Hardly a day goes by without the reported shortage of a medicine – and rightly so. For one patient to have to wait to receive their medication is one too many. It shouldn’t happen, but it does. In fact, issues of availability and supply of medicines to community pharmacy have never been so widespread or challenging.
Healthcare Distribution Association (HDA) distributors are managing around 1,000 different medicine lines at any one time in an attempt to provide equitable and fair distribution across the UK. It is not a perfect system by any means, and we know community pharmacists feel this only too well when they are on the frontline with a patient waiting. HDA members share the frustration felt by all pharmacists in dealing with shortages.
HDA wholesalers and distributors are struggling to source between 100-150 different products, which have a production or regulatory problem. Five years ago, this number was around 40-50. An example of reasons for current shortages problems may be pharmaceutical factories in a key producing country closing and relocating, due to new environmental legislation, while other sites have had MHRA inspection issues.
When supply problems such as these arise upstream, manufacturers supply medicines to HDA distributors based on finite quotas. HDA member companies then have an inflexible amount of stock to distribute to pharmacies – they can’t acquire any more. This is one reason why many medicines have pharmacy purchase order quotas on them currently, to at least try and provide some sort of equitable availability for all.
Overlaying these challenges, which are not new, there is now the broader picture of increased product demand from some of HDA members’ customers. Why? Where is this increased demand coming from?
Our members believe that some of this excessive demand could be coming from businesses who hold a wholesale dealer’s licence, or WDA, and is free to buy and sell medicines. For example, the HDA believes there may be a few small licence holders offering to buy small amounts of stock from different locations and then hoarding it – for price gain purposes – or exporting them in bulk, a process pejoratively known as ‘skimming’.
There are many pressures on medicine supplies. To try and safeguard this supply for UK patients in these febrile times, the HDA is calling on the MHRA to consider a more rigorous and transparent enforcement of the obligations on all WDA holders in line with good distribution practice legislation, which states that: “A holder of a wholesale dealer's licence…shall ensure…the appropriate and continued supply of such relevant medicinal products to pharmacies and persons who may lawfully sell such products by retail…so that the needs of patients in the UK are covered.”
A way forward?
We believe there are two initiatives worthy of urgent consideration by the MHRA to try and create a more stable environment, to safeguard the supply of medicines for patients in the UK:
- Mandate that the business purchasing from a wholesaler distributor must declare whether they are purchasing as a wholesaler or a dispensing entity
- Consider reissuing all the wholesale dealer licences in the UK with new specific classifications that clearly and publicly state the type of medicine supply use for which that licence can be used – as happens already in France and Germany.
The HDA is committed to protecting the safe and equitable supply of medicines for UK patients, and will work with all supply chain members, including regulators and policymakers, to ensure this. This is especially important as issues of concern about supply are rightly raised in the context of Brexit.
The MHRA declined to comment on this article when contacted by C+D.
Martin Sawer is executive director of Healthcare Distribution Association, which represents the UK's largest medicine wholesalers.