The chemists running out of vital drugs — because they’ve been sold abroad

YOU rush to the chemist in your lunch hour, only to be told the medicine your GP has prescribed isn’t available. The pharmacist is very apologetic, but no one has it in stock as there are ‘supply issues’, she says. ‘Try again tomorrow.’

But how would you feel if you knew the reason your prescription couldn’t be filled is because someone had snapped up all the stock to sell for a profit elsewhere in Europe?

It’s not only frustrating, it’s dangerous: as a result of drug shortages patients are being harmed and even hospitalised, according to a survey of GPs and pharmacists for the parliamentary All-Party Pharmacy Group (APPG).

The APPG first noted the problem back in 2012, blaming ‘speculators’ — licensed traders who snap up medicines on the cheap in the UK to sell abroad.

It highlighted the shameful case of a pregnant woman whose pharmacist was unable to get the progesterone tablets prescribed to her to prevent her suffering yet another miscarriage. It took five days to track down the drug. The fate of the woman’s unborn child is unknown.

In other incidents, shortages meant patients with mental health conditions had not got the drugs they needed and diabetic patients had suffered hypoglycaemic attacks and ended up in hospital.

Now, almost five years on, not only has the APPG’s call to restrict the export of UK medicines been ignored, but the number of licensed dealers has risen by a third — and shortages of medicines are worse than ever.

There’s a fortune to be made. Drug companies price medicines differently in different markets — and, thanks to the bargaining power of the NHS, the UK pays much less for drugs than others.

THAT’S good news for NHS budgets — but also tempting to dealers, especially when the exchange rate between sterling and the euro makes export all the more attractive.

Last December researchers led by the Austrian Public Health Institute unearthed the price of cancer drugs in 16 countries and found huge variations. While these are not drugs you’d get from your pharmacist, they show the kind of profit that can be made.

For example, bortezomib (marketed as Velcade), a treatment for cancer of the bone marrow, is priced at £799 in the UK, but fetches £1,138 in Germany, according to the report in the journal Lancet Oncology Research. That’s a quick windfall of almost 50 per cent. Even greater profits are possible with prescription drugs, as an investigation in 2013 by the Irish Economic and Social Research Institute discovered.

Researchers calculated the average wholesale price per dose of 210 prescription drugs sold in eight European countries, and found the NHS consistently paid the least.

Overall, the basket of drugs cost on average £46 per dose in the UK, compared with more than £78 in Germany and as much as £83 in Ireland — two clear opportunities for dealers to export drugs for profits of 63 and 81 per cent.

The practice is legal — but if exporting a drug creates a shortage for the NHS, it becomes a criminal offence, punishable by an unlimited fine and up to two years in prison.

In 2013 the Department of Health promised action, saying the Medicines and Healthcare products Regulatory Agency (MHRA) would carry out ‘a series of targeted inspections’ of licence-holders, promising ‘those breaching existing duties to supply medicines will face the consequences’. But three years on, not a single one has been prosecuted or had their licence revoked.

In fact, now there are even more licence-holders able to profit from the scandal. In 2012 there were 1,700 UK licence-holders. Today there are more than 2,200 and more licences are being issued daily in exchange for the £1,803 fee — 65 were granted in November alone.

And drug shortages continue. In a survey carried out for the APPG between October 2015 and January 2016 over half of pharmacists said drugs were ‘almost certain’ to be out of stock once a day. Nearly 40 per cent of GPs said the same.

Pharmacists reported delays, or the prescription of alternatives, ‘may have or did require patients to receive moderate medical treatment’.

In some cases where the pharmacy was unable to find the prescribed drug, as many as 3 per cent reported that this may have or did lead to the patient being hospitalised. Further evidence emerged in August when a survey by GP magazine also found patients were ‘coming to harm’.

More than 80 per cent of GPs said that in the previous 12 months, shortages had forced them to prescribe a second-choice drug and in one in five cases patients suffered negative effects as a result, ‘including harm or slower recovery’.

Hunting for missing drugs is also costing the NHS valuable time. In the APPG survey, half of pharmacists said they spent 21 to 50 hours a month dealing with shortages.

Shortages of branded medicines have now become so routine pharmacists aren’t bothering to report them, says the Pharmaceutical Services Negotiating Committee (PSNC), which represents NHS pharmacists and runs an online reporting system to list shortages.

Now, says the PSNC, cheaper generic drugs — copies of branded drugs on which the patent has expired — are also increasingly in short supply. Prices of drugs go up when they are in short supply and more and more generic drugs are costing above the price agreed with the NHS. Each month there are more and more of these so-called concession drugs, for which the NHS allows pharmacists to pay more than the agreed price.

WHAT isn’t clear is which of the 2,200 licencees, from individual GPs and High Street pharmacists to pharmaceutical manufacturers and specialist wholesalers, are responsible for the trade.

Several witnesses at the 2012 APPG inquiry pointed the finger at pharmacists. The Association of the British Pharmaceutical Industry (ABPI), the trade organisation for the branded drugs industry, claimed then that some medicines intended for use in the UK were being ‘traded and sold abroad for a profit by a small number of retail pharmacies’.

The ABPI says there is still a problem with shortages in which trading by pharmacists plays a part. ‘ The reasons for medicine shortages are often complex and varied and occur when demand outstrips supply,’ said Dr Rick Greville, director of distribution and supply for the ABPI.

This, he told Good Health, could be caused by manufacturing problems, companies recalling medicines for quality or safety concerns, ‘ or the export of medicines intended for UK patients’.

Like the APPG, the ABPI wants the number of Wholesale Distributor Authorisation licences in the UK, which is ‘well above the European average’, reduced –— or, at least, ‘the activities undertaken when wearing the “hat of a wholesaler” or the “hat of a retail pharmacy” should be clearly separated and declared’.

This, Dr Greville told Good Health, ‘would help manufacturers and suppliers better understand whether an order for a medicine is for local UK use or to be traded’.

Solving the shortage is not as simple as clamping down on export, suggests Martin Sawer, executive director of the Healthcare Distribution Association, which represents the major drugs wholesalers.

Ban exports, he says, and ‘ the whole system will collapse . . . yes, there are occasional shortages but the system also allows imports to make up for those and save the NHS a lot of money’.

And therein perhaps lies a clue to why so little seems to be being done to tackle shortages.

Asked why it had disregarded the call to reduce the number of licences, a spokesman said only that the MHRA ‘recognises that there are a large number of licensed wholesale dealers in the UK. This has traditionally been the case and there is a legitimate role for [them].’

The UK, the spokesman added, ‘ has had an active and diverse licensed wholesale dealing market [that] in the past . . . has seemed to help protect [it] from shortages’.

That isn’t how the APPG saw it. In 2012 it called on the Government to ‘unequivocally state that the interests of UK patients must come first, not provisions concerning the free movement of goods’.

In June this year, MP Sir Kevin Barron, chair of the APPG, wrote to the Department of Health seeking a meeting ‘to consider actions that would improve the situation’.

Five months on, Sir Kevin has not even received a reply to his letter.

A Department of Health spokeman insisted it was ‘on our agenda to take this meeting forward’.