Medicines Shortage

[Tram]

Is anyone else having issues getting prescription medicines?
My wife has a prescription for a daily dose drug and been having a devil of a job getting it.
There are two versions, one being sugar free and also now found another brand that can be used as a substitute.
Crazy situation where I have to go into the pharmacy to find out which they have (if any)
They then reserve if for me whilst I ask for the GP for a prescription.
One of the three is out until next Spring and the others sporadically available.

No one seems to be able to give a definitive answer why this is happening.
Epilepsy and HRT meds are also affected, no doubt lots of others too.
Only been like this for the past year, are they stockpiling because of the B word or just a lack of manufacturing resource?

[wornish]

Re: Medicines Shortage

Despite what a lot of UK reports are saying it's not just a UK issue.
Here is a bigger picture by country.

https://www.ema.europa.eu/en/human-r...ages-catalogue

and here for the USA

https://www.drugs.com/drug-shortages/

[Tram]

Re: Medicines Shortage

Despite what a lot of UK reports are saying it's not just a UK issue.
Here is a bigger picture by country.

https://www.ema.europa.eu/en/human-r...ages-catalogue

and here for the USA

https://www.drugs.com/drug-shortages/

What is causing it I wonder, purely demand outstripping supply or who knows what?

[Naughty Nigel]

Re: Medicines Shortage

What is causing it I wonder, purely demand outstripping supply or who knows what?

This is a long running problem which has been discussed on radio and television for a while now. I don't think there is any one cause, but a complex combination of causes including raw material supply, quality, licencing and regulatory problems and withdrawal of certain drugs owing to health concerns. Increasing demand is also causing problems.

For balance I have provided links to articles in the Grauniad and the Torygraph which both seem to be saying much the same thing.

Grauniad: NHS running short of dozens of lifesaving medicines

Torygraph: Pharmacists warn of shortages in every category of drug

[shenstone]

Re: Medicines Shortage

Having worked in that industry I can provide a little insight to the general problems, but not specifically on any one problem.

1. There can be raw material or production issues which hold up supply. the company I worked for made things that used biological (e.g. blood plasma) as a raw material and getting high quality raw materials was sometimes a problem. Every Raw material that came in went through rigorous testing and sometimes problems were found with even the most "routine" things.

2. There are stringent quality control processes that need to be followed, if a problem is found then stock in the supply chain may be bonded until people are 100% (or as close as you can be) sure it's OK

3. There can be shipping issues, we had things that were meant to be temperature controlled 2-8 degrees C was left on the side of a runway in Moscow in winter once. All ruined of course and a real scramble to make more product

4. There can be demand fluctuations e.g. when there was a news story about some adverse effect (real or fake news) it could result in people throwing things away and purchasing or asking for prescriptions for alternatives

5. Paperwork... when you may any change to the way you make something there is a mountain of paperwork that has to be submitted to regulatory authorities worldwide. Some of these will respond in 30/90/120 off days and will not tell you when they will get around to your paperwork making planning very hard. We moved a factory and built a years stock of some items and it was touch and go at the end for some things even with that built into the plan

6. Lastly there are of course the commercial aspects. Some things just get too expensive to make for often good reasons like a different drug that is cheaper and works for most people has been developed leaving a very small batch process which is expensive so you make it less frequently to try and reduce the "per batch" costs like the QC processes. Then if there is a run on things you don't have the ability to react as fast.

These are real things we used to worry about on a daily basis because we always wanted to be able to supply when needed

I would NEVER recommend purchasing online because you never know if its a fake or not and I would NEVER recommend self diagnosis/prescription, but if you want to be armed with all the information for a sensible conversation with your GP about Alternatives I would take a look at the BNF(British National Formulary) online or app versions are available at https://www.bnf.org/

Regards
Andy

[Tram]

Re: Medicines Shortage

I have noticed an increase in the number of generic drugs that are available.
One that I take for a neurological condition was prescribed instead of my usual brand.

No way was it the same, no side effects which are very apparent and it didn't work.
Fortunately the powers that be say treatment for this condition cannot be withheld on cost ground because of the possible suicide risk.
Luckily had some of my usual medication, very bad news cost cutting with these non effective substitutes.
Also how can something that cost a quarter of the cost be the same, can't see that at all

[Jax]

Re: Medicines Shortage

We use a national chemists that has an outlet within the Health Centre / Surgery. I recently complained at being given non-branded generic medicines on prescription. I was informed by the chemist that they were now under strict instructions from the NHS to always source the cheaper generic non-branded medicines where possible.

Having said the above, I have purchased ointment online which is said to contain the same active ingredient and paid 50% less than the branded product. In this instance it was equally as effective as the branded product.

The last time I visited the doctor I was given a prescription for ointment which turned out to be exactly the same generic product I had previously purchased online.

Even Aspirin, and Paracetamol if obtained on prescription, now comes in plain white unbranded packaging.

I can see the advantage and reasoning behind the NHS insisting on cheaper generic products providing they contain the same active ingredients as the branded versions. We keep being advised not to purchase generic medicinal products online as they could be fake but surely that concern can apply to generic products sourced by the chemist and packaged in plain white boxes

Jax

[Naughty Nigel]

Re: Medicines Shortage

I have noticed an increase in the number of generic drugs that are available.
One that I take for a neurological condition was prescribed instead of my usual brand.

No way was it the same, no side effects which are very apparent and it didn't work.
Fortunately the powers that be say treatment for this condition cannot be withheld on cost ground because of the possible suicide risk.
Luckily had some of my usual medication, very bad news cost cutting with these non effective substitutes.

Also how can something that cost a quarter of the cost be the same, can't see that at all

Even the side effects of big brand medicines seem to vary between batches. I have noticed that some batches of Amlodipine, a very common antihypertensive, cause lower leg and foot swelling. This is a known side effect but some batches are tolerated better than others. This suggests to me that it could be impurities in the medicine rather than the medicine itself which is responsible for the side effects.

As for cost, the pharmaceutical industry is a huge commercial business and all of the players will sell drugs for what they can, not for what they cost to make. Like many other products copyright and patents prevent direct copies of new drugs for a number of years (unless licensed otherwise), but once that has expired I guess it becomes a free for all. The cost of generic products from the likes of Boots (which is a highly reputable pharma manufacturer in its own right) gives some idea of the true cost of some common medicines.

The big problem, I understand, is that new versions of some drugs (such as antibiotics) are desperately needed, but there is little commercial interest in developing them because they will need to be prescribed very sparingly to avoid antibiotic resistance.

[Keith-369]

Re: Medicines Shortage

I have noticed an increase in the number of generic drugs that are available.
One that I take for a neurological condition was prescribed instead of my usual brand.

No way was it the same, no side effects which are very apparent and it didn't work.
Fortunately the powers that be say treatment for this condition cannot be withheld on cost ground because of the possible suicide risk.
Luckily had some of my usual medication, very bad news cost cutting with these non effective substitutes.
Also how can something that cost a quarter of the cost be the same, can't see that at all

One of the items on my wife's prescription was changed to a generic item which she accepted. Some days later her symptoms started to return and she had to make quite a fuss to get the prescription changed back to the branded product which worked fine.

Don't know how they can get away with producing an inferior product and saying it's the same. I thought everything had to be passed, trialed, etc.

[Naughty Nigel]

Re: Medicines Shortage

One of the items on my wife's prescription was changed to a generic item which she accepted. Some days later her symptoms started to return and she had to make quite a fuss to get the prescription changed back to the branded product which worked fine.

Don't know how they can get away with producing an inferior product and saying it's the same. I thought everything had to be passed, trialed, etc.

Medicines can be licenced to another manufacturer, which often happens when Big Brand no longer has an interest in manufacturing a product owing to low selling price, etc.

If the product is to the same formula the same there should be no need to retest or retrial it, but it would appear than some generic manufacturers like to cut costs by cutting active ingredients.

[shenstone]

Re: Medicines Shortage

We keep being advised not to purchase generic medicinal products online as they could be fake but surely that concern can apply to generic products sourced by the chemist and packaged in plain white boxes

Jax

Fair point and I should have been clearer

A reputable chemist will have purchased from a supplier who has to keep legal records of the batches sold at every point in the supply chain, what environmental conditions they were kept in (if relevant) and even details of the transport used. if you took some back in stating there was a problem they could report it back through all that chain and if there is a real problem there will be a proper recall despite the colour or branding of the box.

When I said on-line I was not meaning the likes of Boot/Lloyds etc. who will be doing this, but the ebay/amazon sellers who are not sourcing through these reputable and regulated channels

The difference between the good generics companies and the original developing companies is mainly one of the level of R&D that has to be put in (and hence paid for) the generics know the formula that they need to achieve and simply have to prove that level of purity and then very limited clinical trials (if any). it's good for us because it keeps those prices down, but means the companies want to charge more whilst their products are under patent.

The difference between ebay etc. purchases and reputable companies if that none of the above is guaranteed whatever the box looks like

Regards
Andy

[Naughty Nigel]

Re: Medicines Shortage

The difference between ebay etc. purchases and reputable companies if that none of the above is guaranteed whatever the box looks like

Regards
Andy

Thanks Andy.

We have just been talking about this and my daughter has mentioned that some drugs, whilst of the same formulas as human medicines, are only approved for veterinary use.

[Jax]

Re: Medicines Shortage

Classic example from what I consider to be a reputable online chemist:

Canesten CreamGeneric Product: .... Active ingredient Clotrinazole 1% 50gr

[Jax]

Re: Medicines Shortage

Thanks Andy.

We have just been talking about this and my daughter has mentioned that some drugs, whilst of the same formulas as human medicines, are only approved for veterinary use.

Hc45, is an ointment widely used and available over the counter for the treatment of Eczema, Dermatitis, and insect bites. When purchasing online or at the local chemist however, you will be asked where you intend to apply it. (Some replies no doubt cause a raised eyebrow or 2 )

They are legally obliged to ask because the product is not licensed for use on the face.

Jax

[DavidB]

Re: Medicines Shortage

My GP's surgery has it's own pharmacy and they're constantly telling me they "can't obtain" various medications which I have on repeat prescription, but the local Tesco pharmacies, etc., etc. have no such problem and say there's no shortage, but the surgery is reluctant to issue prescriptions so I can obtain my meds elsewhere.

The problem appears to be not one of availability, but availability at a price where the GP's practice can make a certain level of profit.