Guild targets direct supply, meds shortages

medicines meds shortages prescription rx

The Pharmacy Guild highlights “stress and strain” of medicine shortages, recalls… while another company going direct has Guild leaders “in a fury”

Australia’s medicines supply chain is showing some signs of stress and strain with medicine shortages and recalls, says Guild executive director David Quilty in his latest editorial.

“Until a few years ago, medicine shortages in Australia were few and far between,” he writes in Forefront.

“Sadly, they have become a routine part of the working day for community pharmacists, who spend an increasing amount of their time seeking out details of medicines shortages, trying to source products, working with prescribers to identify suitable alternative therapies, and providing clinical support to patients whose therapies need to be changed.”

He says in some cases pharmacists may not be able to offer an equivalent brand, or patients may have to pay more for a different product or revisit their doctor for an alternative prescription.

According to Mr Quilty, the Health Minister has recognised the current system is not working, tasking his department to come up with a Medicines Shortages Strategy.

This will be welcome news to the entire pharmacy sector, including the Society of Hospital Pharmacists of Australia (SHPA) which released a report on medicines shortages in June this year.

Their survey of 280 healthcare providers across Australia revealed 100% of respondents had experienced a medicine shortage in the preceding 12 months.

And on a specific day during the survey (4 April), 95% of respondents had recorded at least one medicine shortage.

“Increasingly, hospital pharmacists are spending large amounts of time contacting multiple suppliers, in order to pay a higher price for a delayed delivery of key medicines,” said the SHPA in its report [emphasis theirs].

In addition, notification of shortages is voluntary and the most common time (70%) that procurement officers realised a medicine was in shortage was when trying to order the medicine.

Information about current or impending shortages was found to be “highly unreliable”, with shortages flagged by pharmaceutical suppliers only 15% of the time.

“When we cross-referenced the responses with warnings and alerts available that day through government websites, including the TGA’s Medicine Shortages Information portal, 85% of reported shortages were not listed by their respective companies,” said SHPA National President Professor Dooley.

“A commitment to timely and effective notification would return a significant dividend for Australians, both in patient care and in the effective use of limited hospital resources,” said the SHPA.

The TGA told AJP in July that a Medicines Shortages Working Group is being established in order to look at strategies to improve information about, and management of, medicines shortages.

AJP has approached the TGA for an update on the Working Group but as of publication the TGA has not yet responded.

Guild “very concerned” about potential impacts of direct supply

Another issue adding to stress on the medicines supply chain is a “recent decision by a manufacturer to bypass the full-line wholesalers with a number of its higher priced medicines”, Mr Quilty argues.

He is presumably referring to the revelation late last month that AstraZeneca would be exclusively distributing a proportion of their products direct to pharmacies.

The nine AstraZeneca product ranges in question began direct distribution effective from 1 November, using DHL to deliver its medicines via its existing direct-to-pharmacy distribution service, used since 2012 for Pfizer Direct.

The Guild is “actively lobbying Health Minister Hunt to address the issue of direct supply by manufacturers by advocating that all PBS medicines be made available to pharmacies through the full-line wholesalers”, National President George Tambassis said in a statement at the time.

On Thursday this week another company, Amgen, reportedly also opted for direct distribution of its osteoporosis biologic Prolia (denosumab) using DHL, according to PharmaDispatch.

Amgen’s decision to go direct from 1 December reportedly only applies to the one drug.

NSW Guild President David Heffernan has told the AJP that Guild leaders are “in a fury” over the decision.

“Members are furious – they do not like the decision. You can understand why members see it as a cynical attempt to bypass the PBS in order to extract more profit from the consumer – you can’t blame them for feeling that way.

“The PBS was designed for access and affordability.”

And a Guild spokesperson told the AJP: “We are very concerned about the potential impact on patients and community pharmacy businesses.”

“The Guild’s preferred mode for distribution of PBS medicines is through CSO compliant distributors that the whole community pharmacy network can readily access,” said the Guild in its submission to the King Review.

“When Pfizer implemented its exclusive supply arrangements in early 2011, there were many complaints from pharmacists. This was partly because of implementation issues with the new arrangements and partly because of the potential precedents.

“Pharmacists were naturally concerned about the additional administration required for ordering and receiving their dispensary stock from different suppliers, which could potentially become unwieldy if the practice escalated.

“While pharmacies have largely adapted and complaints have reduced significantly, there are still concerns regarding pharmacists being able to meet unanticipated urgent requests.

“The Guild is concerned that one of the four central objectives of National Medicines Policy is put at risk by exclusive supply arrangements, namely ‘Timely access to the medicines that Australians need, at a cost individuals and the community can afford.’”

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  1. John Wilks

    It is reported that ” a Guild spokesperson told the AJP: “We are very concerned about the potential impact on patients….” of a major supplier going solo with the supply of high cost medicines. Their sense of ‘fury’ is understandable, given that patient health is compromised.

    Now, dear Guild leaders, hold that “fury” as a concept and reassign it to how accredited pharmacists feel about the use of a monthly HMR quota system (without even a carry-over from a busy month to a quiet month). The imposition of a monthly quota is, in my view, an act of medical malpractice because it means that an accredited pharmacist has to decide who is the most needy patient in any given month, and may have to defer a referral to another month. Hence OUR “fury.” Both situations are about compromised patient health but the Guild leaders seem impervious to the reality of the HMR situation.

    Some might suggest that excess HMRs should be given over to another accredited pharmacist. Would we suggest this as a solution when a patient had to see a cardiologist, or more precisely, ask a patient to see a different cardiologist each visit? I have some patients whom I have been caring for for more than 8 years – continuity of care for these chronically ill people is vital.

    So my suggestion is that the Guild leadership see that they and we are both obsessed with patient care, however the Guild negotiated policy on HMR quotas represents an abandonment of best practice.

    • Jarrod McMaugh

      A few points:
      1) Every service funded out of the CPA is capped. Every single one. The best method to have unrestricted HMR is to have it funded via the MBS.

      This requires an MSAC application. The requirement for evidence for such an application is vigorous. At this point, no one has been able to supply the level of evidence required for MSAC to add HMR to the MBS as an unrestricted service.

      2) Your comment refers to such concepts as triage and waiting lists. This is a fact of life in health service provision, whether we like it or not.

      3) There has been news recently of tasmanian patients seeking medical attention in Victoria for an operation to save their sight. This is an issue that affects all areas of the health sector, not just HMR provision.

      Yes it would be great if HMR were unrestricted and available to all people who need it, in all settings, with referrals from any health professional who identifies that there is a medication-use issue. We do, however, have to live in a reality where health funding is finite.

      On the flip side, the PBS is not supposed to be a restricted service – changes that impact on the delivery of the PBS (or private medications) need to be addressed as a priority, since access to medication is one of the pillars of the national medicines policy.

      • Big Pharma

        Agree MBS funding is required! Interesting the item 900 rebate paid to the GP for their involvement in the HMR process (uncapped) is evidence based but the medication review itself (capped) is not? How bizarre. I think it’s more likely that those campaigning for HMRs have little financial backing so are unable to influence politicians with substantial party donations.

        Tasmanian Ophthalmic Surgeons are capped out after one patient a day? I don’t think so. More likely wait times are extensive due to surgeons being booked solid. Don’t confuse the different reasons for triage….specialist unavailability with arbitrary caps

        • Jarrod McMaugh

          MSAC came in to existence more than 6 years after the introduction of HMR services. Item 900 was grandfathered in.

          making an application to MSAC takes quite a lot of evidence. At the moment, if MSAC were to approve HMR as an MBS item, there would be no caps, but the population for which it would gain MBS eligibility (based on th available evidence) would be smaller than the current eligible population funded (under caps) through the CPA.

          Time, money, evidence, and the resulting change in eligibility are things that are “blocking” MSAC application.

    • Big Pharma

      The PGA is well aware of the HMR situation. Excess HMRs being completed by a different provider, purely as a result of overflow, is always going to result in a poorer quality service. Preferred providers with greater knowledge and experience are capped out early in the month. The Guild’s involvement in HMR quota negotiation was a recommendation for complete cessation of the HMR program.

      The PGA has no interest in patient benefit or best clinical practice unless they can cash in. Remember the 2011 deal with Blackmores? Every script dispensed was meant to encourage companion placebo sales which can only be described as a massive cash grab with no clinical benefit.

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