Posted Sep 30, 2022, 5:36 PM
Pharmacy supply shortages are taking hold in the landscape. The “tension” rate, that is to say the inability to supply the requesting pharmacy for at least a week, “has almost doubled since January, going from 6.5% of the number of drug references to 12 .5% in mid-August”, observes David Syr, from the economic interest group (GIE) Gers.
Created by pharmaceutical companies, the GIE Gers provides comprehensive data on the supply of medicines to pharmacies and hospitals in France. In this case, the 12.5% pressure calculated by the Gers relates to drugs – reimbursable or not – supplied to pharmacies (excluding hospital purchases).
900 molecules
12.5% of voltage references, the rate is much higher than the long-term average, which the Gers estimates at around 8%. It remains to decipher it, because tension does not always mean shortage.
Each drug is available in several packagings (box of 8 or 16 tablets, liquid version, etc.) which are all references. This multiplies the alternatives to a missing reference. Just like generics, when they exist. Moreover, the tension may relate to a non-reimbursable drug for daily bobology, in which case, the stake is not vital.
No alternative
The trouble starts when a reference has little or no alternative. This is the case of drugs of major therapeutic importance (cancer, antidiabetics, etc.), which have little variety of packaging and whose most recent generation does not have a generic, again limiting substitutability.
The other very problematic case is when the tension concerns generics replacing more than 85% of the original drug, which cannot take over in large quantities.
The Gers wants to be reassuring. “The same molecule can have dozens of different references and currently, supply disruptions do not affect any drug for more than half of its references”, assures David Syr.
Shortage of antidiabetics
This is not the opinion of the National Medicines Safety Agency (ANSM), which alerted on September 23 to “strong supply tensions” relating to a class of treatments for type 2 diabetes (linked to obesity): “GLP-1 analogues”. This class is represented in France by two drugs under patent, now in short supply: Ozempic from the Danish diabetes specialist Novo Nordisk and Trulicity, the star product for type 2 diabetes, from the American Eli Lilly. These are injections, impossible to choose another packaging.
In terms of pathologies treated by the 12.5% of references in tension, not all of them require treatment that can be interrupted or deferred. There are certainly references to paracetamol, for example, but also, among other things, “antidiabetics, statins for cholesterol, treatments for erectile dysfunction or even a drug for gastric reflux”, lists David Syr.
Not enough stock
As for the causes of tension, they can be varied. For antidiabetics out of supply, the ANSM evokes “a significant increase in global demand”. According to the International Diabetes Federation, 8.8% of the world’s population had diabetes in 2015 with more than 80% having type 2. Its link to junk food means that the growth of this pathology is very rapid in some developed countries, the problem is therefore structural.
We should produce more in France and favor the French market over exports. But observers also see, in the current tensions, the consequence of shortages linked to the invasion of Ukraine (on cardboard boxes, glass bottles, aluminum lids, etc.), as well as a French system of “archaic and very expensive” supply of pharmacies, judge Pascal Perez, economist and adviser to wholesale drug sellers.
Wholesaler-distributors supplying pharmacies are required to have a fortnight’s stock. A bit tight if a medicine comes from Asia. In addition, pharmacies also obtain their supplies from “custodian” intermediaries with no obligation to stock, or directly from pharmaceutical laboratories. Since last year, the latter have been required to have security stocks, but “the implementing decree does not specify that the stock must be in France and the measure is largely ineffective, as shown by the recent shortages observed” , Judge Pascal Perez.
