Medicine shortage exacerbated by inflexible pricing, says industry analysis

Ireland is facing a more acute shortage of medicines than the European Union as a whole as winter bites and the health system contends with a rise in Strep A and RSV infections, according to a new analysis.

Industry insiders say Ireland is being harder hit because of the low price it is prepared to pay for many long-established but critical medicines.

A total of 187 medicines used by Irish patients are currently out of stock, according to a list maintained by the medicines regulator – the Health Products Regulatory Authority (HPRA) – including 11 that feature on the World Health Organisation’s “critical medicines” list.

Of these, 40 per cent have just a single supplier. That means pharmacists have no way of sourcing an alternative for patients. According to an analysis being published this week, it also leaves Ireland out of sync with the rest of Europe. A report published by the European Commission last year said that, across Europe, just 25 per cent of medicines in scarce supply come from a single source.

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The medicines currently experiencing shortages, according to the HPRA are used across a range of health areas, including infection, pain relief, cancer treatment, seizures, mental health, blood pressure, diabetes and hormone replacement therapy.

Amoxicillin and penicillin, which are currently in high demand as winter infections rise, are among those on the World Health Organization critical medicines list that are currently experiencing supply issues. Another medicines on the WHO critical medicine list is the widely-used chemotherapy drug Vinorelbine.

“Our analysis is further evidence that, while the problem of medicine shortages is a global one, Ireland is increasingly an outlier when compared to neighbouring countries,” said Sandra Gannon, managing director of Azure Pharmaceuticals, which specialises in producing additional supplies of out-of-patent medicines that are still in widespread use.

“The consequence is that patients and pharmacists are in an ever-worsening situation. Patients will be increasingly anxious. Pharmacists are exposed by the reality of single-source supply situations, overstretched doctors and inflexibility to give them new mechanisms to respond.”

“We are paying the price for not paying the price,” Ms Gannon said, saying that it had been evident for a number of years that Ireland’s ongoing downward pressure on drug prices was leaving the State increasingly exposed to medicine shortages.

“The disparity between Ireland and other EU markets is particularly acute in older, low-value medicines,” she said, citing the price set by the Health Service Executive for paracetamol in Ireland of €1.73 per 100 tablets, compared with €3.51 across Europe, a difference of 51 per cent.

“The problem for the industry generally is that prices in the EU are so low that companies have shut down the plants that make the active pharmaceutical ingredient (API) and moved to the lowest-cost source,” Ms Gannon said.

“For paracetamol, there are only two plants globally still making the API and they are both in the Far East. As demand has surged in the wake of Covid as people got out and about again, so the price from those plants has risen – by more than 300 per cent.”

Ireland lacks a flexible system that allows the reimbursed price to rise for drugs that are important but in short supply, she says.

“We use reference pricing – comparing a medicine’s price against a basket of European countries – to drive prices down; we should be open to using the same system to adjust prices up when justified,” she says.

Even in the UK, where Ms Gannon says they have pushed prices down “to the lowest of the low”, there is a mechanism for adjusting the price when shortages arise. She cited a brand of sleeping pill that usually cost the health service 80 pence sterling for a packet of 28 tablets, on which the price has risen to £28 because of a temporary supply issue.

“We are a small market on the edge of Europe with additional costs involved with some of the lowest prices across the EU. In those circumstances when a shortage arises, you will not be well served.”