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HDA UK Media And Political Bulletin – 14 December 2016

The chemists running out of lifesaving drugs because they have all been sold abroad: Over half of pharmacist report daily medicine shortages

Daily Mail, Jonathan Gornall, 14 December 2016

 

The Daily Mail reports that drug shortages in the UK are resulting in patients not being able to access critical care and even some having to go to A&E. The article argues that drug shortages are closely linked to an increase in the number of licenses and profits being made from exporting cheap UK drugs. Dr. Rick Greville, director of distribution and supply for the ABPI explains that the causes of drug shortages in the UK are complex and calls for a reduced number of wholesale licenses. Martin Sawer, HDA Chief Executive said that clamping down on exports won’t solve the issue of drug shortages.

 

Hammond backs Brexit transition, says would help EU too

Reuters UK, Andy Bruce and William Schomberg, 13 December 2016

 

Chancellor Philip Hammond said that businesses, regulators and “thoughtful politicians” were increasingly supportive of a transition period for Brexit, and that other European countries stood to benefit as well. He also reiterated his view that Britain’s future controls on the flow of workers from EU countries should not cut off the supply of skilled staff needed by British firms.

 

BREAKING: NPA splits from Pharmacy Voice

P3 Pharmacy, 13 December 2016

 

The National Pharmacy Association has announced that it would not continue to fund Pharmacy Voice beyond the end of 2017. Chairman Ian Strachan explained “Recognising the challenges ahead for the whole sector, and especially independents, the NPA Board has asked me to take steps to increase the capability of community pharmacy leadership in England.” Rob Darracott expressed his disappointment following the news, and reiterated his belief “in the need to maximise the combined resources of the network through more effective joint working”.

 

The news was also reported by Pharmacy Business and Chemist & Druggist.

 

Parliamentary Coverage

House of Commons Questions, 13 December 2016,  Drugs: Competition

 

Justin Madders: How many pharmaceutical companies have been referred to the Competition and Markets Authority in each of the last five years for which figures are available.

 

Business, Energy and Industrial Strategy

Margot James: In the last five years the Competition and Markets Authority and its predecessor bodies have launched a total of 20 investigations into the pharmaceutical sector involving 41 pharmaceutical companies. There have been: 11 merger cases, 8 Competition Act 1998 cases and 1 review of previous undertakings that were imposed on a firm.

 

Full Coverage

The chemists running out of lifesaving drugs because they have all been sold abroad: Over half of pharmacist report daily medicine shortages

Daily Mail, Jonathan Gornall, 14 December 2016

 

  • Patients in the UK are being hospitalised due to drug shortages in pharmacies
  • The All-Party Pharmacy Group (APPG) announced this problem already in 2012
  • They blame licensed traders who snap up cheap UK medicine to sell abroad

 

You rush to the chemist in your lunch hour, only to be told the medicine your GP has prescribed isn’t available.

 

The pharmacist is very apologetic, but no one has it in stock as there are ‘supply issues’, she says. ‘Try again tomorrow.’

 

But how would you feel if you knew the reason your prescription couldn’t be filled is because someone had snapped up all the stock to sell for a profit elsewhere in Europe?

 

It’s not only frustrating, it’s dangerous: as a result of drug shortages patients are being harmed and even hospitalised, according to a survey of GPs and pharmacists for the parliamentary All-Party Pharmacy Group (APPG).

 

The APPG first noted the problem back in 2012, blaming ‘speculators’ — licensed traders who snap up medicines on the cheap in the UK to sell abroad.

 

It highlighted the shameful case of a pregnant woman whose pharmacist was unable to get the progesterone tablets prescribed to her to prevent her suffering yet another miscarriage.

 

It took five days to track down the drug. The fate of the woman’s unborn child is unknown.

 

In other incidents, shortages meant patients with mental health conditions had not got the drugs they needed and diabetic patients had suffered hypoglycaemic attacks and ended up in hospital.

 

Now, almost five years on, not only has the APPG’s call to restrict the export of UK medicines been ignored, but the number of licensed dealers has risen by a third — and shortages of medicines are worse than ever.

 

There’s a fortune to be made. Drug companies price medicines differently in different markets — and, thanks to the bargaining power of the NHS, the UK pays much less for drugs than others.

 

That’s good news for NHS budgets — but also tempting to dealers, especially when the exchange rate between sterling and the euro makes export all the more attractive.

 

Last December researchers led by the Austrian Public Health Institute unearthed the price of cancer drugs in 16 countries and found huge variations.

 

While these are not drugs you’d get from your pharmacist, they show the kind of profit that can be made.

 

For example, bortezomib (marketed as Velcade), a treatment for cancer of the bone marrow, is priced at £799 in the UK, but fetches £1,138 in Germany, according to the report in the journal Lancet Oncology Research.

 

That’s a quick windfall of almost 50 per cent. Even greater profits are possible with prescription drugs, as an investigation in 2013 by the Irish Economic and Social Research Institute discovered.

 

Researchers calculated the average wholesale price per dose of 210 prescription drugs sold in eight European countries, and found the NHS consistently paid the least.

 

Overall, the basket of drugs cost on average £46 per dose in the UK, compared with more than £78 in Germany and as much as £83 in Ireland — two clear opportunities for dealers to export drugs for profits of 63 and 81 per cent.

 

The practice is legal — but if exporting a drug creates a shortage for the NHS, it becomes a criminal offence, punishable by an unlimited fine and up to two years in prison.

 

In 2013 the Department of Health promised action, saying the Medicines and Healthcare products Regulatory Agency (MHRA) would carry out ‘a series of targeted inspections’ of licence-holders, promising ‘those breaching existing duties to supply medicines will face the consequences’.

 

But three years on, not a single one has been prosecuted or had their licence revoked.

 

In fact, now there are even more licence-holders able to profit from the scandal. In 2012 there were 1,700 UK licence-holders.

 

Today there are more than 2,200 and more licences are being issued daily in exchange for the £1,803 fee — 65 were granted in November alone.

 

And drug shortages continue. In a survey carried out for the APPG between October 2015 and January 2016 over half of pharmacists said drugs were ‘almost certain’ to be out of stock once a day. Nearly 40 per cent of GPs said the same.

 

Pharmacists reported delays, or the prescription of alternatives, ‘may have or did require patients to receive moderate medical treatment’.

 

In some cases where the pharmacy was unable to find the prescribed drug, as many as 3 per cent reported that this may have or did lead to the patient being hospitalised.

 

Further evidence emerged in August when a survey by GP magazine also found patients were ‘coming to harm’.

 

More than 80 per cent of GPs said that in the previous 12 months, shortages had forced them to prescribe a second-choice drug and in one in five cases patients suffered negative effects as a result, ‘including harm or slower recovery’.

 

Hunting for missing drugs is also costing the NHS valuable time. In the APPG survey, half of pharmacists said they spent 21 to 50 hours a month dealing with shortages.

 

Shortages of branded medicines have now become so routine pharmacists aren’t bothering to report them, says the Pharmaceutical Services Negotiating Committee (PSNC), which represents NHS pharmacists and runs an online reporting system to list shortages.

 

Now, says the PSNC, cheaper generic drugs — copies of branded drugs on which the patent has expired — are also increasingly in short supply.

 

Prices of drugs go up when they are in short supply and more and more generic drugs are costing above the price agreed with the NHS.

 

Each month there are more and more of these so-called concession drugs, for which the NHS allows pharmacists to pay more than the agreed price.

 

What isn’t clear is which of the 2,200 licencees, from individual GPs and High Street pharmacists to pharmaceutical manufacturers and specialist wholesalers, are responsible for the trade.

 

Several witnesses at the 2012 APPG inquiry pointed the finger at pharmacists.

 

The Association of the British Pharmaceutical Industry (ABPI), the trade organisation for the branded drugs industry, claimed then that some medicines intended for use in the UK were being ‘traded and sold abroad for a profit by a small number of retail pharmacies’.

 

The ABPI says there is still a problem with shortages in which trading by pharmacists plays a part.

 

‘The reasons for medicine shortages are often complex and varied and occur when demand outstrips supply,’ said Dr Rick Greville, director of distribution and supply for the ABPI.

 

This, he told Good Health, could be caused by manufacturing problems, companies recalling medicines for quality or safety concerns, ‘or the export of medicines intended for UK patients’.

 

Like the APPG, the ABPI wants the number of Wholesale Distributor Authorisation licences in the UK, which is ‘well above the European average’, reduced –— or, at least, ‘the activities undertaken when wearing the ‘hat of a wholesaler’ or the ‘hat of a retail pharmacy’ should be clearly separated and declared’.

 

This, Dr Greville told Good Health, ‘would help manufacturers and suppliers better understand whether an order for a medicine is for local UK use or to be traded’.

 

Solving the shortage is not as simple as clamping down on export, suggests Martin Sawer, executive director of the Healthcare Distribution Association, which represents the major drugs wholesalers.

 

Ban exports, he says, and ‘the whole system will collapse… yes, there are occasional shortages but the system also allows imports to make up for those and save the NHS a lot of money’.

 

And therein perhaps lies a clue to why so little seems to be being done to tackle shortages.

 

Asked why it had disregarded the call to reduce the number of licences, a spokesman said only that the MHRA ‘recognises that there are a large number of licensed wholesale dealers in the UK.

 

‘This has traditionally been the case and there is a legitimate role for [them].’

 

The UK, the spokesman added, ‘has had an active and diverse licensed wholesale dealing market [that] in the past . . . has seemed to help protect [it] from shortages’.

 

That isn’t how the APPG saw it. In 2012 it called on the Government to ‘unequivocally state that the interests of UK patients must come first, not provisions concerning the free movement of goods’.

 

In June this year, MP Sir Kevin Barron, chair of the APPG, wrote to the Department of Health seeking a meeting ‘to consider actions that would improve the situation’.

 

Five months on, Sir Kevin has not even received a reply to his letter.

 

A Department of Health spokeman insisted it was ‘on our agenda to take this meeting forward’.

 

Hammond backs Brexit transition, says would help EU too

Reuters UK, Andy Bruce and William Schomberg, 13 December 2016

 

Chancellor Philip Hammond on Monday backed the idea of a transition period to smooth the process of leaving the European Union, and said EU countries also stood to gain from a gradual Brexit.

 

In a hint of the differences that have emerged within Britain’s government over its strategy for leaving the bloc, Hammond said businesses, regulators and “thoughtful politicians” were increasingly supportive of a transition period.

 

Britain is due to launch a two-year process of Brexit negotiations by the end of March and the European Commission has said it wants an even shorter period for the talks, saying they should be completed by October 2018.

 

That tight deadline has raised concerns among businesses, including many British-based financial services firms, about what will happen if the new relationship is not agreed by then.

 

Prime Minister Theresa May said last month she understood business concerns that Britain could fall off a “cliff-edge” after the negotiations and she promised to address those fears in Brexit talks.

 

Speaking on Monday, Hammond – considered to be one of the most prominent advocates of a so-called “soft” Brexit – said a transition could be used to phase in the terms of a deal successfully negotiated during the two-year divorce period, or to bridge the lack of a final settlement.

 

Sterling added to its gains earlier on Monday as Hammond spoke.

 

He also countered suggestions that a transition deal was only something that would benefit Britain.

 

“I don’t think we should approach this on the basis that we need transitional arrangements, because I think we can only get to a situation where we have a transition if there is a genuine meeting of minds on both sides of this negotiation that they are beneficial,” Hammond told MPs on Monday.

 

“Collectively, I think transitional arrangements would be beneficial to us.”

 

UK won’t stop flow of highly skilled workers after Brexit – Hammond

Hammond, who has previously suggested that a transition period is necessary, said he expected discussions about it early in the negotiations between Britain and the EU’s other 27 member countries.

 

He reiterated his view that Britain’s future controls on the flow of workers from EU countries should not cut off the supply of skilled staff needed by British firms.

 

“I can’t conceive of any circumstance in which we would use that system to choke off the supply of highly skilled, highly paid workers,” he said.

 

BREAKING: NPA splits from Pharmacy Voice

P3 Pharmacy, 13 December 2016

 

The National Pharmacy Association (NPA) has given notice that it will not continue to fund Pharmacy Voice beyond the end of 2017, the association’s chairman Ian Strachan has announced today (13 December).

 

Explaining the decision Mr Strachan said: “Recognising the challenges ahead for the whole sector, and especially independents, the NPA Board has asked me to take steps to increase the capability of community pharmacy leadership in England.”

 

The NPA has made this decision, which comes at the end of the current three-year agreement between Pharmacy Voice’s founding associations, in order to develop a simpler structure for community pharmacy representation, give independent community pharmacy a strong and distinctive voice and to embed a positive legacy from Pharmacy Voice activity, said Mr Strachan.

Insisting that pharmacy’s leadership structures must be fit for purpose at this crucial time for community pharmacy, Mr Strachan added: “The mission is to move community pharmacy to a position where it is secure, thriving and fulfilling its potential – against the backdrop of current government policy which threatens the opposite. This involves defining and describing what a sustainable, long term future looks like, persuading government and NHS to back the changes needed – including sustained public investment – and supporting pharmacies to meet the challenge of continuing improvement and consistent delivery of excellent care. The structure of pharmacy leadership must be capable of delivering all this”.

 

Responding to the announcement, Pharmacy Voice chief executive, Rob Darracott, said: “Naturally, I am disappointed at the decision by one of our member associations to give their notice to withdraw from Pharmacy Voice at the end of 2017.”

 

Mr Darracott has made assurances that Pharmacy Voice’s work will continue: “Over the next year, Pharmacy Voice’s small but unique team of policy, public affairs, communications, and governance professionals will continue to work, as we have always done, on behalf of the whole of the community pharmacy sector in England to promote the value of the network and support the role frontline pharmacy teams play within an integrated health and care system. We have an exciting and important programme of work planned for 2017, which will help get community pharmacy back on the front foot, and demonstrate the sector’s continued commitment to innovation and partnership.”

 

In particular, Pharmacy Voice will see to turn the vision of the Community Pharmacy Forward View into a reality. “Work is already underway with NHS England and others to ensure the sector gains access to the investment it needs from the pharmacy integration fund,” said Mr Darracott. “Pharmacy Voice was created in the midst of the passage of the Health & Social Care Act. That major reorganisation of the NHS, and the changes that followed it, created a new landscape for the sector to navigate. The Community Pharmacy Forward View, and our plans to implement it, recognise this new reality. Up and down the country, local LPC leaders, leading practitioners and innovator companies know that change is needed, and have been working with us to achieve it.”

He continued: “In addition to delivering on the promise of the Community Pharmacy Forward View we will also continue the discussion we have been holding with our member organisations on the future representation of the sector. We have always believed in the need to maximise the combined resources of the network through more effective joint working, both between the sector’s national bodies and with other partner organisations. I’m disappointed that this announcement has pre-empted the conclusion of some of those discussions, but my team and I remain committed to participating in dialogue on the future of a sector we care so deeply about.

“Regardless of how it is delivered in the future, the need for the thought leadership and sector-led development that Pharmacy Voice was established to provide, has never been more essential than it is today.”

 

In response to the announcement, Sue Sharpe, PSNC chief executive, said: “The community pharmacy sector has been facing unprecedented challenges in the last year and it is understandable that the community pharmacy organisations will look at whether they should make changes so they can represent their members’ interests as well as possible in the future.  PSNC is also in the process of reviewing its own structures.  We will continue to work as closely as possible with the NPA and the whole sector.”

HDA UK Media And Political Bulletin – 14 December 2016

From Factory to Pharmacy

As part of our mission to build awareness, understanding and appreciation of the vital importance of the healthcare distribution sector, we developed an infographic explaining the availability of medicines. It identifies the factors that can impact drug supply, as well as the measures that HDA members undertake day in, day out to help mitigate the risks of patients not receiving their medicines.

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