Medicines have become scarce lately. Pediatricians in particular are currently sounding the alarm because antibiotic juices for children are in short supply. In the pharmacies where the medicines are dispensed, problems are noticeable early on. Pharmacists have therefore been warning of supply bottlenecks for medicines for ten years.
The Federal Institute for Drugs and Medical Devices (BfArM) listed 270 supply shortage reports in August last year (as of August 10, 2022). There are currently 479 (as of May 3, 2023). Since the summer of last year, the situation has worsened due to delivery bottlenecks in the pharmacies, says Thomas Preis in an interview with the star. He is a pharmacist in Cologne and chairman of the North Rhine-Westphalia Association of Pharmacists. He reported to the star in August 2022 about the situation in the pharmacies.
Already last year there were supply bottlenecks for numerous medicines, including fever syrups for children and medicines for the treatment of cancer. But the large number of delivery bottlenecks has meanwhile spread further and carried more and more manufacturers with it: “If an active ingredient is not available from a manufacturer, we turn to the next manufacturer with the same active ingredient – and then this is sold out after a short time. The next step is to take action we pharmacists have to resort to medicines with a similar active ingredient. Their manufacturers are also unable to cope with the high demand and can no longer deliver very quickly,” says Thomas Preis, describing the situation.
At the moment, in addition to antibiotics for children, insulin preparations that diabetics need are difficult or impossible to obtain for pharmacies. “In such cases, we have to switch to other preparations,” says the pharmacist. For patients in such cases, this can mean that their therapy has to be changed – to a new drug. That was the case in the past with the breast cancer drug tamoxifen. Since there is no alternative to the drug, breast cancer patients had to be switched to another drug for follow-up care if tamoxifen was not available.
Another reason for a tense situation at the moment is the infection process. “Since last summer there have been a lot of infections – especially among children. And they have actually lasted all year. We can only hope that it will be warmer soon and that fewer antibiotic juices will have to be prescribed, otherwise we will go into the next one ill-prepared Winter.”
Whether fever syrups, antibiotics, blood pressure medication or cholesterol pills – it is not very lucrative for manufacturers to produce such basic medicines. But precisely those drugs are needed by many people in Germany. “Due to the energy crisis, the shortage of skilled workers and rising labor costs, the manufacture of such drugs is becoming less and less attractive and manufacturers are sometimes working at a loss.” Some manufacturers would remain in the market out of a sense of responsibility, but Thomas Preis sees little hope that other pharmaceutical companies will produce basic drugs in the future.
The problems of supply bottlenecks have been apparent for some time – pharmacists have been warning for ten years that Germany is poorly positioned to ensure the long-term supply of medicines. “At the end of 2018, 197 delivery bottlenecks were listed at the BfArM and now there are 479 – that’s an increase of over 150 percent in five years.” In addition: The problem is likely to be much larger than the BfArM list shows. “The list only takes into account so-called supply-relevant medicines. In addition, the medicines on the list must also be prescription-only. So many medicines don’t even appear there.”
The management of delivery bottlenecks is very complex and would make emergency and night services more difficult for pharmacists: “The emergency services are very difficult for us because there are many prescriptions for medicines that patients really need immediately. Is a If the drug is not available, the search for alternatives becomes a real feat for us pharmacists.” In the emergency service, action must be taken very quickly and pharmacists lack the necessary freedom to do so, criticizes Thomas Preis. If a prescription drug cannot be obtained, doctors must issue a new prescription for a drug with a similar active ingredient.
“Technically, we pharmacists are able to dispense medicines with a similar active ingredient. There is agreement between doctors and pharmacists as to which active ingredients can be exchanged with each other,” says the pharmacist. But without more freedom, it will probably continue for a while that he and his colleagues go to the emergency service with a queasy feeling, knowing full well that urgently needed antibiotics are in short supply. “Some pharmacies produce antibiotic juices for children themselves, but this cannot compensate for the losses, especially since there is also a lack of the necessary active ingredients.”
Generics are imitation products of a drug. If the patent protection for an original drug expires, other manufacturers may also sell drugs with the active ingredient in the same active ingredient strength and dosage form under a different name. Because multiple manufacturers can now offer a drug with the same active ingredient, the price of generics is usually lower than the originator.
At the beginning of April, the federal government passed a draft law that is intended to bring more security to the delivery of medicines. “We have overdone the economization of the drug supply,” said Federal Minister of Health Karl Lauterbach at the federal press conference. Germany should again be more attractive as a production location for generics.
The draft law of the Ministry of Health still has to go through the Bundestag. If Karl Lauterbach has his way, the law should come into force as soon as possible. It currently looks like it could come into force at the beginning of August. Among other things, the draft plans to abolish fixed and discount contracts for children’s medication. Pharmaceutical companies are therefore allowed to raise prices once by up to 50 percent of the last applicable fixed amount. The health insurance companies would compensate for the price increases. According to plans by the health minister, this should make it more attractive for pharmaceutical companies to produce children’s medicines.
In addition, the production of medicines will increasingly take place in Europe in the future. Pharmacies should be able to communicate more easily with one another when medicines are scarce. And for certain medicines, a three-month stockpiling at pharmacies is to become mandatory. Criticism of the draft law comes from the Central Association of Statutory Health Insurance Funds (GKV). There it is feared that the elimination of fixed amounts could make medicines more expensive for consumers.
The pharmacists also have doubts about the health minister’s plans: “The pharmacists’ assessment is that these long-term projects will not lead to an improvement in supply in the short term. We also do not believe that the structurally caused supply bottlenecks can be eliminated that quickly “, says Thomas Preis about the proposed legislation. “Germany used to be the pharmacy of the world” and production was relocated to China and India for decades – this cannot be reversed so quickly. “The way to produce in Europe is the right one. But it must also be clear that the future supply of medicines will cost much more money if we want to have enough medicines in Germany.”
As long as certain medicines are not available, consumers will not always be able to get the medicine they want from the pharmacy around the corner on the same day. But how should people who depend on their medication deal with it?
Thomas Preis advises all consumers who need medication regularly to take care of supplies at an early stage. So: Don’t just get a new prescription from the doctor’s office when the last tablet is in the blister. Because: “More and more products are affected by the delivery bottlenecks and depending on the drug, patients cannot be sure that it will be available in the pharmacy on the same day.”
Sources: BfArM, Ministry of Health, Pharmaceutical Newspaper, GKV
