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Contractors: Shortages of naproxen are 'killing us'

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Pharmacy owner Indira Panchal (centre): We’re having to turn prescriptions away
Pharmacy owner Indira Panchal (centre): We’re having to turn prescriptions away

Shortages of a growing range of medicines, including Adalat and naproxen*, are costing pharmacies' precious time and money, contractors have told C+D.

Indira Panchal, who owns four pharmacies in Bedford, told C+D this week (January 22) that she has experienced shortages of naproxen.

The supply problems have sparked an increase in the price of these medicines that is “killing us”, she explained.

“At the moment, with naproxen we get reimbursed £4.16 and we’re getting it [from wholesalers] for £22,” she said.

“People are wanting those medicines and I can’t get hold of them. You’re having to turn prescriptions away.”

Hours after Ms Panchal spoke to C+D, packs of 56 naproxen 500mg gastro-resistant tablets were granted a concessionary price of £18.01, leading contractors to call for the reimbursement price of other strengths of the drug to be reviewed.

“Staff are constantly on the phone”

Olutayo Arikawe, superintendent pharmacist at The Priory Pharmacy in Dudley, said she has struggled to source naproxen, furosemide and Adalat in recent weeks, which is costing her time and money.

“The staff are constantly on the phone trying to find products,” she said.

“Sometimes you simply can’t get anything. Sometimes you end up changing the medicine with the GP and by the time you call back to order it they have [the original medicine] again.”

Domino effect

Mike Hewitson, owner of Beaminster Pharmacy in Dorset, said: “The problem is that medicines are available, but at silly prices.” He has had issues with “all the sartans” – including candesartan, valsartan and irbesartan – as well as naproxen.

The shortages had an effect “a bit like dominos: one falls over, so the demand moves to another medicine,” he said. “Then there’s not enough supply to meet that demand and [that medicine supply] falls over too.”

Mr Hewitson has seen ondansetron increase in price from “£1-something up to £18-odd a pack” overnight, he added.

Shortages “getting worse”

Sid Dajani, owner of Wainwrights Chemist in Hampshire and a Royal Pharmaceutical Society English pharmacy board member, agreed the shortages “have been getting worse”.

He listed 16 medicines that were in short supply at his pharmacy, including naproxen, Adalat, Cardura and Elleste Duet.

“When there’s a rumour that something might be in short supply, some people start stockpiling it, then the price naturally goes up,” he added.

“Of course, independents are first in line to get stuck for it, because we don’t stockpile as much as the multiples do. We’re constantly ringing around.”

Pharmacists “doing their best”

Mike Keen, CEO of Kent local pharmaceutical committee, said he had heard “a lot” of reports of shortages from contractors over the past year.

The supply chain is under pressure from “short-line wholesalers and suppliers, coupled with some clinical commissioning groups extending periods of treatment”, he claimed.

Pharmacists are “doing their best to look after their patients and often having to dispense at a loss”, he said.

C+D reported on Monday (January 21) that pharmacists may be able to dispense an alternative in the case of “serious” medicines shortages – if the government announces a shortages “protocol” for that specific drug – from February 9.

*This article was updated after publication to clarify the medicines that pharmacies are struggling to source

17 Comments
Question: 
What medicines are you experiencing shortages of?

SIMON MEDLEY, Community pharmacist

I thoutht I was buying wisely, but my monthly drug bill seems to be larger than the reinbursement, sometimes by as much as £3k ! Where are our negotiators ?

Graham Turner, Non Pharmacist Branch Manager

Well, I would like to go out on a limb here and suggest that you are an independent, Simon. Which means that the negotiators are unlikely to have your concerns at the top of their agenda. Precisely what they are actually negotiating is beyond me though.

Dipak Pau, Community pharmacist

After weeks of shortages and correspondingly high prices of Naproxen, even the BBC reported the national shortage of Naproxen and the sky high prices paid by pharmacists so that the patient can get their Naproxen supplies. There have been articles in the national press to highlight the shortages and prices as well. As yet NO PRICE CONCESSION has been made for Naproxen 500mg Tablets.I dispair.

How High?, Community pharmacist

It's easy.

Anything over DT price "I can't get due to the current drug shortages". 

GPs are now prescribing alternate NSAIDs and either branded Amias or other angiotensin II receptor antagonists. 

I have no intention of funding the NHS to the tune of £5 to £15 per pack on some of the most commonly used drugs in the UK in the hope that 30 days later some concession may be granted and will continue to be "unable to obtain" in order to avoid a breach of the NHS contract until the current mess is recognised and sorted out.

Wake up, get real and start influencing locally. If you don't you may as well kiss your businesses goodbye.

N patel , Non Pharmacist Branch Manager

That's just how to sort this

Lucky Ex-Boots Slave, Primary care pharmacist

''GPs are now prescribing alternate NSAIDs and either branded Amias or other angiotensin II receptor antagonists''

No and no. As a Practice Pharmacist in general practice I can tell you this may be your case but most practices out there won't be doing this. With naproxen shortages GPs will simply ask people to go buy ibuprofen themselves and that's even a local ccg policy. They don't care at all at what prices community pharmacies are getting stocks in since it's none of their business. All these price hikes during price concessions will reflect directly onto the GP practices' prescribing budgets, potentially making practices overspending at the end of the financial year and therefore most GPs will be reluctant in prescribing branded versions because on the screen the branded drugs are nearly always way more pricey than generics. And with the Prescribing Incentive Scheme in place GPs will do whatever they can to push down their prescribing costs so they don't overspend in the end. So no they will not be prescribing Amias in place of candesartan. 

Sean Whelan, Information Technology

So then dispense the hugely inflated cost of the generic and have it come out of the GP budget.

Not quite sure how the hell GPs have more concern over their prescribing budgets than the care of their patients.

What a lovely position to be in - 'leave it to pharmacists to be out of pocket as long as I'm alright Jack'

Paul Dishman, Pharmaceutical Adviser

If the pharmacy can't obtain generic candesartan, then return the script to the GP with the suggestion that it's either Amias or another sartan. Their choice.

Andrew Martin, Primary care pharmacist

What's combisartan?

N O, Pharmaceutical Adviser

Though the title now does not mention "Combisartan", in my opinion it is combination of all sort of SARTANs which are currently AWOL !!!! :-))

N patel , Non Pharmacist Branch Manager

Nooose flash....independent pharmacies dispensing sooooo many items at a loss that we will have achieved the DoH target of 3000 closures by this time next year without any help from them...show me another business that is contractuallly obligated to do ANYTHING at a loss and I will show you a pig that can fly

Uday Thakrar, Community pharmacist

Metoprolol, Betoptic SDU. Lopidine SDU, Lixiana 60mg,Madopar 62.5 Capsules,Metronidazole 400mg,Co codamol30/500 Caplets,Canesartan. some od the products are on quota and you have to fax every prescripttion to get supplies. On an average i am having to fax at least twice a day to get products.

 

N patel , Non Pharmacist Branch Manager

fake noooose..... naproxen 500 has not been granted a concession price of 1801p....it is naproxen ec 500.. biiiiiig difference .... got my hopes up high thinking DoH  thought we were GPs and was throwing money at us

 

Paul Brett, Community pharmacist

Same here - I thought dhsc had finally decided to pay cost price... but no. We're 7 days from the end of the month and we've been dispensing a top 50 drug which is only available at 64% above December's concessionary price, with no assurance we will be reimbursed a penny more than tariff price.
Why have psnc stopped negotiating? Is it not as obvious to them as it is to us that concessionary prices have generally been inadequate ever since dhsc decided to trial a new method of calculating concessionary prices?

N O, Pharmaceutical Adviser

It is just like the Universal credit TRIAL. But the question is how long before the PSNC puts it foot down and refuses to accept this model and go for a fair deal with the wholesale prices ????

N patel , Non Pharmacist Branch Manager

nooooo one at the psnc really really cares about pharmacy reimbursement. dont forget contractors pay their wages...but i  bet you none of the top brass have taken a cut in their wages or their pension contributions.. perhaps it is time contractors forced the psnc wallahs to have performance related pay......all the rats will leave the sinking ship then

James Waldron, Editorial

Thanks for flagging. I'll amend the article to be more specific.

Regards,

James Waldron, C+D Editor

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