News

Media and Political Bulletin – 08 June 2020

Media and Political Bulletin

08 June 2020

Media Summary

Drug firms hike cost of life-saving pills by 800% during pandemic, meaning thousands of Britons may have faced delays or not had vital treatments

Daily Mail, Sally Wardle, 06 June 2020

The Daily Mail reports that drug firms could be investigated by the Government’s watchdog for ‘price gouging’ amid concerns they may profit from the Covid-19 pandemic.

“Medicines are subject to supply and demand,” explains Martin Sawer, executive director at the Healthcare Distribution Association. “If there is plentiful supply, then the price comes down. If supply can’t meet demand straight away, then the price goes up. These prices change on a daily basis.”

Prices paid by NHS chemists for antidepressants and a breast cancer treatment have soared by more than 800 per cent in recent weeks, The Mail on Sunday can reveal. While some pharmacies have paid over the odds in order to meet patient needs, others have been unable to, meaning that Britons may have faced delays or struggled to get the treatment they need.

The Government’s Competition and Markets Authority has said it will investigate price rises throughout the supply chain during the Covid-19 pandemic and take action against any increases which it considers to be “unjustifiable.”

Pharmacies partly to blame for quota crisis, wholesalers claim

P3 Pharmacy, Pharmacy Network News, 05 June 2020

Following a statement made last week by the PSNC, expressing its concerns over the rise in drug quotas being imposed by wholesalers and manufacturers, Pharmacy Network News spoke to HDA executive director Martin Sawer,

Describing quotas as an “emotive issue,” Mr Sawer said one of the main reasons quotas are used is to limit onward sale by pharmacies. “Quotas are there to ensure an even and fair distribution of product across the dispensing points and to eliminate some customers who might buy excess stock because they want to resell it, either within the UK [or abroad],” Sawer explained.

Mr Sawer said the HDA has discussed the issue of quotas with PSNC for some time and welcomed their efforts to “collect robust data”. The HDA will “see if we can learn any lessons” from the data, he said.

‘Virus drains no-deal Brexit medicines stockpiles’

BBC News, Faisal Islam, 08 June 2020

BBC News reports that, according to an internal pharmaceutical industry memo which was prepared for the government in May, after the pandemic ends there will be “less or zero product available in the market to allow for stockpiling a broad range of products” than there was in 2019, when stockpiling occurred in preparation for a possible no-deal Brexit.

The memo emphasises that the government needs to be storing a much broader list of medicines going forward, because of the joint challenge of the pandemic and in the event of a no-deal Brexit deal at the end of this year. But the pharmaceutical industry says that to have significant impact, the stockpiling will have to start in the next few weeks.

Parliamentary Coverage

House of Commons – Written Answer, 05 June 2020

Clive Lewis (Norwich South): To ask the Secretary of State for Health and Social Care, what steps his Department plans to take to ensure stocks of medicines for end of life do not run short.

Jo Churchill: As part of our concerted national efforts to respond to the COVID-19 outbreak, we are doing everything we can to ensure patients continue to access safe and effective medicines, including those used in end of life care. The Department is working closely with the pharmaceutical industry, the National Health Service and others in the supply chain to help ensure patients can access the medicines they need, and precautions are in place to reduce the likelihood of future shortages.

NHS England and NHS Improvement have advised clinical commissioning groups to establish local hubs to ensure rapid access to anticipatory medicines. These hubs could be a community pharmacy, primary care network (general practitioner practice), community hospital, acute or other setting where palliative medicines (including controlled drugs) can be safely and legally stored and rapidly released when needed.

The Department and NHS England and NHS Improvement have published a standard operating procedure (SOP) for the use of medicines labelled for one patient, who no longer needs them, to be used by another person, in hospices and care homes. This will protect the medicine supply chain and ensure that patients can access critical medicines at end of life. The SOP can be found at the following link:

https://www.gov.uk/government/publications/coronavirus-covid-19-reuse-of-medicines-in-a-care-home-or-hospice

Northern Ireland Assembly – Written Question Tabled, 05 June 2020

Mr Gordon Dunne: To ask the Minister of Health what additional funding has been put in place to support community pharmacies during the COVID-19 crisis.

Medicines and Medical Devices Bill, 05 June 2020

There are several new Public Bill Committee amendments which have been tabled to the Medicines and Medical Devices Bill which can be found here.

House of Commons – Written Question Tabled, 04 June 2020

Anne Marie Morris (Newton Abbot): To ask the Secretary of State for Health and Social Care, if he is taking steps to ensure that the public is consulted prior to bringing forward legislative proposals to grant pharmacists the power to amend prescriptions as they see fit in the event of shortages of medicine.

Full Coverage

Drug firms hike cost of life-saving pills by 800% during pandemic, meaning thousands of Britons may have faced delays or not had vital treatments

Daily Mail, Sally Wardle, 06 June 2020

Drug firms could be investigated by the Government’s watchdog for ‘price gouging’ – inflating the cost of vital medication needed by millions of Britons – amid concerns they may profit from the Covid-19 pandemic.

Prices paid by NHS chemists for antidepressants and a breast cancer treatment have soared by more than 800 per cent in recent weeks, The Mail on Sunday can reveal.

And dozens of other commonly taken drugs have seen extraordinary price increases during the pandemic. These include painkillers such as ibuprofen and co-codamol, antibiotics, and even medication to treat overactive bladders.

While some pharmacies have paid over the odds in order to meet patient needs, others have been unable to – meaning that thousands of Britons may have faced delays or struggled to get the treatment they need.

Some chemists say that due to shortages, they have at times not been able to give heart patients aspirin, which is prescribed as a blood thinner to prevent heart attacks.

Companies that supply the drugs claim price hikes are due to increased demand, lockdowns causing hold-ups in production and problems getting products from India and China, where most medicines are made.

But Government officials are also concerned that ‘a minority of bad apples’ may artificially inflate prices during the pandemic to make money.

Other examples of price gouging, investigated by consumer watchdogs in recent months, include high-demand products such as hand sanitiser, bleach and baby formula.

Experts are also warning that if a second wave of coronavirus hits in the winter, when demand for medicines is typically higher, there could be further cost increases and shortages.

‘When there are shortages, a pharmacist will do whatever they can to source that product,’ says Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies.

‘If they can’t get hold of it, patients will sometimes be switched on to similar-acting medicines. But with some antidepressants, for example, it’s not very easy to just switch a patient from one medicine to another – and if someone suffers from anxiety and depression, not having their medicine will make them more anxious.

‘Shortages of cancer drugs are also particularly difficult.

‘In a lot of instances, patients are put on drugs for specific reasons and it’s difficult to just substitute them for something else.’

The process of making and distributing prescription drugs is complex. Firstly, the raw ingredients that make them work, known as active pharmaceutical ingredients, need to be manufactured.

These are then transported to factories where they are made into tablets or prepared for injections into the patient. The finished products are traded between wholesalers until they are sold to pharmacies and hospitals, which dispense them to patients.

Today, the majority of generics – cheap, unbranded versions of commonly taken drugs – are  imported from abroad. Just 20 to 25 per cent of those supplied to the NHS for use in pharmacies and hospitals are made in the UK.

About a quarter come from India, and India gets 70 per cent of its raw ingredients from China.

‘We are at the end of a very long supply chain for some drugs,’ says Dr Andrew Hill, honorary senior visiting research fellow in the Institute of Translational Medicine at the University of Liverpool.

‘If anything breaks down, then we are in trouble.’

In February, some factories in China ceased production as Covid19 spread. And in March, India introduced restrictions on the drugs it would export, so it could meet its own demand for medicines. The effects of the disruption caused to the supply chain are still being felt in the UK.

Fin McCaul, who has owned and run a pharmacy in north Manchester for nearly 40 years, says two wholesalers he uses regularly have been recently out of stock of aspirin.

‘We have been spending a lot of time trying to source appropriate products, and working with GPs to find alter­natives that patients can switch to,’ he says.

Shortages of prescription drugs can also be costly.

‘Medicines are subject to supply and demand,’ explains Martin Sawer, executive director at the Healthcare Distribution Association, which represents wholesalers.

‘If there is plentiful supply, then the price comes down. If supply can’t meet demand straight away, then the prices go up. These prices change on a daily basis.’

The NHS reimburses pharmacists for prescription drugs they dispense, paying a set price known as a drug tariff. But when there are problems and a drug is in short supply, pharmacies may end up paying above the listed price to get hold of it.

If this happens, the Department of Health will meet the higher price and pay back pharmacies – this is called a concession.

The list of concession prices, published by the Pharmaceutical Ser­vices Negotiating Committee, gives a good indication of drugs which are in short supply. A total of 43 items were listed in March, but this grew to 74 in April and 80 in May.

Figures from May suggest the price of antidepressant sertraline was up by 823 per cent, with the NHS reimbursing £14.32 for a pack of 100mg tablets, instead of its usual £1.55. Exemestane, a hormone therapy used to treat breast cancer in post-menopausal women, soared in price by 827 per cent.

A 30-pack usually costs the NHS £6.64, but in May the concession price was £61.57.

The Government’s Competition and Markets Authority has said it will investigate price rises throughout the supply chain during the Covid-19 pandemic and take action against any increases which it considers to be ‘unjustifiable’.

Warwick Smith, director-general of the British Generic Manufacturers Association, says: ‘If manufacturers increase prices for no good reason, then we will be the first to criticise them.’

As the UK prepares for a possible second wave of Covid-19, some experts argue that the supply chain must be strengthened to ensure patients have access to essential, life-saving drugs.

Shortages so far have not just been limited to pharmacies, Dr Hill warns. ‘I’ve spoken to doctors who ran out of certain drugs in intensive care,’ he says.

He believes the Government must now consider how it will source drugs and the ingredients to make them to avoid similar problems for pharmacies and hospitals in the future. ‘At the moment, if China goes down, we don’t have another option,’ he says. ‘The key is to have at least a Plan B, if not a Plan C. As a last resort, we should have the ability to make drugs within the UK.’

For patients worried about shortages, the advice is clear. ‘Order your medicine seven days before you run out,’ pharmacist Fin McCaul says. ‘If there is an issue, this gives us time to source the medication, or speak to your GP about finding an alternative.’

A Department of Health and Social Care spokesman said: ‘Fluctuations in price for generic medicines are normal, but companies must not capitalise on the pandemic by charging unjustifiably high prices.

‘The Competition and Markets Authority has set up a taskforce to investigate reports about businesses behaving unfairly, and can take action if necessary.’

Pharmacies partly to blame for quota crisis, wholesalers claim

P3 Pharmacy, Pharmacy Network News, 05 June 2020

Pharmacists with wholesale dealer licences may be partly to blame for the growing impact drug quotas are having on UK pharmacies, the head of the Healthcare Distribution Association has claimed.

PSNC issued a statement this week expressing its concerns over the rise in drug quotas being imposed by wholesalers and manufacturers, inviting pharmacy teams to share their experiences as part of a data gathering exercise. The issue appears to have worsened during the Covid-19 crisis.

Speaking to Pharmacy Network News on Wednesday, HDA executive director Martin Sawer said one of the main reasons quotas are used is to limit onward sale by pharmacies.

‘Emotive issue’

Describing quotas as an “emotive issue,” Mr Sawer said: “There are 2,100 wholesale licences out there – our members only have about two per cent and the vast majority of the rest are owned by pharmacies.

“The challenge then is, if we distribute to a pharmacy that also has a wholesale licence then they could, if they wanted to, sell that medicines on.

“Quotas are there to ensure an even and fair distribution of product across the dispensing points and to eliminate some customers who might buy excess stock because they want to resell it, either within the UK [or abroad].”

Mr Sawer said quotas are “worked out at a macro level” by manufacturers, who allocate a certain amount of each medicine to the UK, and that wholesalers must “work with them to make sure that patients get those medicines”.

He did not respond when invited to share evidence of the impact pharmacies with wholesale licences have on the medicine supply chain.

Longer scripts a factor

Asked why quotas appear to be increasingly common during the Covid-19 pandemic, Mr Sawer told PNN that at the start of the pandemic the longer prescriptions issued by doctors had put strain on the supply chain.

“The doctors were prescribing three months’ worth of medicines at the beginning, and if this was one of the medicines under quota… that would start to be a challenge unless it was flexed because quotas are typically weekly or monthly allocations to a pharmacy.”

He also said that with some patients travelling across the country when lockdown measures were announced, prescription nominations “were moving around quite dramatically” and that this may have had an impact on quotas.

Global supply chain issues such as India’s temporary export ban may have had some impact on UK quotas but were not likely to have been “the big driving force,” Mr Sawer said.

Mr Sawer said the HDA has discussed the issue of quotas with PSNC for some time and welcomed their efforts to “collect robust data”. The HDA will “see if we can learn any lessons” from the data, he said.

“The issue is about manging stock to make sure the distribution is fair and equitable, and where that is not happening individual wholesalers working with manufactuers will work it out.”

‘Virus drains no-deal Brexit medicines stockpiles’

BBC News, Faisal Islam, 08 June 2020

The UK has been warned by the pharmaceutical industry that stockpiles of medical supplies have been “used up entirely” by the coronavirus pandemic.

A memo seen by the BBC advises the government to buy and store “critical” medicines to treat the virus.

Drug makers fear stockpiles cannot feasibly be built back up again, if the UK should fail to strike a post-Brexit trade deal with the EU.

The government said “robust contingency plans are in place”.

The spokesperson added: “We want a relationship with the EU which is based on friendly cooperation between sovereign equals and centred on free trade.”

However, firms fear disruption to global supply chains will seriously impact the NHS.

The internal pharmaceutical industry memo, which was prepared for the government in May, warns that after the pandemic ends, there will be “less or zero product available in the market to allow for stockpiling a broad range of products” than there was in 2019, when stockpiling occurred in preparation for a possible no-deal Brexit.

At the time, the industry itself paid for six weeks’ worth of stockpiles.

“Preparations for the end of the transition period must complement plans to secure the supply of coronavirus therapeutic and supportive products,” the memo says.

The pandemic has led to a massive increase in demand for medicines not previously stockpiled for critical care and respiratory medicines, such as inhalers.

At the same time, coronavirus lockdown measures imposed by governments have caused significant supply bottlenecks due to factory closures and export bans, as well as a drastic decline in air freight.

The memo was put together by a cross section of pharmaceutical industry groups anticipating preparations for a failure to strike a trade deal with the EU, alongside a refusal to extend the negotiating period.

If this happens, the UK would trade on World Trade Organization (WTO) terms, which would mean trade barriers from the start of next year.

Keeping the flow of medicines going

The memo goes on to remind the government that the flow of medicines has been kept going through the pandemic thanks to “international coordination and information sharing within global companies to ramp up, and where necessary, redirect manufacturing”.

As a result, the pharmaceutical industry writes: “We would warn against any drastic policies mandating wholesale changes to global supply chains, as this could fundamentally disrupt the supply of medicines for the NHS and patients in other countries.”

The pharmaceutical industry has long anticipated that a no-deal Brexit could cause congestion at the ports of Dover and Calais, which is the route that 90% of imported drugs and medicines from the EU take to get to the UK.

As a result, the industry has advised that the government itself will have to buy and store a longer list of “critical products” where “supply could be challenging due to either COVID-19 or the end of the [Brexit] transition period”.

The need for trading stability is even more important this year, because the pattern of demand for medicines is likely to be very different to normal.

That means, the memo says, that the government needs to develop a new broader list of critical products which “reflect the challenges posed by both the end of the transition period and continues response” to the coronavirus crisis.

Urgent government action needed

The memo also emphasises that the government needs to be storing a much broader list of medicines going forward, because of the joint challenge of the pandemic and in the event of a no-deal Brexit deal at the end of this year.

But the pharmaceutical industry says that to have significant impact, the stockpiling will have to start in the next few weeks, and even after the pandemic ends, stockpiling will not be possible for every medicine required.

In a normal year, Christmas would be “the worst time of year to ask companies to increase their stockpile levels”, the memo says.

The pharmaceutical industry is expecting the system of no-deal government-chartered freight ferries and aeroplanes to be re-established, given that border disruption is expected at the end of the Brexit transition period. It says the government needs to signal that this will be the case by next month.

And it has requested “urgent clarity” on the implementation of arrangements for Irish Sea trade, under the Northern Ireland Protocol.

The Association of the British Pharmaceutical Industry (ABPI), one of the organisations involved in drafting the report, says firms had “worked around the clock” during the pandemic to make sure medicine supply chains held up.

“With this pressure likely to continue over the coming months, the pandemic has reinforced why it is essential that the UK and EU reach a deal on their future relationship,” said ABPI’s chief executive Dr Richard Torbett.

In the meantime, he said its members would continue to work closely with government to put detailed plans in place.

“But not everything is in the gift of industry. Stockpiling is one element – having alternative supply routes and making sure that goods can continue to flow uninterrupted across borders is also critical,” he stressed.

Media and Political Bulletin – 08 June 2020

From Factory to Pharmacy

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