The UK risks continuing shortages if it does not pay more for its medicines, Community Pharmacy England (CPE) director of pharmacy funding Mike Dent has warned.

In a parliamentary inquiry into pharmacy yesterday, Mr Dent told MPs that the low cost of medicines in the UK made it a low priority for global manufacturers when shortages did occur.

And he suggested that the government should be prepared to pay more for drugs if it wanted to ensure security of supply.

Meanwhile the British Generics Manufacturers Association (BGMA) said medicines shortages were ‘double’ what they were last year, and outlined recommendations to improve security of supply.

Mr Dent said that while shortages are caused by multiple issues, he thought the UK ‘will have problems’ if it did not compete sufficiently in the global medicines market.

‘If there is a shortage [globally], we’re not going to be top of the list. Because we are very, very cheap on an international basis,’ Mr Dent told the Health and Social Care Select Committee (HSCC).

He said that the DHSC paid less than £1 for 17% of generics, while around 45% were reimbursed at less than £2.

‘Those products have probably been made in the far east, shipped halfway across the world, have been through pre-wholesale, wholesale, into community pharmacy and given out to a patient for £1,’ he said.

And while the UK offered manufacturers a stable and predictable market, the ‘relentless downward pressure’ put on drug pricing by the community pharmacy procurement system was impacting security of supply, he suggested.

‘It feels like an addiction to cheap medicines to me, and I personally would prefer to feel like we had more medicine security – that if this is the NHS’s primary means of treating people, we need to take them seriously and accept that that costs money,’ Mr Dent told MPs.

He suggested that a solution might need to be ‘a combination of UK manufacturing, possibly stockpiling, possibly paying more [and] being seen as a better place to do business’.

Medicines shortages have ‘doubled’ since last year

The committee also heard from manufacturer representatives at the BGMA and the Association of the British Pharmaceutical Industry (ABPI).

Mark Samuels, chief executive of the BGMA, told the committee that medicines shortages were ‘around double what they were a year ago’, with 101 shortages already recorded this month.

And in written evidence submitted to the inquiry, he said medicines shortages were ‘among the top items of some integrated care boards’ risk registers’.

He also suggested that ‘on a strategic level, falling resilience within the supply chain has been worsened because the generic and biosimilar market has not been a priority for government despite the huge reliance the NHS has on these medicines’. This sentiment was also summarised by HSCC chair Steve Brine, who is also the MP for Winchester.

Both Mr Samuels and Dr Rick Greville, the director of distribution and supply at the ABPI, highlighted issues with delays at the Medicines and Healthcare products Regulatory Agency (MHRA).

‘It now takes between 24 and 30 months to licence a new generic drug,’ Mr Samuels told the committee.

‘That is wildly unacceptable. It should only be 12 months. It used to be 12 to 15 months, it must return to that,’ he said.

He suggested that retaining staff and their  knowledge at the MHRA could be critical to solving delays, highlighting that the agency lost 20% of its budget when it lost European funding, and lost ‘experienced staff’ when it downsized.

Domestic manufacturing that prioritises supply chain resilience and includes both innovative and everyday generics drugs should also be considered, Mr Samuels said.

He suggested that the UK could learn from India’s example of having a special economic zone for generic manufacturing.

While Dr Greville said that the ‘global nature of the supply chain’ must be recognised.

Ensuring there are ‘very few disruptions to the movement of medicines around the world’ was ‘absolutely critical for maintaining a supplier resilience to the UK’, added Dr Greville.

‘In many ways we see that as equally if not more important than the onshoring of specific manufacturing to the UK,’ he said.

Both Mr Samuels and Dr Greville highlighted challenges with the Voluntary Scheme for Branded Medicines Pricing, Access and Growth (VPAG) that requires manufacturers to pay a rebate to the UK Government.

Mr Samuels said that one branded generics manufacturer had found the VPAS payment made their breast cancer drug ‘loss making’, and eventually had to ‘withdraw the drug from the UK because they just couldn't supply to us at a loss for any longer’.

Meanwhile Dr Greville said that the APBI saw the VPAG as ‘an untested scheme’.

But he said there was a mechanism within the agreement to raise exemptions ‘if some medicines are found to be unviable under the current VPAG’ for supply to the UK.

'Hidden cost' of shortages not recognised

The Health and Social Care Select Committee Inquiry heard that shortages, particularly those of GLP1-RAs, were impacting patients.

Diabetes UK head of policy campaigns and mobilisation Helen Kirrane said that medical issues resulting from medicines shortages could also ‘develop over time’.

Those giving oral evidence to the committee also described the impact that shortages were having on clinicians’ time.

Ms Kirrane said that shortages of GLP1 RAs meant that ‘individuals might need to spend a lot more time with clinicians reviewing alternative courses of treatment’, and clinicians would need to take time ‘to initiate patients on new treatments’.

This was ‘all taking away time for people being able to access their regular routine care which, over the last couple of years, has still been really piecemeal across the country and very hard for many people to access’, she added.

Meanwhile, CPE chief executive Janet Morrison said she believed ‘we should be making more use of the pharmacists’ skills to be able to allow them to make substitution for alternative appropriate medication or formularies’.

She added this would both ease pressure on GPs, as it would stop patients needing to go back to their prescriber for an alternative prescription, as well as preventing ‘over reliance on one or two products when there's a range of products that would do the same job’.

In addition, Mr Dent said the ‘hidden cost’ of sourcing alternatives on GPs and pharmacists ‘is not measured’ or recognised.

‘It’s not part of the decision making [to do with medicines supply and security] and actually it would be really helpful if it was somehow,’ he said.