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Medicine shortage? Overlooked implications of Brexit

June 28, 2016

First, don’t panic. This is complicated, and the implications are scary, but at the moment I’m not hearing about any problems in the UK, and they’d likely take a few months to show up anyway.

When Greece went into financial meltdown last year, one of the first and most badly hit areas was availability of prescription medicines, especially more expensive meds.

There are lots of reasons for this. The simplest is that most meds are traded internationally in dollars. With worries about Greece returning to the Drachma, wholesalers were demanding payment upfront in cash, which healthcare organisations didn’t have.

The more complicated reasons are mostly around ‘International Reference Pricing’. This is where the health authorities in one country look at the prices paid by other countries to decide how much they are willing to pay for medicines. Greece was on a lot of reference lists for other European countries, so if the manufacturers dropped prices to a point where Greece could afford to keep buying their drugs, other countries would expect the same low prices.

There wasn’t an actual shortage of medication. At the time, I kept getting medication dispensed by pharmacies in England that was labelled in Greek, a process called ‘parallel trade’ – the meds were brought by wholesalers at lower Greek prices, then sold at higher UK prices. The medication was there, it just wasn’t getting distributed to the people who needed it.

The UK is unusual in that we don’t use International Reference Pricing. The NHS has very strong monopsony (single purchaser) power, and uses NICE to work out how much new medicines are worth by looking at how much they will benefit patients. This means that a lot of other countries and organisations look to the UK as a reference point when deciding how much to pay for medicines. So if we in the UK start paying less, profits for pharmaceutical companies will fall internationally, so they will be extremely reluctant to give the UK a big discount if we have difficulty paying them in dollars for a while.

Don’t panic. I’m not saying that this will definitely happen. The NHS is very different from the Greek healthcare system. The same factors which mean other countries look to the NHS for pricing guidance also mean that the NHS has a fair bit of clout when it comes to negotiating with pharmaceutical companies and wholesalers. The NHS is already good at using generic medications, which are cheaper and often have multiple suppliers, rather than expensive branded medicines. I’ve not heard yet of any problems in the UK. However, this explains why I am concerned that one of the first ways the problems with Brexit will hit most people is with medication shortages. I would expect this to show up particularly in high-value in-patent medicines, for example newer atypical antipsychotics such as quetiapine.

As patients, there isn’t much we can do about this at the moment. I’d suggest making sure you pick up repeat prescriptions in plenty of time before running out, but that’s always a good idea. Write to your MP, and to your local newspaper (more people read and trust local papers than national) pointing out that the NHS is going to need more money to pay for medicines while the pound is weak. In England you can also write to your local Clinical Commissioning Group, in Wales to your Health Board, in Scotland to your NHS Board, and in Northern Ireland to your Health and Social Care board.

It wouldn’t be appropriate for me to give advice on clinical practice in a blog, but there’s already been a lot of good work in the NHS on rational prescribing of generics, and minimising drug acquisition costs. I’d also advise anyone who works in healthcare and feels able to speak up to talk to their elected representatives about this and other issues.

Don’t panic. None of this has happened in the UK yet. Stockpiling drugs is a bad idea for all sorts of reasons, and in any case your GP isn’t allowed to prescribe more than a few months at a time. If you have worries about your own situation, please talk to your doctor – I’m not qualified to treat individual patients, and even if I was then taking medical advice from strangers on the Internet is a bad idea.

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