Better communication is needed around why medicine supply issues are happening and when pharmacists can expect them to be resolved, the executive director of the Healthcare Distribution Association (HDA UK) has told The Pharmacist.
Martin Sawer, who leads the organisation representing the interests of large-scale wholesalers and distributers, also suggested that members of the supply chain should work together to resolve issues and ensure access to medication for patients.
What causes medicine supply issues?
‘Most people in the supply chain probably don't know what the real reason [for shortages] is,’ Mr Sawer said.
He added that this ‘confusion and lack of understanding’ would be ‘particularly difficult and awkward’ for community pharmacists faced with a patient in front of them, or the additional workload of finding an alternative.
‘Manufacturers of medicines in the UK have an obligation as a MAH [Marketing Authorisation Holder] to maintain a continuous supply of medicines into the UK, if they’re able to do that,’ Mr Sawer said.
But he told The Pharmacist that problems at various points of the supply chain – including production, regulatory and financial issues – could ‘get in the way’ of this continuous supply of medicines to patients.
‘There could be a batch release failure. There could be issues in the production,’ Mr Sawer suggested.
In particular, he said that there had been challenges with the production of active pharmaceutical ingredients in China and India since the Covid-19 pandemic.
‘Therefore, products sometimes aren't being produced in the volumes they used to be, or they might get delayed,’ Mr Sawer suggested.
He also cited issues such as container shipping problems and missed delivery slots to wholesalers.
‘There's just a myriad of issues. You can't always anticipate what they're going to be,’ he said.
And there are ‘a whole load of things that have to be in sync’, he added.
He also said that the global nature of the medicines market could sometimes mean that ‘there's not enough produced for the UK’.
‘There might be less generics of a particular molecule available because some manufacturers have decided they're going to lose money by putting products into the UK,’ he suggested, citing issues such as Brexit, the pound exchange rate, low reimbursement rates or high VPAS rebates.
An increase in the voluntary scheme for branded medicines pricing and access (VPAS) payments this year sees manufacturers of branded medicines, including branded generics, returning 26.5% of their revenue to the government.
The British Generic Manufacturers Association (BGMA) recently termed this rate ‘crippling’ and warned that it could cause manufacturers of branded generics and biosimilars to withdraw their products from the market and discourage any new launches.
Mr Sawer also suggested that sometimes medicinal products could ‘move sideways’ between wholesalers, rather than being supplied directly to community pharmacies.
‘They will eventually end up with dispensers and pharmacies, but not necessarily in good time,’ he said.
And he called for tighter controls to avoid this issue.
‘As HDA, we would like to see more of an obligation on the supply chain, where there are supply issues, making sure that the product gets down to dispensing level and patient level more speedily,’ he said.
And he added that HDA full-service wholesaler members tended to only keep 10 days worth of stock, supplying it quickly to dispensers.
And where they do have to implement caps on how much a community pharmacy can order, ‘that’s because they just haven't got enough stock to go around,’ he said.
Surges in demand also caused supply shortages, especially when these were unexpected, Mr Sawer said.
For example, he said that when the prescribing threshold was lowered for Strep A antibiotics in November last year, manufacturers and wholesalers ‘weren’t told about it’.
He said that medicine suppliers were not regularly included in conversations about prescribing priorities, which could also sometimes cause problems.
How could suppliers communicate better when shortages occur?
Mr Sawer called for suppliers to be clearer with community pharmacies about the reasons for medicines shortages.
‘I just think the pharmacist needs to know more quickly why they haven’t got a product and when it might next be in,’ he said.
He added: ‘At the moment with the noise and concern [around medicines shortages], and pharmacists on the frontline having to deal with patients, the supply chain should try to improve [communication]; we would aim to try and improve communication [about supply issues].’
He noted that manufacturers and wholesalers do not always know with certainty when an issue might be resolved, but stressed it was the ‘responsibility for those involved in the supply chain to do their very best to try and help the patient’.
It was his view that manufacturers, wholesalers and pharmacy organisations should ‘think about sitting down together’ and try to ‘gently work out: what would help the dispensers and the patients?’
He added that the HDA was in the process of working out its own set of principles on what could help pharmacies manage supply chain issues, alongside pharmacy bodies including Community Pharmacy England (CPE).
‘I think for the sake of patients, we should try to calmly come up, if possible, with a simple communication system that gives pharmacy a bit more confidence when they're talking to patients, and they're not operating too much in the dark, as unfortunately, they seem to be too much at the moment,’ Mr Sawer added.