Pharmacists and manufacturers continue to accuse each other over persistent UK drugs shortages. But Chris Chapman and Jennifer Richardson think it’s time to focus on solutions and stop the recriminations.

Quotas. A word currently sending chills up the spines of pharmacists around the country. Over the past months contractors have reported increased difficulty obtaining medicines. Out of stocks lists at some pharmacies have extended to three pages, with Arimidex, Zyprexa, Cellcept, Neoral and Keppra being difficult, if not impossible, to obtain.

Manufacturer quotas seem to be the scapegoat when it comes to this drugs drought. But are they the real problem?

Contractors certainly believe so. VJ Mithani, of VSM Pharmacy, Camberley, says quotas are “very detrimental” in a supply situation that’s getting worse day by day. His voice is supported by other community pharmacists around the country. And according to PSNC, independent contractors spend around one hour every day sourcing medicines for patients.

And yet manufacturers insist quotas are a vital element in protecting medicines supply. Nick Francis, head of communications at Eli Lilly, insists that direct-to-pharmacy sales and quotas are the only way manufacturers can ensure the drugs pipeline leads to UK patients.

He says: “If we can see who’s ordering, and where it’s going, we can ensure supply. By entering into arrangements it will give us a visibility of out of stocks.”

Mr Francis says the main reason behind quotas is to prevent parallel exports diverting medicines from the UK supply. He is supported by others in big pharma. The Association of the British Pharmaceutical Industry say 4 per cent of the UK market is being exported abroad. Last week, ABPI commercial director David Fisher told C+D there would be “complete anarchy” if quotas weren’t in place to protect the stream.

And Paul Johnson, of IMS Health, says the ABPI’s comments are supported by evidence. “The level of product manufacturers are putting into the marketplace meets the total UK demand as we measure it, so it does appear to be exports. I would say that quotas have been necessary to protect supply,” he says.

However, parallel exporting is perfectly legal. And according to the British Association of European Pharmaceutical Distributors (BAEPD), overall trade around the EU hasn’t changed. BAEPD secretary-general Richard Freudenberg likens parallel trade within the EU to a balloon: where one area expands, another reduces.

The weak pound has made parallel exports an attractive proposition, while conversely causing the imports market to shrink. Mr Freudenberg says there has been a 40 to 50 per cent fall in a trade that added 60 million packs into the UK market in 2007: creating a current shortfall of 25 to 30m packs.

Grassroots pharmacists have noticed a soar in demand for drugs for export. Amish Patel, of Hodgson Pharmacy in Dartford, says he’s been approached several times by wholesalers with offers to buy drugs so they can be exported.

“We don’t parallel export,” he says, “but I have been approached by a number of companies that ask us ‘can you buy this in?’ and so on – the drugs [manufacturers] put quotas on. So the quotas do protect against parallel exports.”

But is parallel trading too simple an answer for the current shortage? Community Pharmacy Scotland’s Alex MacKinnon points out that parallel trade has gone on for years. He says quotas are definitely the root cause of Scotland’s medicines troubles.

“We don’t believe the level of exporting in Scotland is what’s causing the problem,” he says. “We believe it’s the severity of quotas and the approach taken.”

Perhaps the problem is a combination of the two. Martin Sawer, executive director of the British Association of Pharmaceutical Wholesalers (BAPW), says it’s an oversimplification to say parallel exports or quotas are to blame: both are part of the problem.

He says: “I think it’s more complicated than just parallel exports. They are a factor, but I do agree strongly… that quotas are tight and inflexible.”

Mr Sawer says the solution is to improve communication between manufacturers and wholesalers, so that wholesalers can spread out supply and ease the impact of any shortages that occur.

And Sue Sharpe, chief executive of PSNC, says that while parallel trading is an issue, manufacturers are not taking enough responsibility for the situation. The time has come, Ms Sharpe says, for government intervention.

“There is now clearly a need for regulatory action to solve the problem... the Department of Health will need to find a way of doing so that is compatible with European competition laws.”

Bharat Shah, managing director of Sigma Pharmaceuticals, suggests a way forward. He says the solution is to change the pricing structure of medicines, ensuring both UK supply and parallel trading.

He says: “I think a solution to this problem is to do a dual pricing for UK and exports stocks. If a pharmacist needs more than his allocated demand in a month, he supplies proof and gets the stock.”

But ultimately it doesn’t matter where the fault lies, suggests Mark James, group managing director of wholesaler AAH Pharmaceuticals.

Mr James says that leakage from the supply stream caused by parallel exports can never be reduced to an absolute zero. He believes manufacturers have to make an allowance for the constant trickle and overestimate UK drugs demand.

“Providing 100 per cent of estimated UK demand, on an attractive product for export, will result in shortages to UK patients,” he says.

“All those involved in the pharmaceutical supply chain need to move beyond blaming each other and start working on solutions,” Mr James says. “That will involve compromises.”

What you can do

• Let C+D know which stocks are hard to obtain. Email chapman@cmpmedica.com 

• PSNC is monitoring stock shortages and will feed evidence to the Department of Health. Report supply problems at www.psnc.org.uk or by calling 01296 432823.

• Community Pharmacy Scotland wants pharmacists to send specific examples of stock shortages in Scotland. Email enquiries@communitypharmacyscotland.org.uk or call 0131 467 7766.