Canadians relying on too few drug companies
When the pandemic shut down the country in March, Canadians got an unexpected lesson in supply chain logistics. Just like empty grocery store shelves became a reality, COVID-19 also turned into a stress test for managing and maintaining Canada’s drug supply.
For years, physicians, pharmacists and drug distributors have had to manage drug shortages partially caused by an increasingly complex global supply chain. It might surprise many Canadians to learn that there was an average of 65 drug shortages a week in Canada long before the coronavirus arrived.
As a result of increased pressure on generic drug prices, fewer factories worldwide are producing the active pharmaceutical ingredients that are the building blocks for so many common prescription medicines.
When COVID-19 arrived in Canada, patients rushed to renew prescriptions early and for longer durations.
This stockpiling meant that a drug supply system accustomed to “just in time” availability was suddenly faced with a spike in demand — similar to long lines at the grocery store with overflowing grocery carts and product shortages.
Doctors also adjusted their protocols to keep COVID-19 from spreading — for example, by shifting from nebulized to inhaled forms of medications — which put additional pressure on the drug supply.
Faced with the triple pressure of a complex global supply disruption, stockpiling and shifts in demand, Canada’s drug supply began to strain under the pressure.
As a result, policy-makers took the difficult but necessary decision to limit drug dispensing to 30 days in much of the country, ensuring that supplies were not exhausted.
In addition, distributors worked with drug manufacturers to limit pharmacy ordering to ensure that the entire drug supply was not allocated on a “first come, first served” basis.
These decisions, although difficult, were critical in ensuring patients were able to continue receiving life-saving medications without disruption.
By the end of June, the gap between drugs ordered and deliveries made had narrowed, and pharmacists could once again dispense up to 90-plus days of medication, following their professional judgment and not government orders.
As Canadians spent the summer recovering from the initial onslaught of COVID-19, pharmaceutical distributors like McKesson Canada were thinking about a second wave and started investing in better supply management tools to handle a likely spike in demand this fall.
Because of these investments in technology and communication, as well as increased coordination with manufacturers and governments, Canada’s drug supply is in stronger shape than in the first wave. But the work is hardly finished, considering also the renewed and compounding threat of U.S. importation.
As policy-makers look to reboot the economy sustainably, strengthening the supply of medication is a no-brainer. There are three areas where federal investment can help “build back better.”
First, the federal government should encourage new drug manufacturers to enter the Canadian market. Canadians are relying on too few companies to make their drugs. We need more. Fully one-third of generic drugs in Canada are made by only one or two manufacturers, exposing our most prescribed drugs to shortages.
Second, Ottawa and the provinces should properly fund pharmaceutical distribution. The challenge of sustaining a strategic pharmaceutical distribution system has increased dramatically in recent years as funding has tapered off.
The ability to continue serving communities in northern and rural Canada is at risk. We could learn a lot from Australia, which reoriented its distribution funding system to stimulate investment in rural communities.
Finally, there is tremendous potential to further leverage our pharmaceutical distributors for critical health needs. Six provinces already use pharmaceutical distributors to expand access to seasonal flu shots, all the while reducing waste. As we eagerly await a COVID-19 vaccine, there is overwhelming evidence that supports using our distributors to deliver the vaccine directly to community pharmacies to reach Canadians in a nationwide vaccination program.
COVID-19 has hit all of us hard, including our drug supply. Smart, focused efforts to sustain our drug supply system can ensure that we are ready for whatever comes next.