Drug shortages squeezing pharmacies

James
James McLeod
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Pharmacists dealing with short supplies on national level

Recently, a patient waited in line at a St. John's pharmacy to fill a prescription, only to be told that the medication was on back order.

Then, the next person in line stepped up for a different drug, and was told the same thing.

Telegram photo illustration/Thinkstock Images

Recently, a patient waited in line at a St. John's pharmacy to fill a prescription, only to be told that the medication was on back order.

Then, the next person in line stepped up for a different drug, and was told the same thing.

The pharmacist said she's never seen anything like it before; "pages and pages" of drugs that pharmacies just can't get.

Keith Bailey, a pharmacist with Shoppers Drug Mart, said things are slowly improving, but they've been grappling with shortages all year.

"At any time you're always going to have three or four products that are unavailable in the marketplace - that's just the way it is," he said. "But this year it seems to be a very weird year. At any one time you could have 20, 30, 40 different shortages of different products."

Pharmacists have needed to get creative: recently Bailey had to substitute a children's liquid version of a drug, because the adult pills were out of stock.

"So, you had to take a load of the kids liquid to equal up to the adult tablet," he said. "Other times you might actually have to work with the physician to actually change the drug."

In the case of one drug - metoclopramide, an anti-nausea treatment often used on cancer patients - there is no easy substitute.

Bailey is one of the pharmacists with the Pharmacists' Association of Newfoundland and Labrador (PANL) to undertake a survey, trying to get to the bottom of the problem.

He said most of the problem seems to be with generic drugs, as opposed to the brand-name variety, but PANL hasn't been able to put it's finger on a single, clear cause for the shortages.

Part of the problem, he said, may be that manufacturing drugs isn't an easy, overnight proposition. A pill maker will typically make a big batch of one medication, then stop production, clean all the equipment to prevent contamination, and make a big batch of something else.

The problem isn't restricted to Newfoundland.

A survey conducted by the Saskatchewan College of Pharmacists looked into the same problem.

The college found that nearly 70 per cent of the time, manufacturers gave no reason for the shortages.

Julie Tam, with the Canadian Generic Pharmaceutical Association couldn't give a single clear reason for the shortages, although she said that there are also shortages among brand-name drugs.

One problem, Tam said, was global shortages of the active ingredients in drugs.

Another issue is that if a batch of pills isn't up to Health Canada's safety standards, it gets tossed and can't be quickly replaced.

"For the well-run system there is no shortages, but the reality is that you're always working to get the supply of the active ingredient, making it in time and working with what the shelf-life is," she said.

The other problem, Tam said, is that with generic drug companies profit margins squeezed, they don't have much wiggle-room.

"Depending on the drug you don't always have the luxury of making lots of extra batches," she said.

In Ontario regulations recently changed; generic drug companies used to be able to charge 50 per cent of their brand-name equivalents, but now they can only charge 25 per cent.

Quebec and Newfoundland are expected to follow suit.

If there's a problem with one drug manufacturer - a bad batch of pills, for example - the effects can ripple across the whole industry.

"When they don't have any, every pharmacy switches to every other manufacturer and gobbles up whatever supply they have," Bailey said.

In this province, the situation appears to be improving, but as long as the shortages last, Bailey said, they put a strain on the whole health care system.

Pharmacists have to spend more time consulting with physicians and developing workarounds, and they suffer reduced confidence from patients.

He said it would be easier to deal with, if the drug companies would at least keep pharmacists in the loop.

In the Saskatchewan study, 93 per cent of respondents said they got no advanced warning of shortages.

"It's really hard for physicians and the patients who are stuck in the middle," he said. "We don't know, sometimes, that things are short until we pick up the phone and try to do an order."

jmcleod@thetelegram.com

Organizations: Saskatchewan College of Pharmacists, Shoppers Drug Mart, Association of Newfoundland and Labrador Canadian Generic Pharmaceutical Association Health Canada

Geographic location: St. John's, Newfoundland, Ontario Quebec Saskatchewan

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Recent comments

  • I buy
    July 20, 2010 - 13:03

    Outlaw the Pharmacy Board. This is the worst thing this province has ever done for the health care of the people in this province. They dictate what you can and can not take. It is a monopoly that has created more harm then good. This government wants people on welfare. Preventing access to medications that allow people to continue to work is criminal.

  • Lisa
    July 20, 2010 - 13:02

    I work for a generic pharma manufacturer and we struggle with short supply of many products. Backorders are a complex issue and it is in no way a price fixing situation, as Seamus suggested. Manufacturing drugs is a very complex process and there are very tight rules around their release to the public. If something is not up to scratch, all batches are rejected and not released for sale. This is to keep everyone safe. It can take months for scientists to resolve the drug manufacturing issues and be ready to try another batch with different recipes or ingredients. No pricing conspiracy...just quality first.

  • Curtis
    July 20, 2010 - 13:02

    @seamus... I don't think you understand the situation as demonstrate by your comment. Whether a drug is backordered or not, ther price stays the same as the gov't sets the price. The only time costs would go up is to switch to brand name and then it is increased costs to people, lost sales to generic manufacturers, and brand name companies depositing a large cheque. There is no benefit for a generic manufacturer to have a back order. Unless of course the thought of moving generics away from ON and PQ to the other provinces that pay a more reflective cost would occur. This issue is plaguing the whole country, so that goes out the window. Regulated prices do not go up.

  • I will not be a victim
    July 20, 2010 - 13:02

    If people would stop double-doctoring and the pharmacies monitored this practice more closely,maybe there wouldn't be a shortage.Then the people who NEED medication can get it,not just those who get prescriptions to SELL. I overheard someone at work the other day complaining that they had to actually get out of bed and go to the doctor to get a prescription for Percocet,and that thye would not bother getting out of bed except that they were going to sell the pills for $100.All you have to do is look for the clinics with the line-ups outside to see where the abuse is going on.

  • Annette
    July 20, 2010 - 13:02

    I went to get my medications today and they didn't have enogh. I have to wait until Monday to get it. I always get mine refiled a few days early so waiting until Monday is not big deal for me. But I can see if they have to wait longer then that or those who wait until they are down to their last pill before getting it refiled that this could cause a problem for them.

  • Seamus
    July 20, 2010 - 13:02

    Sounds to me like a great example of manipulating supply and demand and price fixing (Both highly illegal but nearly impossible to prove). You have a so called bad batch that you have to toss and then the price of the existing product on the shelf goes up. Next good batch you have the prices stay up because that is what the consumer is used to paying. All the pharmaceutical companies take a hit from time to time for the good of the whole. Their revenues continue to rise annually and they are putting less product on the shelf and thus have less overheard and a higher profit margin.