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With a weak pound being outpaced by the euro, many hospitals are sending drugs to the Continent for higher profits. What can NHS do to stop this practice?
UK pharmacies-both retail and hospital-are currently facing shortages of medicines. This may be a result of recent trend for pharma companies to take hold of their own distribution chain rather than selling to wholesalers. However, it’s also being caused by products that are destined for UK patients being exported in parallel to Europe in search of higher profits.
Some hospital pharmacists are reportedly coming under pressure from their finance departments to cash in on the growing parallel export market from the UK. But the Department of Health has warned that it is unacceptable to take advantage of the pound’s current weakness against the euro by selling medicine supplies for profit. The government’s chief pharmaceutical officer, Keith Ridge, wrote a letter to all National Health Service Trusts (the bodies charged with delivering healthcare services at a local level) saying that this practice is irresponsible and threatens patient care. Products that are in particularly short supply at a hospital level include Novartis’ Myfortic (mycophenolic acid), used to prevent rejection in kidney transplantation.
This represents a reversal of the normal trend, as in recent years it has been increasingly common for drugs from southern Europe (where government-controlled pricing keeps drugs cheap) to end up in the UK supply chain. According to IMS Health, 11 percent of the 12,600 pharmacies in the UK are now engaging in this practice.
Retail pharmacists are also reporting difficulties in obtaining a number of important drugs, according to a stock survey carried out by industry publication Chemist & Druggist. More than a third of the pharmacists surveyed said they spent between two and five hours a week chasing out-of-stock drugs, while only 10 percent said that they spent less than an hour every week. Half of the respondents said that between five and 20 of products were currently out of stock at their wholesaler; a quarter said that 20–50 were unavailable; and 14 percent claimed the number was above 50. Three-quarters said that it typically takes at least three days to receive an emergency stock delivery when ordered direct from the manufacturer.
At the top of the list of unavailable products are Roche’s Xenical (orlistat) and Lilly’s Zyprexa (olanzapine), with more than a third of pharmacists having difficulty obtaining these meds. Lilly implemented its new system of supplying through just two distributors a couple of weeks before the survey was carried out, making it the latest of a long list of companies that have now gone down this route. And many companies have initiated a scheme where they sell direct to pharmacies, paying distributors or wholesalers a fixed fee for delivery.
But whatever the reason, patients are now facing long waits for important drugs, with pharmacists unable to source them from the wholesaler and having to go direct to the manufacturer. According to the Association of the British Pharmaceutical Industry (ABPI), the number of emergency deliveries has soared, with more than 77,000 made between January and May of this year by three major UK pharma companies alone. That compares to just over 6,000 in the same period of 2008-a staggering increase of more than 1,100 percent.
ABPI claims that the problem is not with its members, as the oversupply numbers are13 percent for Zyprexa, 8 percent for Xenical, and 65 percent for Myfortic. “This paradox has nothing to do with the method of supply-shortages are hitting both the wholesaler model and the direct to pharmacy models,” says an ABPI spokesperson. “The root cause is that medicines are cheaper in the UK than elsewhere in Europe, a situation that is being made even worse by the weak pound, creating a financial incentive … for parallel exporting.”
Meanwhile, the Royal Pharmaceutical Society of Great Britain has reiterated to its members that exporting medicines like this could be construed as breaching their code of ethics. “Pharmacists exporting medicines or selling stock for exportation by others may be exacerbating existing supply problems, or creating new supply problems,” they said. “This is not in the best interests of patients or the public, and pharmacists should carefully consider their ethical responsibilities to their patients and the public.”