He shortage of medicines in Spanish pharmacies is steadily increasing in recent years. The latest data from the Spanish Agency for Medicines and Health Products (AEMPS) indicates that currently a total of 740 medicines in Spain have supply problems, more than 881 in the last three months. This figure is almost three times what it was four years ago. The inefficiency of the industry is causing concern in the pharmaceutical sector, but a solution has not yet been agreed upon a complex problem considered multifactorial. The causes include occasional increases in demand, packaging supply problems, the lack of raw material supply from China and India and the increase in parallel exports.
The president of the Federation of Pharmacy Associations of Catalonia (Fefac), Anthony Torres, warns that the situation is getting worse: “The shortage of medicines in Spain will go further, it will affect more and more relevant molecules”. Laboratories and distributors accuse each other of being the cause of the proliferation of product diversions to European countries with higher regulated sales prices. According to Torres, the price differences are high between Spain and part of the rest of Europe, of the order of 50% on average with Germany, although he assures that in some specific presentations of medicines they can reach seven times the regulated selling price in Spain. “The current healthcare system with low investments, low wages and low drug prices is not sustainable. Drug prices keep falling two or three times a year”, he assures. But there are no reliable studies comparing prices in Europe and the labs tend to be jealous of the information.
mitigate the problem
In the European framework, formulas are being sought to mitigate the problem, which include a system of aid or solidarity between countries for cases of deprivation. Also on the table is the setting of price brackets for medicines in the Community market, the creation of a list of strategic drugs and the limitation of the movement of pharmaceutical products in the EU.
The struggle to limit the expenditure on company health in the last crisis of 2008 led to a containment of the public budget in medicines from which the laboratories have not yet recovered. The context of low prices favored the production of basic principles in China and their handling in India, whose GDP growth in recent years has been matched by greater domestic consumption of medicines and more problems to ensure the supply abroad. As a result, a perfect storm has been brewing in which European dependence on the outside world has intensified. The last pandemic made the problem even more evident.
The employer Farmindustria believes that “the low price of certain medicines in our country invites wholesalers to selectively export products to other countries where prices are higher. This is a legal practice, but it affects domestic markets. Our companies notify the authority healthcare what volumes of medicine they make available to the Spanish market – considered strategic for our associated companies – but the companies subsequently cannot guarantee that this product does not leave Spain”.
For the distributorsgrouped in the employer’s office Fedifar, “responsibility for waste on the part of distributors is reduced by their position in the chain, the laboratories are responsible”. The distributors point out that the main problem has so far been “peaks in demand. What the distributors do is order product from the laboratories. Much of the problems were due to problems with packaging and preparation of leaflets”.
Structural causes and global causes
For Torres, it is true that there are structural and accidental reasons, and also global causes for the deprivations that Spain suffers. Among the first, he explains the case of Ozempic, for example, which is used with a weekly dose to improve blood sugar (glucose) levels in adults with type 2 diabetes mellitus and to reduce the risk of serious cardiovascular problems such as now heart attack, stroke or death in adults. The problem is that it is also used for weight loss, which has caused an unexpected shortage due to higher than expected demand. The lack of prompt information to doctors when prescribing drugs can aggravate the problem. But it is striking that the medical community has not raised criticism in the face of supply problems that are mostly pointed out by the laboratories. Good relationships between doctors and laboratories may have played a role.
Among the structural causes that pay for the lack of resources, it stands out recently, for example, the lack of supply of children’s syrup in antibiotics, although there may be alternatives in sachets, capsules or tablets. In these cases, pharmacists also propose more capacity to offer pharmacological alternatives and “with broader criteria”. They propose “not to compel pharmacists to dispense the cheapest medicine”, since price differences between similar drugs are generally very small and this obligation concentrates demand and eliminates alternatives.
The Farmaindustria employer also advocates for the increase of regulated prices. The general director of Farmaindústria, Juan Yermo, defends establishing improvements in the procedure for setting prices and public financing of medicines and establishing an “agile, predictable and efficient” model. “The goal is achievable, but it requires an in-depth reform. It is necessary to reformulate the price and financing system; the evaluation methodology; the function, terms and structure of the therapeutic positioning reports (IPT) that accompany the new medicines, and the mechanisms for early access to drugs that bring more clinical benefit to patients,” Yermo recently opined.
According to sources of the Business Federation of Spanish Pharmacists (FEFE), 50% of consumption in units occurs with medicines priced below six euros. Portugal has just passed a price review for medicines with a 5% price increase for drugs for those under 10 euros. Prices between 10 and 15 euros will be updated with a 2% increase. In addition, it is planned to create a list of essential or critical medicines whose availability will be monitored with particular attention. Portugal’s example is being closely followed by Spain, although the election year may slow down and postpone any move to raise the price of medicines.
Expenditure on medicines and health products from hospitals and pharmacies in Spain it has remained between 36.4% and 38.3% of health expenditure total public between the years 2005 and 2021, as collected by the data of the Public Health Expenditure Statistics (ESGP) published by the Ministry of Health and collected Pharma Diary.
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