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my vague understanding is that drug shortages are a problem generally and it stems from the situation that has arisen in that many commonly used drugs are nearing the end of patent or have become generic...pharma' co's despite high R&D/regularity/trials costs haven't got a pipeline full of nice new superstar drugs hitting the market to maintain earnings and manufacture of existing products is being dumped if not profitable or manufacture continues but by the cheapest and not the most reliable routes/contractors...pretty normal product life cycle stuff then add in that in the mature large economies like the US have a highly regulated but free market in which a handful of buyers set the price for the majority of prescribed drugs but the free market on the supply side says stuff it we may want to appear responsible but we answer to shareholders
Brexit related? yes and no...pretty sure if still lived in UK that I'd be stockpiling the drugs my daughter depends on everyday to stay alive...in the last few years have seen supply side issues with 2 out of 3 when production locations changed add in NHS stockpiling and a pretty creaky industry resorts to rationing
Was surprised earlier in the week that Pharmacist had to check with supplier if could get me a replacement epipen as still in short supply after last years can't get for months problems
My test strips have been reduced from 2 boxes to 1, my insulin has been reduced from 10 vials to 5, I am challenged every time I order a prescription to change my test meter and strips to an alternative that is cheaper. I am not sure it is anything to do with supply but GP's managing stricter budgets.
This is what I don't get. It isn't as if we are going to use less, we'll just put more prescriptions in.
Pretty much all the UK's insulin supply is imported. There will undoubtedly be some attempt at stockpiling going on, which will have ramped up for the March date earlier this year and again now. The question is whether individual GP surgeries and regions have been given guidance to limit prescribing to allow the stockpiling to accelerate. It doesn't help if GPs and the DoH are not communicating with patients, as HtS will testify.
None of it inspires confidence that we won't be utterly ****ed in the event of No Deal. The whole thing is a shambles.
To be honest, if I were the OP, I would already have made an appointment to discuss this with the Practice Manager. The waste of his/her time is the penalty they pay if they withhold crucial medication without explanation.
my vague understanding is that drug shortages are a problem generally and it stems from the situation that has arisen in that many commonly used drugs are nearing the end of patent or have become generic…pharma’ co’s despite high R&D/regularity/trials costs haven’t got a pipeline full of nice new superstar drugs hitting the market to maintain earnings and manufacture of existing products is being dumped if not profitable or manufacture continues but by the cheapest and not the most reliable routes/contractors…pretty normal product life cycle stuff then add in that in the mature large economies like the US have a highly regulated but free market in which a handful of buyers set the price for the majority of prescribed drugs but the free market on the supply side says stuff it we may want to appear responsible but we answer to shareholders
This isn’t really causing acute shotages.
What is causing the current round of shortages is stockpiling.
We are stockpiling at work, doing this means that our team aren’t focussed on reviewing and releasing batches - they are focussed on reviewing and releasing things like raw materials to produce a batch. Meanwhile we have batches building up in the warehouse that haven’t been released for consumer use. Then when we do try to release, we have more deviations than usual - so the process is delayed more than normal - because manufacturing have been working like lunatics trying to smash out as many batches before brexit as possible.
Insulin will definitely be hit, it has nothing to do with what you are taking about and everything to do with the fact that it is hard to produce (so generics manufacturer’s don’t bother) and that the distribution chain is rather complicated.
Half-wits like Andypaul will keep ignoring what people who actually work in this field think though.
Us prostate sufferers are in for an interesting time as both Finasteride and Tamsulosin are on the at risk list of shortages after the event.
I think I have about 48 hours or so after I stop peeing before I need to be in A&E and then a ward bed.
Some of the recent shortages have been due to the pound being cheap and pharmacy wholesalers selling their stockpile off to take advantage of the better profit margin. The minister issued guidance/an order to stop this recently.
will keep ignoring what people who actually work in this field think though.
I think the people of this country have had enough of experts etc.
I thought I had read that GPs have been asked to minimise prescribing to stop people stockpiling? One thing for sure - if I needed insulin I would be stockpiling as much as I could. Its a bit beggar your neighbour but its a life and death issue
Prescription went in last night. Let's see what happens on Friday when I go and get it.
Oh, and to whoever it may concern, **** you again. I'm still raging after re-reading your comment. Best hope that we never meet.
my daughters prescription included glucose tablets, which was put on there by the diabetic team in the hospital for obvious reasons. The doctors decided to remove it from the prescription and when questioned they just said that she didnt have enough hypos. The diabetic team are writing to the practice manager and various other bodies to complain about this prat. He doesnt even have the records on her T1D so it was an uninformed decision to cut back, he has never even seen her regarding her T1D.
surely the glucose will be cheaper off prescription? Or do diabetics get an exemption from prescription changes? Or are yo in scotland?
Yetidave, you can buy dextrose tablets over the counter if needed.
Stockpiling is a major factor, be it in the supply chain or by the end user. The amount of medicines that are thrown away is amazing. As beneficiaries of the NHS we all have a responsibility to try and cut down on waste. The whole just in case mentality would change dramatically if we had to pay the actual costs involved.
If you had entered a cycling event and the organiser was giving you a free spare inner tube, most people would take it. If you were offered a second free tube you'd probably decide that it was prudent to take that also. However, if the second spare tube was £5 the vast majority of people would make do with the one free spare.
Yes, the above is a massive generalisation but many people need to think differently for the NHS to function in what, for a variety of reasons, is a difficult time. Blaming this and that will make no difference. Thinking carefully about what you are demanding may.
Stockpiling coldchain medicinal products is particularly problematic. There is simply a finite number of refrigerated storage areas in GDP licensed warehouses.
Stockpiling is a major factor, be it in the supply chain or by the end user. The amount of medicines that are thrown away is amazing. As beneficiaries of the NHS we all have a responsibility to try and cut down on waste. The whole just in case mentality would change dramatically if we had to pay the actual costs involved.
If you had entered a cycling event and the organiser was giving you a free spare inner tube, most people would take it. If you were offered a second free tube you’d probably decide that it was prudent to take that also. However, if the second spare tube was £5 the vast majority of people would make do with the one free spare.
Yes, the above is a massive generalisation but many people need to think differently for the NHS to function in what, for a variety of reasons, is a difficult time. Blaming this and that will make no difference. Thinking carefully about what you are demanding may.
LOL @ Comparing insulin medicine with spare inner tubes.
Now I’m all for railing against the abuse of medicine, but the majority of waste comes from people not sticking to their prescriptions and not taking the drugs when they need to.
You sound like a Tory who’s telling people they need to buck up and be thrifty/ration for the benefit of the glorious brexit war.
Rationing won’t help - most people are prescribed what they need. What will help is not ****ing brexiting.
Isn't there a Magic Medicine Tree growing in the same garden as the Magic Money Tree which is looked after by the DUP? And doesn't that very same garden host the Magic Radioactive Isotope Hedge which supplies all the isotopes to keep the x-ray scanners working? I'm sure Boris said something like that but I do find it difficult to stay focused on his waffle
Is it uncommon to have supply issues? No due to manufacturing, importing and unforeseen problems such as natural disasters but to then to add the massively real issue brexit and a no deal brexit will cause just exacerbates these issues.
Yeti GPs will sometimes remove items from prescriptions that are infrequently used and/or cheaper to buy over the counter. Glucose tablets can be bought in pharmacies and supermarkets for pennies.
Does the Slovak Republic have a large drugs export market?
That free inner tubes analogy… does the poster think that diabetics choose to use more insulin than they really need? Or that they are throwing it away? Or that some of us non-diabetics are injecting ourselves with it to “enjoy” the thrill of a risky hypo?
Indeed. We do it for a laugh too. The added risk of hospitalisation just adds to the thrill.
Is it uncommon to have supply issues?
Broadly speaking yes, it's uncommon.
At a UK level you can see the list of products 'officially' in short supply i.e. those where the marketing authorisation holder are in correspondece with the MHRA regarding an issue preventing supply:
https://www.sps.nhs.uk/category/shortages-discontinuations-and-expiries/
At an EU level, shortages affecting multiple markets are collated by the EMA:
Yeah Tallpaul I maybe should have used unheard of rather than uncommon.
22 shortages in the EMA since 2013......look at all those shortages in the UK alone this year.
Does the Slovak Republic have a large drugs export market?
~EUR 400 million total revenue generated by Slovakian drug manufacturers in 2017. Countries like Slovakia are certainly growing their capacity for manufacturing and make attractive locations for generics production and as service providers to the European Pharma Industry.
When my previous company were looking at transfer of QC activities from UK to mainland Europe as contingency for post-Brexit batch release, we found that there were plenty of companies offering services at attractive prices with no impact to quality and able to demonstrate an exemplery inspection history from national and international regulators
Tallpaul,
Our place just has a plan to move a few key personnel (QP's) who are, I assume, registered in Europe as well in case we lose equivalency - between sites. We have QC facilities in mainland Europe as well.
Not that it will help with the distribution issues associated with biologics.
22 shortages in the EMA since 2013……look at all those shortages in the UK alone this year.
I'd caution interpreting the difference in that way. As an example, here is Irelands list which has 165 current entries (some replication due to multipe strengths of same product):
https://www.hpra.ie/homepage/medicines/medicines-information/medicines-shortages
So, a few months ago it took my pharmacy over a week to get my insulin.
With all the worry I put in a repeat as soon as I was able to on line.
I also ordered my libra sensors, still only getting 2 at a time.
Any way the sensors were ready but the doctors have not sent them the Order for insulin, still says pending on the doctors web site.
Let’s see whaT happens in the next few days.
There's not a whole lot of replication on there for 2019 Tallpaul.
Any way the sensors were ready but the doctors have not sent them the Order for insulin, still says pending on the doctors web site.
We had that as well… script for test strips sent to pharma, but script for insulin held back, despite being requested together at the same time. I had to go in and insist, and take it myself to pharma. Script still not fulfilled (so GP was right not to forward it at that point I suppose). Going back to pharma again on Friday.
Popped in on the off chance today; picked up six week’s worth.
Be pushy and chase up what you need, no point moaning, just insist on what your family needs. And don’t accept ‘just in time’ supply of what they need, as if we’re living though normal times... no one currently really knows what will happen or when, with you know what. Get more than a month’s worth this month.
Matt24k
Member
Stockpiling is a major factor, be it in the supply chain or by the end user. The amount of medicines that are thrown away is amazing.
With some drugs, sure. But with insulin, no, because nobody stops taking insulin. The only time you're ever going to have wastage is if you change regime which is very rare (I've literally changed insulin three times in 34 years of being a diabetic) or when you die, which is rarer but not massively so.
Stockpiling is a major factor too, but in this case that just moves demand around, it doesn't increase it. And since the brexit deadline is 3 weeks away and we have literally no idea what's going to happen, not having a small stockpile of medication that your life depends on is pretty daft.
Yeah but you just need to buck up Northwind.
You ****ing layabout remoaner traitor. Your disease is your fault anyway! It’s a lifestyle choice!
You could make it go away if only you belieeeve hard enough!
Only poor people get diseases Northwind, you’re not a poor person are you?
#nukefrance #bringbackthespitfire
But with insulin, no, because nobody stops taking insulin.
Not many but there is some who are shockingly bad at taking it.
Yeah but you just need to buck up Northwind.
You * layabout remoaner traitor. Your disease is your fault anyway! It’s a lifestyle choice!
You could make it go away if only you belieeeve hard enough!
Only poor people get diseases Northwind, you’re not a poor person are you?
#nukefrance #bringbackthespitfire
I hope this was a joke, if not you sir are a *
I'm suspecting it was a joke.
Currently sat in hospital with my T1 son. Very bad headaches and BG through the roof.
His pump was due to be renewed 9 months ago. Its now out of warranty so if it breaks we are knackered. No sign of it being replaced yet.
The amount of time we spend in and out of the pharmacy is crazy. I'm going back later to see if mine has arrived. Requested a week ago, one of which is readily available, the other has supply issues. Not got either.
Ive just got enough to see me through these delays as its the occasion I've forgotten to take the drug has meant I have a few days spare now. Not acceptable if your life depends on a drug.
Mine doesn't but I'll just be poorly.