2023-07-08 10:09:52
Panel of experts sees considerable potential in measures within Austria to reduce supply problems
Alpbach (OTS) – Mag. Bernd Grabner, President of the umbrella organization of European pharmaceutical wholesalers GIRP and board member of PHAGO, the voluntary interest group of Austrian pharmaceutical wholesalers, presented three theses on the subject of supply bottlenecks at the beginning of the PRAEVENIRE Talks on the subject of pharmaceutical supply in Alpbach: There is a lack of Openness, too many cooks spoil the broth, far too much time has already been wasted. A lot of time was spent in Austria to assess the situation and to look for solutions. The main cause of delivery bottlenecks is globalization, as there are many breaks in the global supply chain. A problem that cannot be solved at European level alone. However, a more detailed analysis of delivery bottlenecks shows that in most cases these only occur nationally or only affect very few countries and the corresponding drug would certainly be available on the European or worldwide market – this has to be considered when looking for solutions. The competition between the many wholesalers, as practiced in Austria, makes it possible for supply bottlenecks not to be supply bottlenecks: because if a pharmacy has one or two wholesalers, but only the third and fourth can supply the product, then it is in not available at the pharmacy concerned. In principle, there would often be enough medicines in the country, but not all wholesalers due to the quotas of the manufacturers.
Grabner does not consider the measures taken by the federal government to get the delivery and supply problems under control to be satisfactory, as they ignore reality. For example, when it came to the ordinance for stocking up medicines, Austria followed Finland, which has a completely different market structure. The draft of the regulation also has the deficit that many parameters such as financing, space for storage, expiry dates were not considered.
In order to improve the situation, he believes that AGES, as the supervisory authority, should be able to look transparently at the stocks of pharmacies, as is the case in Denmark. Pharmacies there have to return their contingents if they are needed more urgently elsewhere. In this way, delivery bottlenecks can be easily combated. “Everyone in the supply chain needs to work closely together to improve the situation,” Grabner concludes.
Exchange goods instead of hoarding medicines
According to a worldwide study on drug shortages by the market research institute IQVIA, which specializes in the pharmaceutical market, Austria is in second place behind Italy, explains consultant and former pharmaceutical top manager Dr. Claudia Albert. The bottlenecks mainly affect products for which the patent has expired and for which there is generic competition. Worldwide, 60 to 70 percent of all pharmaceutical products are generic – including in Austria.
If there were actually supply bottlenecks, this might become life-threatening for patients, warns Albrecht. Since availability is not uniform across Europe and products are available in some countries and not in others, or at least scarcely so, procurement processes need to be liberalized to make it easier to redistribute products across Europe. The instrument of “unlicensed medicines” should also be given more thought. These are tried-and-tested products that are approved but not licensed for sale in Austria. These might help to bridge a short-term shortage of nationally customary products.
In the short and medium term, Albrecht sees three major levers that might improve the availability of medicines: In the short term, but not popular, replacing a product with a similar product. Pharmacies are already doing this, but clearer legal regulations are needed. The second point he sees is raw material production, since a large part comes from China and India and is often unavailable due to production downtime. However, raw material production in Europe would be a rather long-term project. As a third point, he addresses the price level for medicines in Austria. At the moment there is little incentive for manufacturers to keep their products on the market.
Albrecht considers it necessary to keep the scope for action open in retail and to support freedom of movement. Export bans lead to reciprocal actions, he warns. It is also completely counterproductive if countries hoard medicines through restrictive storage – that would only make sense in a pandemic.
“The last will be bitten by the dogs”
“We see at the tip of the iceberg that the strong price pressure leads to adjustments that severely limit flexibility,” explains Dr. Wolfgang Andiel, President of the Austrian Generics Association. 72 percent of off-patent medicines are only made by 1 to 3 manufacturers. A development that, according to Andiel, will continue to deteriorate. “We can’t stockpile anything that isn’t manufactured,” he warns. Additional market pressure would come because “antibiotics with a shortage” would be on the price range list. This will further deteriorate supply as margins for producers continue to shrink. “It is completely ignored in the discussion that the manufacturers have to find a financially interesting environment, otherwise they will not stay in the country,” warns Andiel. The economic situation in Austria is explosive for both manufacturers and wholesalers.
“The only sector in the hospital that is legally stocked, which is currently 14 days,” explains Mag. Gunda Gittler, MBA, head of the institutional pharmacy at the Hospital der Barmherzige Brüder Linz and PRAEVENIRE board member. This causes high costs. Different consumption situations such as pandemics, influenza outbreaks, etc. have created extreme bottlenecks for individual medicines. Not least because of the price pressure, the industry was not flexible enough to adapt its production to the changed demand, she says. “A pack of medication often costs less than a pack of chewing gum – something is wrong there,” warns Gittler. Gittler considers the idea of countering the supply bottlenecks through central purchasing in order to create a higher market weight to be questionable, since he reacts much too late to specific demand situations. On the other hand, she can certainly gain something from export bans to protect the drug stocks in the country.
“In everyday practice, delivery restrictions mean a significant additional effort, since you have to constantly check whether a drug to be prescribed is actually available,” says Dr. Erwin Rebhandl, general practitioner in the PVE Haslach (Upper Austria). In addition, the list of sales restrictions in practice is often not available on a daily basis via the surgery software, which makes the search for alternatives very time-consuming and ultimately the patients are unsettled because they suddenly have to take other medication. In some cases it is no longer possible to treat patients in accordance with the guidelines. And if the drug they want is available on the market, patients often have to travel long distances to get it because the pharmacy closest to where they live doesn’t have it. Rebhandl expressed the desire for better integration of the availability in pharmacies into the software systems, which would save doctors a lot of time.
“The list of the export restriction register says nothing regarding whether a drug is really available in a pharmacy,” explains DI Dr. Günter Waxenecker, Head of AGES Medical Market Authority. He locates a massive lack of information. Because the sales restrictions are offset by the delivery quantities of the pharmaceutical industry – however, it is not possible to trace where the material is actually located. Traditional market mechanisms are no longer working. The market supervisory authorities will have to play a greater role in regulating this. Waxenecker hopes that the situation will improve as a result of the revision of the EU drug directive, which will take the first steps in the right direction. “Now it takes more train to the goal. We have to help together,” he appeals.
“Patients are completely confused and don’t understand why the medication they have been taking for many years is suddenly not available,” says Theresia Albrecht, from the Tyrolean state representative of the Austrian Association of Medical Assistants. Seriously ill patients sometimes cannot get their preparations in three or four pharmacies and have to travel an odyssey to get them somewhere. “The delivery bottleneck is sometimes dramatic in individual cases,” says Albrecht. Therefore, the ordination assistants urgently demand a list from which the availability of medicines in pharmacies can be viewed.
We will keep you up to date on the talks and discussions in Alpbach. Pictures and video recordings can be found here and are constantly being added to: https://gesundheitsgespraeche.co.at/mediathek/
PREVENT ÜBER
The non-profit association PRAEVENIRE – Society for the Optimization of solidary health care offers with numerous events, such as the health days in the Seitenstetten monastery, the health talks in Alpbach or summit talks in Vienna and other places in Austria, an independent platform to discuss important health policy topics and questions regarding care discuss and work out proposed solutions and recommendations for action in the form of a yearbook for politicians and decision-makers in the healthcare sector. In all considerations, the focus is always on the patient.
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