UK pharmacies say they are being forced to dispense antibiotics to treat strep A infection at a loss due to soaring wholesale prices, as health chiefs denied there were any shortages.
An unusually early outbreak of group A streptococci, mainly among schoolchildren, has driven up demand for penicillin and amoxicillin, the main antibiotic treatments, in recent days, adding pressure on already overstretched pharmacies.
A total of 851 cases of Strep A were recorded by the UK Health Security Agency in the week ending November 20, compared to an average of 186 in the same period in recent years. The bacterial infection, which usually causes mild symptoms including a sore throat or rash, has led to the deaths of 16 children across the UK, according to the UKHSA.
In response to the outbreak, health officials lowered the prescription threshold for penicillin and amoxicillin, and even considered allowing the administration of preventative antibiotics to close contacts of infected people, which led to an increase in demand.
As a result, pharmacies reported having difficulty sourcing drugs from wholesalers and whenever antibiotics were available said the wholesale price exceeded the compensation they received from the NHS, meaning that they were losing money on every prescription.
“All those things that used to be taken for granted – that you push a button, order amoxicillin, have it arrive the next day, have the pharmacy make some money, and have the patient get their medicine – it’s all gone,” said Olivier. Picard, managing director of Newdays Pharmacy and board member of the National Pharmacy Association (NPA). He said several parents told him they had called more than a dozen pharmacies and found no antibiotics in stock.
Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said the situation was unsustainable. “We need better visibility into the supply of wholesalers and manufacturers, and we need pharmacists to be properly reimbursed for these drugs because they cannot afford to give them away.”
Health officials and wholesalers insist there are sufficient stocks of antibiotics, but have acknowledged they are slow to get to pharmacies.
“We have a lot of antibiotics,” NHS medical director Stephen Powis told the BBC. “Obviously we asked people to prescribe them a little earlier. This means pharmacies have needed extra supplies, so the government is working with wholesalers to make sure those supplies get out.
Three pharmacies told the Financial Times that the minimum they had paid for a liquid solution of amoxicillin or penicillin from wholesalers, including Alliance Healthcare and AAH, in recent days was £5, more than double the amount they will receive in compensation as part of the NHS medicine. tariff scheme.
Martin Sawer, executive director of the Healthcare Distribution Association, which represents wholesalers, said the higher price was a direct reflection of how much wholesalers had to pay manufacturers. He denied there was a shortage, but said the supply chain had to adapt to “the sudden huge increase in demand”.
Sigma Pharmaceuticals has apologized for setting its wholesale price at more than £19 for the liquid solution of amoxicillin, almost 10 times the reimbursement cost paid by the NHS to pharmacies, attributing the error to a ” computer problem”.
Andrew Lane, chairman of the NPA, has urged the Department of Health and Social Care to update its preferential price for amoxicillin and penicillin “as quickly as possible” so pharmacies do not have to “pay the bill” of the streptococcus A epidemic.
If a drug is added to the concession list, pharmacies are reimbursed for any price increases.
A total of 158 drugs were on the November concession list. Janet Morrison, chief executive of the Pharmacy Services Negotiating Committee, which negotiates concession lists with the Health Department, said pharmacies were at “breaking point”.
She said they were “powerless in the face of market forces working against them, and urgently need assurances from the government that all drugs will be available, and not at grossly inflated prices.”
The health department said there was “no shortage of suppliers”, explaining that “prices may fluctuate” due to the surge in demand for certain antibiotics. “But no company should use this as an opportunity to exploit the NHS.”