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.’”