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Pharmacist spends month securing medicine for terminally ill patients

Butec patches are included on the list of medicines that are now only supplied via Phoenix or AAH
Butec patches are included on the list of medicines that are now only supplied via Phoenix or AAH

A pharmacist has told C+D of a month-long ordeal to secure pain relief medication for terminally ill patients – after the manufacturer’s reduced wholesaler model disrupted supply.

Last month, Sakthivel Thiagarajan, superintendent of Anji’s Pharmacy in Leyton, London, attempted to source several brand-specific medicines manufactured by Napp Pharmaceuticals, to help patients suffering from respiratory diseases and terminal illness, he told C+D last week (May 4).

On March 24, Numark announced that Napp Pharmaceuticals would move to a reduced wholesaler model from April 1, partnering with Phoenix and AAH, and dropping Alliance Healthcare as a supplier.

The list of medicines that can now only be ordered via Phoenix or AAH includes Palladone, Sevredol and Butec patches – all of which can be used for pain relief in terminally ill patients.

When Mr Thiagarajan attempted to order several medicines on the list from Phoenix, he was told that he would need to pay a £138 per month membership fee to Numark, and spend a minimum of £5,000 with them, he claimed.

This is “absolutely impossible” for a pharmacy that only needs to make a few small orders a month, he told C+D.

Similarly, when his team attempted to source the medicines from AAH, they were told they would need to spend a minimum of £2,500 a month or face a surcharge between £300-500, he claimed.

Both wholesalers denied having minimum spend requirements when contacted by C+D.

A spokesperson for Phoenix UK said: “It is not and never has been, a policy of Phoenix to restrict the sale of drugs through requesting account upgrades.”

While AAH said: “AAH does not apply a minimum spend target for community pharmacy customers, after pledging our support to independent contractors in December and taking the decision not to add any surcharges to their orders, for any reason.”

Read more of the wholesalers’ responses below.

“Issues during transition to reduced wholesaler model”

An email from a Napp Pharmaceuticals representative, seen by C+D, explained that there had been “some issues with the TPOS system that automatically re-routes orders placed with Alliance to your second line wholesaler” during the company’s “transition period” to a “reduced wholesaler model”.

They said the issue had now been resolved, and orders made via Alliance would automatically be delivered by an alternative wholesaler.

Mr Thiagarajan confirmed that he was able to access the medicines via Alliance Healthcare, his original wholesaler, late last week.

“I am so disappointed with Napp Pharmaceuticals,” he said. “We should be helping patients – especially if they are in a difficult situation – but rather than doing the things that we are here to do, we are wasting our time,” Mr Thiagarajan added.

The manufacturer should have been aware of the important use of its medicines before potentially disrupting access to them, and “rather than leaving us to sort it out”, Mr Thiagarajan added.

All medicines “should be readily available” to pharmacies, he stressed.

A Napp Pharmaceuticals spokesperson told C+D: “We were made aware of this regrettable situation in April and immediately investigated. The wholesalers we work with to distribute our medicines have confirmed that the issue has been rectified and that steps have been put in place to avoid a repeat of the situation.

“Napp believes that patient access to our medicines is of the utmost importance. We can confirm that our medicines can be purchased by pharmacies without restriction or a need to meet criteria.”

Wholesalers “very concerned”

The spokesperson for Phoenix added: “We are very concerned to hear that the pharmacist and subsequently patient has had difficulties obtaining the medicines they need. We do our best every day to protect our nation’s health and meet both our customers’ and their patients’ needs.  

“We are committed to doing our utmost to ensure fluid access to supply of medicines, we are flexible in our approach and aim to be as responsive as possible. We would like the opportunity to review this particular situation and pick up a conversation with the pharmacist in question about how we can support future supply.”

And AAH added: “Our priority is to make it as easy as possible for our customers to do business with us and ensure they’re able to access the medicines they need, when they need them.”

Have you been unable to access any medicines because of minimum spend requirements?

Really? Wow, Superintendent Pharmacist

AAH scrapped min spend fees some time ago and Phoenix do not require you to be a Numark member, especially if it would be an agency account. 

Unfortunately this story seems like a total red herring and concentrating on what is unfortuately not a real issue. 

A story of this nature could have focussed on things like shortage of Eplerenone, Ezetemibe, Ivabradine, Phenergan.... that is what affecting us on the ground. 

Dave Downham, Manager

"Really" not totally accurate. Phoenix/numark only supply solid line without membership, which as far as I can tell is just pradaxa. I think you are right though the min spend for discount, as measly as they are.

TC PA, Community pharmacist

I agree, having a numark account and a pheonix account are two different things with different terms. Numark has minimum spend to qualify for discount and incurs membership fees but I'm not aware this is the case for agency pheonix accounts.


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