The Estonian pharmacists association (EAL) says that availability of medicines is in crisis in Estonia.
The EAL has appealed to pharmaceuticals wholesalers, their representative organizations and government agencies, saying that over 10 percent, or 331, of the over 3,000 medicines registered with the state agency of medicines (Raviamet) are at critical supply levels.
“Medicine delivery difficulties are interfering with or hindering the treatment of tens of thousands of patients today,” said Kaidi Sarv, chief pharmacist at the EAL, which represents qualified, working pharmacists.
“The [state] agency [of medicines] has already registered supply problems with 10 percent of medicines. The number of medicines with actual supply difficulties is likely to be even higher,” she continued.
“There are plenty of signals from pharmacists belonging to the association that wholesalers are unable to supply many of the medicines they need. We do not know whether similar problems exist within the wholesalers’ own pharmacies,” Sarv continued.
Sarv noted that communications between pharmacy wholesalers and her sector was not good.
Sarv claims wholesalers’ systems often give a pharmacy the chance to order the medicine, but when that order is received, the necessary medicine is not included in the shipment.
“Often there is no prior information that the drug is not actually delivered,” Sarv added.
The government recently did an about turn on pharmacy reform which would have placed the sector more in control of individual pharmacists, by making it mandatory that a minimum of 51 percent ownership of a pharmacy was in a qualified pharmacist’s hands. However, after strong opposition from lobby groups like the Estonian Pharmacies Association (EAÜ), representing the large chains, the coalition scrapped the proposed bill, soon replacing it with a new bill which does practically the opposite, lifting the requirement for pharmacists to have a 51 percent stake or higher in an operating pharmacy and allowing others to have an ownership stake, stopping the bar on pharmacy chains owning outlets, as well as relaxing requirements for pharmacy branches.
The EAL, representing pharmacists, is also calling for a crisis plan and solutions to be found involving pharmaceutical wholesalers, drug manufacturers, and representative organizations in the medical sector, due to the crisis in the availability of medicines.
The Family Physicians Association (Eesti perearstide selts) and the Association of Pediatricians (Eesti lastearstide selts) had also already drawn attention to the problem, Sarv said.
“Pharmaceutical wholesalers are focused on pharmacy reform; patients’ needs are neglected,” she added.
Only pharmaceutical wholesalers have the right to import medicines, the largest of which are Postimees Group owner Margus Linnamäe’s Magnum Medical OÜ (which owns the Terve Pere Apteek OÜ Family Pharmacy chain), Tamro Eesti OÜ, the owner of the BENU pharmacy chain) and Apteekide Koostöö Hulgimüügi OÜ.
A separate aspect of the proposed pharmacy reform would have made over-the-counter drugs available in other sales outlets such as kiosks or gas stations; currently pharmacies are the only places to buy such products.
The pharmacies say they expect clear information about precisely which registered medicines are difficult to obtain, or can only be obtained in small quantities.
“Operational information from a wholesaler to a pharmacy would help prevent patient treatment problems and reduce the number of patients seeking a drug running from the pharmacy to the pharmacy,” said Sarv.
“Second, we need a clear solution for wholesalers to be able to supply pharmacies with necessary medicines for patients.”
In response, the drug wholesalers union (Eesti ravimihulgimüüjate liit – distinct from either the EAÜ or the pharmacists’ association) says that it shares concerns about the availability of medicines, though qualified this by noting it agreed with the Raviamet. It also said that its members were not the source of the issues, which are a Europe-wide problem.
“This is an issue that requires a joint effort by all parties involved. The difficulty of supplying medicines is a problem not caused by wholesalers,” a wholesalers association statement on Saturday read.
“We agree with the Raviamet’s view that the problem of access to medicines goes beyond national borders,” said wholesalers association chief Teet Torgo.
“The issue of access to medicines is becoming increasingly topical worldwide and there is no simple one-size-fits-all solution.”
According to Torgo, pharmaceutical wholesalers across Europe are looking for an answer to how to solve the problem of medicine availability.
“Unfortunately, there is no single quick and specific prescription here. The problem of drug availability often starts with the production of the drug, sometimes earlier. Here, it is unfounded and unfair to blame wholesalers because their hands alone on solving the problem remain short.”
The wholesalers, for their part, say they are doing their best to find the solutions for importing medicines to Estonia.
“Wholesalers value and treat all their partners equally, whether it be a state-owned hospital, a nursing home, a pharmacist or a larger chain pharmacy, or a wholesaler supplying pharmaceuticals,” Torgo added.
“Our common goal is to help the patient. Hopefully the members of the pharmacy association will understand and share this goal,” he added.
Torgo said that the state medicines agency’s public register contains information on medicines which experience supply difficulties, with every drug experiencing around 300 delivery difficulties being reported to the pharmaceutical companies, adding that it was often a question of the maker of the medicine in question now not exporting it to Estonia.
“Unfortunately, in almost half the cases, the truth is that the pharmaceutical manufacturer has stopped marketing these medicines in Estonia,” Torgo said.
“Fortunately, in most cases, drug treatment can be overcome or at least alleviated by other treatment options,” he added.
“The Raviamet’s recommendations have also been made public within in the register of medicinal products.We strongly recommend that both pharmacists and doctors take note of this,” Torgo added.