The UK continues to experience shortages of many common prescription drugs, despite efforts to strengthen supply chains.
Drugs for ADHD, epilepsy, GLP-1s for type 2 diabetes and weight loss, as well as ramipril (which is used to treat high blood pressure and heart failure), have all faced supply shortages since the end of last year or beginning of this year.
As products become unavailable, pressure increases across the system to secure alternatives. If patients do not receive treatment promptly and consistently, their quality of life can suffer.
Medicine supply shortages pose a significant threat to the UK’s public health. And, as a recent government inquiry revealed, the UK’s current medicine supply chain is very vulnerable to disruptions.
Making supply chains more resilient would normally have been the best strategy for ensuring the UK can maintain supplies of medicine and recover quickly when problems do occur. But growing global and supply chain pressures mean medicine shortages are likely to continue unless deeper system weaknesses are addressed.
Why shortages keep happening
Medicine supply chains are global, highly regulated and complex. Challenges such as factory maintenance, transport delays or rising demand in other countries can quickly affect medicine supplies in the UK.
Recent disruptions, such as the Iran conflict, have raised concerns about future medicines security. The war has already driven up the cost of some prescription drugs by 30%. This is largely due to the jump in gas and diesel prices, making manufacturing and shipping more costly.
The rising cost of raw materials and energy can also contribute to increasing drug costs for patients and healthcare systems.
The supply and demand for medicines can fluctuate as well depending on disease prevalence, access to diagnosis, market pricing and people’s ability to pay. For instance, ongoing HRT shortages have partly been blamed on increased demand for the drug following GP consultations.
It can therefore be challenging to ensure a constant supply of medication. But this is not just a UK issue – it’s a worldwide problem.
The UK competes globally for access to medicines and critical ingredients. Approximately 80% of the medicines used to treat UK patients are non-branded or “generics”. These are mainly manufactured in China and India. Generics are clinically effective but less expensive than branded drugs, so there’s a heavy reliance on them internationally.
China and India are also the primary manufacturers of many basic pharmaceutical ingredients. This increases global reliance on these countries. Manufacturing problems or transport delays in these countries can quickly reduce worldwide access to medicines.
Community pharmacies, which buy the medicines dispensed to patients in the UK, are directly affected by drug shortages. When medicines are not available and demand exceeds supply, market prices can rise quickly. These independent businesses may therefore be financially challenged by drug prices.
Although the Department of Health & Social Care (DHSC) has agreed prices and will refund pharmacies for the medicines they buy, the pharmacies can still make a loss on the purchases – and DHSC payments are always in arrears.
Patients usually access their medications through their local community pharmacy. But in the past five years, more than 1,000 community pharmacies have closed in the UK. Some of the causes of these closures are directly related to drug supplies, including medicine reimbursement and pressure due to shortages. Closing local community pharmacies puts pressure on the remaining pharmacies to maintain stock.
If patients cannot access their medicines, it can trigger panic orders and stockpiling, which may place even greater pressure on already fragile supply chains and waste. In some cases, these shortages also create opportunities for counterfeit medicines to infiltrate the market, as desperate patients seek alternative sources to meet their needs.
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Low medicine prices have also been cited as a key reason for suppliers leaving the market or companies such as AstraZeneca reducing UK investment.
A lack of timely and informative communication about prescription drug shortages can lead to patient concerns, providers panicking and trading opportunism. Patients do not know why they can’t access their medicines or how long the situation will last.
What can we do?
There are calls from within the sector for earlier signalling of supply issues and changes in demand. This would give UK suppliers more time to find alternative medicines, plan production schedules, reduce delays and disruption and hopefully better prevent medicine shortages.
Effective and timely communication is also needed to support providers in doing their jobs and allay patient concerns.
Focusing on the pricing of medicines and its wider impact on our healthcare system is another important factor. The UK Life Sciences Sector Plan aims to support the sector and attract investors to strengthen local medicine production and reduce the impact of medicine shortages.
Educating stakeholders can help reduce medicine shortages by improving awareness, coordination and responsible behaviour across the supply chain. Educating community pharmacists and patients of the causes and impact of medicine shortages is also key. This can reduce panic orders, unnecessary stockpiling of medicines and prevent counterfeit or unregulated products entering the market.
The UK government should also collaborate more extensively with European partners by sourcing products from trusted or geographically close countries. This would not only promote stronger relationships but also create direct access to alternate medicine supply sources.
The current market leaders benefit from economies of scale and scope, however. More local and distributed manufacture may be stable but expensive. Key ingredients still often have single (or few) sources.
Improving supply resilience is essential for maintaining the availability of prescription drugs and reducing service pressures. But it isn’t the only strategy the UK government should rely on. Appreciation of the role of the patient and the provider as recipients is important in managing the impact and continuity of supply issues.
For patients experiencing shortages, it’s important you don’t panic buy and stockpile items, and continue ordering your prescription only when needed. Your pharmacist can also give you advice on what to do if your usual medicine is not in stock.
