EpiPen auto-injectors are used in emergencies to treat serious allergic reactions.

Channel 5 News on Wednesday claimed that “some pharmacies” in England were refusing to dispense ‘adrenaline pens’ citing a national shortage.

Following the news, Pharmacy Business on Thursday reached out to pharmacy bodies as well as a number of pharmacists across England.

Director of Pharmacy Funding at the PSNC, Mike Dent, in response, said: “Community pharmacies’ terms of service requires them to dispense medicines in a timely manner, but supply issues may hinder their efforts to do so.

“In the event of shortages, pharmacy teams will work hard to try and obtain medicines by making numerous calls to different suppliers, staged dispensing, or liaising with other local pharmacies to see if they have stock. In some circumstances they may also need to refer the patient back to the prescriber to find an alternative product to ensure they receive treatment as quickly as possible.”

An NPA spokesperson told Pharmacy Business: “Pharmacists do a great job under difficult circumstances to get people the medicines they need when and where they need them.

“The reality is that most pharmacies go to great lengths to supply patients promptly, including auto-adrenaline injectors.

“It’s distressing for patients when they find it hard to get hold of life-saving medicines such as these.

“The NPA has issued a reminder to our members about the procedure to follow to obtain EpiPens when they are otherwise out of stock.”

Pharmacies care about patients

A superintendent pharmacist in South West told Pharmacy Business this could not be viewed as pharmacies not caring but more likely as a pharmacy not being able to cope with the workload pressure or knowing how to dispense a device that is in short  supply.

“We always follow the short management information guideline provided by pharmacy bodies such as NPA or PSNC. The issue may be that with so many items experiencing stock issues, colleagues will struggle under the burden of workload pressure to follow set manufacturer protocol and in many cases may not even be aware of the existence of such protocol.

“The stock shortage situations we face daily are unprecedented and with colleagues having to spend up to an hour daily on the phone to try to obtain stock it will not be surprising that what is termed ‘refusal’ may just be ignorance about alternative stock arrangements or lack of the capacity to undertake the time expanded to complete,” he said.

A senior pharmacist in West London agreed and said pharmacists were not refusing the supply.

“Some of the injectors are out of stock from the manufacturers and we don’t really have a good reason from them as to why they keep going out of stock. Or even an expected date when they will be back in stock. There are some available, however, there needs to be a script validation. So we have to send a copy of the prescription to the wholesaler and they will issue only 2 per patient.”

“Pharmacist would never refuse to supply. In fact it’s the manufacturers that need to be questioned, in my opinion!” he added.

Not an issue

A Derbyshire pharmacy manager said he didn’t think it was “really a big issue”.

“We fax over requests to Alliance Healthcare with a copy of the prescription for EpiPen which usually reach us three days later. There does not seem to be a problem with Jext. Not sure about Emerade.”

Another pharmacy lead from Reading agreed and said: “All you need to do is send a redacted prescription to Alliance Healthcare via a special email address ([email protected]) or call 0330100448 and they will pass it on to manufacturers for supply which arrives in a couple of days. It isn’t a problem if a pharmacist really needs the supply.”

He added that if the demand was for Jext or Emerade, his pharmacy team would refer the patient back to the GP surgery for a change of prescription to EpiPen.

Restricted supply

However, a pharmacy manager in North London agreed that she has had difficulties obtaining stock.

“Those patients that were desperate and, as and when stock was available if they had generically prescribed then they were able to source it intermittently. There is SSP (serious shortage protocol) now for this which should elevate any issues and give guidance,” she clarified.

An owner of a large community pharmacy in the South East said: “So facts are: they are on restricted supply. We need prescriptions to be able to order so we are not allowed to stock hold. The prescription is only allowed two devices per prescription. We fax the prescription to Alliance quota team. It then takes 48 hours for them to send the stock. They have had a back log recently so taking a little longer but it does come.”

A spokesperson for Boots UK said: “There continues to be issues with the supply of adrenaline injector pens, and it’s not currently known when this will change. At Boots UK, we do all we can to help our patients get their medicines quickly and easily. Although not all stock is freely available, patients with a script can access prescriptions from their pharmacy via the script validation service for many lines, with a 36-hour turnaround.”

Channel 5 story

Catherine Jones, the health correspondent of 5 News, spoke to a family of three, all allergic to nuts, who were turned away by two chemists. Each must carry two adrenaline pens in case of a severe reaction, her report said.

The mum of two children who desperately need the medication, Annie Simpson, was ‘shocked’ because “I wasn’t asking for paracetamol. I was asking for something that could save their lives.”

For paediatric allergy specialist, Professor Adam Fox, it was not an acceptable situation at all.

“I am very worried that my patients don’t have the access they have to adrenaline auto injectors. Having a risk of anaphylaxis has an enormous impact on quality of life, it causes understandable anxiety.”

An unnecessary anxiety if only the process of dispensing was being followed correctly by all pharmacists, the report said.

Simpson concluded: “It’s very frightening for a lot of families. There is a this total breakdown of communication. And the message isn’t getting through to parents who don’t have EpiPens and chemists who are prescribing them. It’s very dangerous because it’s a life-saving medication.”

5 News investigation

As part of the investigation, Channel 5 News phoned 100 pharmacies, including multiples and independents, asking each pharmacy if they could get hold of two EpiPens. Its straw poll found 30 out of those 100 pharmacies saying they could not supply an EpiPen, with responses ranging from ‘Out of stock everywhere’ to ‘Won’t be able to order any’ and Can’t get EpiPen for toffee’.

Pharmacy Business has seen these responses where 47 out of the 100 pharmacies say they can order and dispense adrenaline auto-injectors (AAIs), while 31 pharmacies responded by saying that they cannot order because the products are out of stock. Twenty-two pharmacies said they were unsure if they would be able to dispense at all.

UK has sufficient supply

However, in a statement issued on Thursday, Department of Health and Social Care said: “Supplies of EpiPen and EpiPen Junior are currently available and all patients who are prescribed a device should be able to obtain one from their pharmacy.

“We continue to work very closely with all the manufacturers of adrenaline auto injectors to ensure supplies remain available in sufficient quantities to support demand.’’

Alliance Healthcare, the sole UK distributor of EpiPen, have told Channel 5 News that “these medicines are currently in stock and are subject to script validation to help manage supply and demand in the market place and ensure patient safety.”

The programme claimed: “It seems many chemists aren’t doing this,” adding “an unnecessary anxiety” could be avoided “if only the process of dispensing was being followed correctly by all pharmacists.”

The report further said that when pharmacists tried to order, AAIs often appeared to be unavailable showing red dots on the computer screen which meant the products were ‘out of stock’. But pharmacists should know to ignore that, the report claimed, adding: “what they should do is take the prescription, cover the details and fax it to the supplier.”

EpiPen manufacturer Mylan maintain that patients can claim two AAIs per prescription through their local pharmacy once the details have been sent to the supplier (Alliance Healthcare).

It added that the company was “in frequent contact with the NPA, who update their system of availability on a weekly basis.”

RPS stand

Stating that medicine shortages had recently become a larger issue, RPS Director of Pharmacy, Robbie Turner, told the programme that “there have been shortages of some of the most commonly prescribed drugs” in country, adding: “A significant number of pharmacists are spending up to two hours a day chasing stock.

“So as a consequence of that they may not know exactly how to get hold of each of those medicine every single time.”

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