Medicines shortages: BGMA recommends reviewing pharmacy reimbursement levels

To mitigate the impact of medicines shortages, the BGMA suggests allowing more substitutions in pharmacies as supply issues arise

The British Generic Manufacturers Association (BGMA), the trade body for off-patent medicines, has made several recommendations to alleviate medicine shortages, which not only have serious consequences for patients but also increase workloads for pharmacists.

England is currently experiencing twice as many medicine shortages as it did two years ago, with some products remaining out of stock for many months, the BGMA reveals in a report, noting that “the vast majority are commonly used generic medicines.”

“We have witnessed the number of products facing supply challenges double in the past two years and remain at a high level since September 2023,” says BGMA chief executive Mark Samuels.

In its report titled ‘Solutions to UK medicines shortages’ published on 1 October 2024, the BGMA proposes policy changes to tackle medicine shortages, including incorporating supply chain resilience and past performance in hospital medicines tenders.

“Tender scoring should include whether supply issues were reported with adequate notice. Suppliers should be informed of changes in prescribing more quickly,” the report says.

The trade body also recommends extending lead times to at least 20 weeks from contract award to the start date as “medicine manufacturing now takes half a year.”

The BGMA report highlights that there is currently no commitment from the NHS to buy in hospital medicines tenders and suggests piloting “a commitment to purchase for key lines or those with persistent supply problems.”

The BGMA also calls for reviewing pharmacy reimbursement levels, noting that “CPI inflation has risen 24 per cent since the current deal was agreed in 2019.”

Additionally, it encourages suppliers to review their dormant UK licences in areas of reduced supply resilience through identification of lines and quick re-establishment of licences.

Other recommendations include extending product shelf life to reduce wastage, avoiding country-specific stockpiling to maintain flexibility in supply distribution, and using public funds to support domestic manufacturing.

To mitigate the impact of future shortages, the BGMA recommends allowing more substitutions in pharmacies as supply issues become apparent and fast-tracking approval for necessary changes to improve the supply chain and delivery (e.g., additional API sources, changes in pack sizes)."

As forward-looking solutions, the trade body recommends reviewing the impact of the 2024 Voluntary Scheme for Branded Medicines Pricing, Access, and Growth (VPAG) on supply issues and its payment percentage levels on supply issues.

Furthermore, it encourages trade associations to host workshops, with government and NHS support, to enhance industry understanding of future trends in demand for specified treatments.

It emphasises the need to promote self-care and discourage patient overordering, which would require government, NHS, and industry to work together.

Future areas of focus should also include improving communication of potential or actual shortages from suppliers to DHSC/NHSE in a timelier way.

The BGMA also suggests establishing an annual national 'health check' roundtable among stakeholders to assess supply chain performance and horizon-scan the next.

Mark Samuels notes that while some of these proposed actions are longer term, many could be put in place almost immediately.

“These practical recommendations can be the basis for improvement and a means for accelerating change,” he adds.

Due to the rising number of medicines facing supply issues, many patients in the UK are finding it difficult to access the treatments they need.

A recent public poll commissioned by the BGMA showed that of all adults who have had a prescription in the past two years, 49 per cent experienced some form of shortage or delay while trying to access medicines. Of those impacted, one in six went without their medicine altogether.