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Supply chain

Pharmacists warn that use of manufacturers' drug quotas is affecting patient care

Pharmacists and pharmacy organisations have clashed with pharmaceutical manufacturers over the use of quotas, which pharmacists say are “impacting significantly” on patient care.

Drugs stacked in a warehouse

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Pharmacists have claimed that quotas designed to manage the supply of medicines are causing “unnecessary distress”

Community pharmacists have called on the government to step in to address the issue of drug manufacturers’ quotas, which they say are impacting on patient care.

Pharmacists have said that the seemingly arbitrary product quotas used by manufacturers that operate direct-to-pharmacy models are “creating havoc” at a local level, and are calling for any use of quotas to be abolished.

Tony Schofield, who has pharmacies in Sunderland and Newcastle upon Tyne, told The Pharmaceutical Journal that medicines manufacturers were “plucking quotas out of the air”, with the result that patient care was being affected.

“It’s causing unnecessary distress at a time when it is already miserable working in community pharmacy,” he said.

“I want it stopped so that wholesalers can buy from manufacturers and pharmacists can buy from wholesalers.”

Schofield claimed that he ordered 45 inhalers from the manufacturer Boehringer Ingelheim at the beginning of December 2018, but the wrong product was supplied. He put in a fresh order but it was rejected on the grounds that he had gone beyond his quota.

He claimed this order was eventually filled but only after he threatened to involve his MP.

Nick Hunter, chief officer for Nottinghamshire Local Pharmaceutical Committee (LPC) and secretary of Doncaster and Rotherham LPCs, told The Pharmaceutical Journal that the use of quotas was “creating havoc” at a local level.

“GPs are tearing their hair out because they don’t know what’s going on and patients get passed from one pharmacy to the next — maybe the third pharmacy may have the drug, but the next month they won’t,” he said.

The biggest problem concerned quotas of the smoking cession drug varenicline (Champix; Pfizer), Hunter said, which some pharmacists are supplying via a Patient Group Direction as part of a locally-commissioned stop smoking service.

He added that pharmacists do not have the time to deal with a number of wholesaler’s and manufacturer’s quotas, and called for the issue to be taken up nationally.

“Only the health minister can resolve this. It’s an ethical issue too, so the Royal Pharmaceutical Society (RPS), national negotiators and the National Pharmacy Association all have a part to play.”

Ash Soni, president of the RPS, raised the issue on Twitter earlier in December 2018, said quota problems had been exacerbated because manufacturers have ignored changing GP prescribing patterns.

He said: “[Quotas] are impacting significantly on patient care. This isn’t just an issue for the RPS. Something needs to be done about this and we need to find a solution — industry needs to take a look again and say what it plans to do to help meet demand.”

The National Pharmacy Association described medicines shortages as a “constant headache” and added that “the medicines supply chain is complex but the arbitrary application of quotas can only exacerbate supply delays”.

The Association of the British Pharmaceutical Industry, which represents drugs manufacturers, said in a statement that quotas were a “legitimate way of making sure patients receive the medicines they need.”

It added: “Manufacturers have, on occasion, received single orders which represent more than the entire UK requirement for one particular medicine. If orders of this level were fulfilled then we would be left with no stock for other pharmacists, and patients in the UK would be unable to get the medicines they need, when they need them.”

Manufacturers, it said, are encouraged to discuss shortages with pharmacists “in areas of genuine need”.

In a statement, Boehringer Ingelheim said it used three wholesalers to deliver products in the UK, and once stock had been sold to the wholesaler it had no legal right to determine how it was distributed.

It continued: “Our understanding is that those wholesalers who do operate quotas have in place routine and rigorous checks to validate supply quantities and requests.

“In those cases where a pharmacy may be experiencing a shortage that will impact negatively on patients, we are able to support them via an urgent supply request, which will allow us to provide a small volume to the pharmacy to cover them over a short-term period.”

The direct-to-pharmacy drug distribution model was introduced more than a decade ago, and was heavily criticised at the time. An Office of Fair Trading investigation into the system in 2007 did not recommend that changes should be made to exclusive distribution deals and no referrals were made on competition grounds.

In a statement, Pfizer said that its supply policy “aims to ensure that sufficient stock is supplied to meet UK patient prescription demand. Pfizer is aware that the existence of a Patient Group Direction can impact local demand for specific products, such as Champix, as well as changes to prescribing guidance and practice change.”

The company said that pharmacists should contact them directly if they had a query on stock allocations.

Pharmaceutical company GlaxoSmithKline announced in October 2018 that it would move from a direct-to-pharmacy model to using wholesalers to distribute its products.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20205932

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