2023-05-14 19:00:02
He shortage of medicines in Spanish pharmacies has been increasing steadily in recent years. The last data of the Spanish Agency for Medicines and Health Products (AEMPS) points out that currently a total of 740 medicines in Spain have supply problems, more than 881 in the last three months. This figure almost triples that of four years ago. The inefficiency of the industry unleashes concern in the pharmaceutical sector but a solution has not yet been agreed to a complex problem considered multifactorialhe. The causes include occasional increases in demand, packaging supply problems, lack of supply of raw materials from China and India and the increase in parallel exports.
The president of the Federation of Pharmacy Associations of Catalonia (Fefac), Anthony Torres, warning that the situation is worsening: “The shortage of medicines in Spain is going to increase, it will affect more and more relevant molecules.” Laboratories and distributors accuse each other of being the cause of the proliferation of product diversions towards 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 it ensures that in some specific presentations of medicines they can multiply the regulated sale price in Spain by seven. “The current healthcare system with low investment, low wages and low drug prices is not sustainable. Drug prices continue to drop two to three times a year“, he assures. But there are no reliable studies that compare prices in Europe and laboratories tend to be jealous with the information in this regard.
Within the European framework, formulas are being sought to mitigate the problem, which include an aid or solidarity system between countries in cases of shortages. Also on the table is the setting of price ranges 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 health spending undertaken in the last crisis of 2008 led to a containment of the public budget for 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 coupled with greater domestic consumption of medicines and more problems in ensuring supplies abroad. As a consequence, a perfect storm has been brewing in which Europe’s dependence on the exterior has become more acute. The last pandemic highlighted the problem even more.
The employer Farmindustria considers 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 national markets. Our companies notify the health authority what volumes of medication they make available to the Spanish market —considered strategic for our associated companies—, but the companies cannot subsequently guarantee that this product will not leave Spain”.
For the distributorsgrouped in the employer Fedifar, “the responsibility of the shortages on the part of the distributors is reduced by their position in the chain, those responsible are the laboratories”. The distributors emphasize that the main problem so far has been “demand peaks. What the distributors do is request product from the laboratories. A good part of the problems were due to problems with packaging and preparation of prospectuses.”
For Torres, it is true that there are structural and accidental reasons, and also global causes for the shortages suffered by Spain. Among the former, it explains the case of Ozenpic, 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 stroke. heart attack, stroke, or death in adults. The problem is that it is also used to lose weight, which has caused an unexpected shortage due to higher demand than expected. The lack of prompt information for doctors when prescribing drugs can aggravate the problem. But it is striking that the medical community has not raised criticism of supply problems that mostly point to laboratories. The traditional good relations between doctors and laboratories may have had an influence.
Among the structural causes that contribute to the shortage, recently, for example, the lack of supply of children’s syrup in antibiotics stands out, although there may be alternatives in sachets, capsules or tablets. In these cases, pharmacists also propose a greater capacity to offer pharmacological alternatives and “with broader criteria”. They propose “not forcing pharmacists to dispense the cheapest drug”, since the price differences between similar drugs are generally very small and this obligation concentrates demand and eliminates alternatives.
The employers’ association Farmaindustria also pleads for the rise in regulated prices. The general director of Farmaindustria, 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 pricing and financing system; the evaluation methodology; the role, deadlines, and structure of the therapeutic positioning reports (IPT) that accompany new drugs, and early access mechanisms for drugs that provide the greatest clinical benefit to patients,” Yermo recently commented.
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According to sources from the Business Federation of Spanish Pharmacists (FEFE), 50% of consumption in units is produced with medicines priced below six euros. Portugal has just approved a price review for medicines with a 5% price increase for drugs for those under 10 euros. The prices of those between 10 and 15 euros will be updated with a 2% increase. In addition, the creation of a list of essential or critical medicines whose availability will be monitored with special attention is planned. The example of Portugal is being followed closely from Spain, although the election year may slow down and postpone any movement in the rise in the price of medicines.
The spending on medicines and health products by hospitals and pharmacies in Spain has remained between 36.4% and 38.3% of the total public health spending between 2005 and 2021, as shown in the data from the Statistics of Public Health Expenditure (ESGP) that has been published by the Ministry of Health and includes Pharma Diary.
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