Shortages are driving up prices of key generic drugs in the UK, which pharmacy representatives say is being caused by Brexit and a handful of other factors.
They say that current stockpiling measures is one factor behind the shortages, but warn that a no deal Brexit could cause the problems to get much worse.
In a letter to the chair of the Commons health select committee, the chief executive of the PSNC (Pharmaceutical Services Negotiating Committee) Simon Dukes called on the government to relax regulations to ease shortages, with generic substitution one of the long-term proposals.
He says some medicines would be “particularly vulnerable” – highlighting a current shortage of pain and opioid addiction treatment Buprenorphine and antipsychotic Risperidone, arising in particular because there are no simple alternatives to which patients can be switched. Others drugs seeing prices rises in 2018 include Allopurinol, Bicalutamide, Latanoprost, and more recently, Naproxen.
After a 2017 that was blighted by generics shortages, the PSNC is reporting that the number of products which require government ‘price concessions’ to offset costs to pharmacies is once again rising.
Simon Dukes, CEO, PSNC
“Last month, the number of price concessions jumped up to 72 and the number in December 2018 is likely to be higher,” says Simon Dukes in the letter.
“The surge may be due to a combination of factors including Brexit planning and contingency; stockpiling; the reduction in Category M prices to recover overpaid margin from previous years; and DHSC using its new data gathering powers to identify stock levels and manufacturer selling out prices to determine concessionary prices.”
Generic substitution would see pharmacies dispensing cheaper generic equivalents in place of certain prescribed branded products – a proposal which will alarm pharma companies whose branded products could lose out if pharmacists were to be granted this power permanently.
However the PSNC concedes that such a major change in legislation is unlikely to be agreed before Brexit D-Day on 29 March.
The PSNC also proposes that the government relaxes the NHS Terms of Service obligation on pharmacists to allow them to refuse supply of drugs if necessary. This would give pharmacies the power to reject complete prescriptions where patients are seeking several months’ worth of a medicine at once, or where they already have sufficient supplies from a previous prescription.
The letter also describes the state of the current pricing and reimbursement systems, which are operated by the Department of Health and Social Care (DHSC).
Pharmacies are concerned that they are increasingly buying medicines at a price higher than the NHS will reimburse according to their monthly drug tariff, therefore incurring costs that will drive pharmacies out of business, says Dukes.
The letter says: “While community pharmacies will continue to do all that they can to manage the supply of medicines to patients, there must be recognition of the impact that this will have on their businesses.
“We would like the government to commit to protecting pharmacies where they are required to invest significant amounts of extra time sourcing and managing stocks, or where they incur significant financial costs as a result of medicines price increases.
“Safeguarding pharmacies in this way will be an important step to ensure that in a time of crisis, patient safety and medicines supply can be maintained, and pressure on other healthcare providers is not unduly increased.”
Meanwhile, the UK government is putting plans in place to allow pharmacists to dispense alternative medicines to the public without prior consultation to a doctor should a ‘no deal’ Brexit arise.