anything, got worse since its publication suggesting that behaviour has not changed, or if it has, not to the extent that makes any difference. More, therefore, needs to be done to highlight the guidance and the importance of it in dealing with stock issues, to affected parties.
If the guidance cannot solve it, more drastic action is needed. The most obvious solution would be a straightforward requirement on manufacturers to supply sufficient stock to meet the demand in the market.
The next step might be to consider putting some of the key requirements of the Guidance onto a regulatory footing. As part of this, the export of “vital” medicines for critical/life maintaining conditions could be made illegal.
Such an approach has, however, to be considered in the context of governments' cutting “red tape” agenda and is likely to offend the European competition regime. A highlight of the guidance is the requirement that, under normal circumstances, pharmacists should receive medicines within 24 hours.
This should continue to be the goal and this should be monitored in practice on a product by product basis to assess how supplies of these products is matching up to this benchmark. Where the target is being missed, an obligation should be placed on manufacturers to release more stock.
It is likely that the problem will ease in time. Over the next few years, the patents on a significant number of branded products will expire and the branded product will be superseded by a generic equivalent. This will ease stock shortage issues with affected products.
In the meantime, however, pharmacists and patients have to put up with a system that is prejudicing pharmacists’ ability to fulfil their supply obligations and compromising patient care.
What are your thoughts on John D'Arcy's views? Email neil@pharmacy.biz with your opinions to the editor.
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