GIRP Press Review 09/12/22 – 15/12/22
Dear member,
Please find below the GIRP Press Review for 09/12/22 – 15/12/22
Press Review 09.12.2022-15.12.22
Best,
The HDA Secretariat
Media Summary
UK watchdog investigates rise in antibiotics prices amid strep A outbreak
Andrew Gregory, The Guardian, 14 December 2022
The Guardian reports that the Competition and Markets Authority (CMA) said on Wednesday it had started an inquiry and is collecting evidence after antibiotics prices soared over the past few weeks.
A spokesperson for the CMA commented: “We are working to establish the facts of what is currently happening in the market and welcome new information as part of our work.”
“People have got real concerns about the price of antibiotics used to treat strep A, and we want companies to be clear about their obligations under the law. There should be no doubt that it is illegal for a dominant company to charge excessive prices, or for any companies to collude to drive up prices.” they added.
This was also reported in: Sky News , Daily Mail , The Financial Times The Express, The Evening Standard Pharmacy Business, P3 Pharmacy, City AM, The Independent Pharmacist
DH bans wholesalers from exporting or ‘hoarding’ strep A antibiotics
The Chemist and Druggist, Eliza Loukou, 14 December 2022
The Chemist and Druggist reports that from the 14 December, wholesale dealer licence holders cannot “hoard” or export certain antibiotics – including amoxicillin and phenoxymethylpenicillin – from the UK.
The Department of Health and Social Care (DHSC) defined the “hoarding” of medicines as “when wholesale dealers withhold a medicine when it’s in short supply”.
The Healthcare Distribution Association (HDA) said soaring antibiotics prices “directly reflect the increase in prices” they are having to pay manufacturers.
Antibiotic supply gone from bad to worse, say pharmacists
BBC News, Philippa Roxby, 14 December 2022
BBC News reports on comments by pharmacists saying that supplies to treat strep A have “gone from bad to worse” in the past week.
Martin Sawer, Executive Director of the HDA, said one national wholesaler had told him that demand for the medicines had risen by 400-500% on last December.
“We are prioritising all the antibiotics amid huge demand for them, particularly liquid solutions,” he said.
Antibiotic supply and pricing issues: Steps taken this week
PSNC, Editorial Staff, 14 December 2022
The Pharmaceutical Services Negotiating Committee (PSNC) reports on recent developments in the antibiotic supply and pricing.
The PSNC issues a warning to the Department of Health and Social Care (DHSC) about the serious impact the shortage of strep A antibiotics is having on pharmacies. The PSNC further reports on the HDA’s position on the availability of strep A treatments.
The HDA stated: “As regards to pricing, the prices charged to pharmacies by HDA wholesale distributors will directly reflect the increase in prices wholesalers are having to pay for these medicines from manufacturers at the moment, in order to be able to continue supplying these medicines to pharmacies. This will be the case until supply and demand are more in sync.”
NI government acknowledges ‘tireless’ work of pharmacies, wholesalers in antibiotic supply
Pharmacy Business, Swati Rana, 14 December 2022
Pharmacy Business reports that The Department of Health in Northern Ireland has acknowledged the efforts of community pharmacies, wholesalers, and procurement teams in securing supply of antibiotics for the treatment of strep A.
A spokesperson for the Department of Health in Northern Ireland said: “While demand is well in excess of what is usual for this time of year, the system has been working hard to replenish stocks as quickly as possible, as such wholesalers are still receiving and making deliveries, with more scheduled over the coming days.”
The Chief Pharmaceutical Officer in Northern Ireland asked that pharmacy teams work with prescribers to understand local antibiotic availability and refrain from ordering excessive quantities to avoid putting the supply chain under additional pressure.
Parliamentary Coverage
There was no parliamentary coverage today
Full Coverage
UK watchdog investigates rise in antibiotics prices amid strep A outbreak
Andrew Gregory, The Guardian, 14 December 2022
The Competition and Markets Authority (CMA) said on Wednesday it had started an inquiry and was gathering evidence after prices soared over the past fortnight.
Drug companies have been accused of increasing prices, with some pharmacists saying they are being charged up to £19 for a box of drugs that normally costs about £2.
Pharmacies say they are losing thousands of pounds a week because they can recoup only a fraction of what drugs truly cost from the NHS.
“We are working to establish the facts of what is currently happening in the market and welcome new information as part of our work,” the CMA said in a statement. “We stand ready to take action if there is evidence of anti-competitive behaviour that breaks the law.
“People have got real concerns about the price of antibiotics used to treat strep A, and we want companies to be clear about their obligations under the law. There should be no doubt that it is illegal for a dominant company to charge excessive prices, or for any companies to collude to drive up prices.”
Group A strep bacteria can cause many different infections, ranging from minor illnesses to deadly diseases. While the vast majority of infections are mild, sometimes the bacteria cause a life-threatening illness called invasive group A streptococcal disease.
At least 16 children across the UK have died from invasive strep A infection and there has been a huge jump in cases of scarlet fever.
The UK Health Security Agency has said there is no evidence that a new strain is circulating and the rise in cases is most likely due to high amounts of circulating bacteria and increased social mixing.
As well as the sudden price increases, pharmacies are also reporting struggling to get hold of antibiotics, with parents forced to go from pharmacy to pharmacy trying to find drugs for sick children.
The Association of Independent Multiple Pharmacies has said the problem is now getting worse and urged the government to take action.
Steve Barclay, the health secretary, said there was no shortage of antibiotics and stock could be moved around if areas were experiencing problems with supply.
However, on Monday the Department of Health and Social Care (DHSC), which Barclay oversees, issued a supply warning for antibiotics for the treatment of strep A.
“Supplies of antibiotics for the treatment of group A strep have seen a surge in demand and may be temporarily in limited supply at certain wholesalers and pharmacies,” the alert said. “Supplies are available with manufacturers, and deliveries into wholesalers and pharmacies are being expedited and are expected in the coming days.”
Reena Barai, of the National Pharmacy Association, said earlier this week that the medicines supply chain in the UK was “broken”.
A DHSC spokesperson said: “Manufacturers currently have supplies of antibiotics available to treat strep A.
“We continue to work urgently with manufacturers and wholesalers to expedite deliveries, bring forward stock they have to help ensure it gets to where it’s needed and boost supply to meet demand as quickly as possible and support access to these vital medicines.”
DH bans wholesalers from exporting or ‘hoarding’ strep A antibiotics
The Chemist and Druggist, Eliza Loukou, 14 December 2022
As of today (December 14), wholesale dealer licence holders cannot “hoard” or export certain antibiotics – including amoxicillin and phenoxymethylpenicillin – from the UK.
The DH added the medications to its regularly updated ‘list of medicines that cannot be exported from the UK or hoarded’, which it uses to identify products that “are needed for UK patients”.
It defined the “hoarding” of medicines as “when wholesale dealers withhold a medicine when it’s in short supply”.
The list also includes ceftazidime, cefuroxime, levofloxacin, linezolid, piperacillin + tazobactam and vancomycin.
Continued sourcing pressures
The Association in Independent Multiple pharmacies CEO Leyla Hannbeck suggested that the move contradicts the DH’s claims last week that there are no antibiotic supply issues.
The DH should have been “open with people from the beginning that there is a problem”, Dr Hannbeck told C+D.
However, the DH reiterated to C+D earlier this week that “there is no supplier shortage” of antibiotics used to treat strep A infections.
“We sometimes have surges for products and increased demand means some pharmacies are having difficulties obtaining certain antibiotics,” a spokesperson said.
This comes after pharmacists raised concerns over difficulties sourcing antibiotics, while England’s chief pharmaceutical officer David Webb warned pharmacy teams last week that they may face “a temporary interruption of supply” of “some relevant” antibiotics.
Dr Hannbeck also urged the DH to make sure its supply of antibiotics – “wherever they have” them – is delivered to pharmacies “as soon as possible, so that patients don’t have to go from one pharmacy to another pharmacy or wait long”.
Pharmacists are still facing difficulties getting hold of the products, she explained.
“[Stock is] very, very sporadic,” Dr Hannbeck added, with patients buying the antibiotics almost as soon they’re restocked in pharmacies.
RPS welcomes move following pharmacy “challenges”
Chair of the Royal Pharmaceutical Society (RPS) English pharmacy board Thorrun Govind welcomed the DH’s move to restrict the export of antibiotics, “given the challenges pharmacies in the UK are facing”.
The DH prohibits the export of a medicine if it determines that the drug is in short supply or at the “risk of being in shortage” and that its export might “contribute to a shortage or risk of shortage of that medicine in the UK”, its guidance explained.
Wholesalers found to be hoarding or exporting a medicine on the list could face regulatory action by the Medicines and Healthcare products Regulatory Agency (MHRA), which “could include immediate suspension of the wholesaler dealer licence”, it said.
Earlier this week, a DH spokesperson told C+D that “there is no supplier shortage” of antibiotics used to treat strep A infections.
“We sometimes have surges for products and increased demand means some pharmacies are having difficulties obtaining certain antibiotics,” they said.
Meanwhile, the Healthcare Distribution Association (HDA) said soaring antibiotics prices“directly reflect the increase in prices” they are having to pay manufacturers, following pharmacists’ complaints that they have been left out of pocket.
It previously stressed that “there is not a shortage” of antibiotics commonly used to treat invasive group A strep, but a “huge” surge in demand.
Antibiotic supply gone from bad to worse, say pharmacists
BBC News, Philippa Roxby, 14 December 2022
Pharmacists say supplies of key antibiotics to treat strep A have “gone from bad to worse” in the past week.
The Association of Independent Multiple Pharmacies (AIMP) said the situation was “unacceptable” and it was time for the government to get a plan in place.
Four antibiotics, which treat different conditions, have been added to a list of products that the UK cannot export.
The UK government says it is working urgently with manufacturers and wholesalers to speed up deliveries.
However, Leyla Hannbeck, chief executive of the AIMP, which represents 4,000 pharmacies in the UK, said the supply of antibiotics to treat bacterial infections including strep A and scarlet fever was “very poor”.
‘Too little too late’
She said the problem had been highlighted a week ago, but it was now getting worse, making it very difficult to get hold of any antibiotics.
“People are having to go from one pharmacy to another – it’s chaos,” she said.
“Supplies are not coming through to us and it feels like no-one cares.”
Dr Hannbeck said putting four antibiotics – three of which are go-to treatments for strep A – on the banned UK export list because of high demand was “too little too late”.
Amoxicillin, phenoxymethylpenicillin (penicillin V), azithromycin oral suspension and cefalexin are used to treat a large range of bacterial infections, including throat, chest and skin infections.
Her message to worried parents is that pharmacists are working very hard to find alternatives, and also changing formulations from solid pills to liquid medicines.
But even the alternatives are running short, Dr Hannbeck says.
A spokesperson from the Department of Health and Social Care said manufacturers currently have supplies of antibiotics to treat strep A and they are trying to get that stock to pharmacies.
“We continue to work urgently with manufacturers and wholesalers to expedite deliveries, bring forward stock they have to help ensure it gets to where it’s needed and boost supply to meet demand as quickly as possible, and support access to these vital medicines,” they said.
GPs have been advised to prescribe antibiotics for children who may have worsening symptoms linked to strep A, a bacterial infection which can lead to scarlet fever and, very rarely, a serious and fatal invasive infection called iGAS.
Antibiotic supply and pricing issues: Steps taken this week
PSNC, 14 December 2022
Following on from our update about antibiotic supply and pricing issues on Friday 9th December, we wanted to share some recent developments.
HDA statement
The Healthcare Distribution Association (HDA), whose member companies distribute over 90% of prescription medicines on behalf of the NHS, has issued a lengthy statement regarding the availability of Strep A treatments.
According to the HDA, the sudden spike in demand for antibiotics used for the treatment of Strep A has meant that there is not enough of these medicines in the supply chain currently to meet this increased demand. As a result, wholesalers are working extremely hard with manufacturers to increase the supply of antibiotics.
The HDA goes on to say:
“As regards pricing, the prices charged to pharmacies by HDA wholesale distributors will directly reflect the increase in prices wholesalers are having to pay for these medicines from manufacturers at the moment, in order to be able to continue supplying these medicines to pharmacies. This will be the case until supply and demand are more in sync.”
In their statement, the HDA has also requested that NHS England and the Department of Health and Social Care (DHSC) issue urgent communications requesting that all those involved in medicines supply do not hoard, stockpile or over-prescribe Strep A antibiotics.
Managing supply
To help ensure the continued supply of medicines to meet the needs of UK patients, DHSC has now added the following products to its list of medicines which must not be parallel exported from the UK:
· Amoxicillin;
· Cefalexin;
· Phenoxymethylpenicillin (Penicillin V); and
· Azithromycin oral suspension.
Hoarding or exporting a medicine on the list is considered a breach of regulation 43(2) of the Human Medicines Regulations 2012 and a contravention of the wholesale dealer licence and may lead to regulatory action by the Medicines and Healthcare products Regulatory Agency (MHRA), which could include immediate suspension of the wholesale dealer licence.
Antibiotic pricing
PSNC continues to hear from contractors who are paying inflated prices for antibiotics used for the treatment of Strep A and who are rightly concerned about the lack of certainty around the final reimbursement prices for these medicines.
With this in mind, we welcome the news being reported today that the Competition and Markets Authority (CMA) is investigating the price of antibiotics.
PSNC’s view
Whilst the above measures are steps in the right direction, PSNC continues to warn DHSC about the very serious impact the shortage of Strep A antibiotics is having on pharmacies and to press them to think broadly about what measures could help to manage the current crisis, such as allowing pharmacists more freedom to change strengths or formulations without prescriber approval (outside of Serious Shortage Protocols (SSPs)).
We have also been clear that more communications are needed to reassure patients and to protect pharmacy staff from the abuse that they are reporting.
The DHSC is considering our applications for price concessions this month and we are continuing to stress the urgency of this.
Pharmacy Business, Swati Rana, 14 December 2022
The Department of Health in Northern Ireland has acknowledged the efforts of community pharmacies, wholesalers and procurement teams in securing supply of antibiotics for the treatment of Group A Streptococcus(Group A Strep) infection in Northern Ireland.
“Locally community pharmacies, wholesalers and procurement teams have been working tirelessly to secure stock deliveries into Northern Ireland. The Department acknowledges the immense efforts from all involved,” it said.
“To put this in context, it is estimated that around one month’s worth of stock based on normal demand was exhausted in less than 48 hours last week.”
“While demand is well in excess of what is usual for this time of year, the system has been working hard to replenish stocks as quickly as possible, as such wholesalers are still receiving and making deliveries, with more scheduled over the coming days.”
The government department, which has lead responsibility for continuity of medicines supply on a UK-wide basis, is working closely with manufacturers and wholesalers to expedite resupply deliveries to secure continuity of supply.
It said: “The Chief Pharmaceutical Officer has updated pharmacy teams on the current situation and to ask that pharmacy teams work with prescribers to understand local antibiotic availability and refrain from ordering excessive quantities to avoid putting the supply chain under additional pressure.”
“The Chief Pharmaceutical Officer and Department of Health colleagues will continue to liaise closely with the Department of Health and Social Care with regard to the UK-wide supply chain, ensuring that Northern Ireland’s supply needs are fully understood.”
