Zi statement on the current discussion about supply bottlenecks for medicines
26.01.2023 14:50
Regarding the current discussion about supply bottlenecks for medicines, the CEO of the Central Institute for Statutory Health Insurance (Zi), Dr. Dominik von Stillfried: "Supply bottlenecks for medicines are not a new phenomenon. What is new, however, is the scope of the active ingredient groups that are difficult to supply and the number of patients affected.
Based on the current delivery bottleneck list from the Federal Institute for Drugs and Medical Devices (BfArM), more than 1.4 million patients received at least one prescription for one of the active ingredients currently reported there in November 2022. Only the prescriptions that could be redeemed in a pharmacy are recorded. Although this only affected two percent of all drug prescriptions, it affected around 75 percent of all prescribing practices. General practitioners and pediatricians in particular are confronted with limited availability: 87 percent of the prescriptions for active ingredients with supply bottlenecks come from them. This particularly affected cardiovascular medications (e.g. antihypertensives), antibiotics and medications for obstructive respiratory diseases (e.g. bronchodilators such as salbutamol). How many patients did not receive the originally prescribed medication cannot be shown based on the pharmacy billing data and is therefore unknown.
Delivery bottlenecks are not supply bottlenecks
The causes of the delivery bottlenecks are diverse: In addition to production problems, the current wave of infections has also led to bottlenecks. The reason for this is that the sometimes enormous increase in demand cannot be compensated for with the existing production capacities. So far, most patients have still been able to receive care despite the delivery bottlenecks. In plain language, this means: A delivery bottleneck does not become a supply bottleneck! But the truth is that the best therapy will no longer be possible in every case.
Increased risk of resistance development
A look at antibiotics, for example, shows that you can usually switch to an active ingredient that is (still) available. However, in case of doubt, this also means that the principles of rational antibiotic therapy must be deviated from and a less suitable antibiotic must be used. Under certain circumstances, this can increase the risk of resistance developing. A particular challenge is supply bottlenecks for active ingredients for the treatment of cancer. These are often part of established therapy regimens and have no suitable alternative.
Workload increases
In addition to fears, irritations and possible health problems for the affected patients, the workload in practices and pharmacies is also increasing. If drug therapy needs to be changed in chronically ill patients, consultation and, if necessary, additional blood sampling is indicated. With time resources already limited, this leads to a further increase in work intensity. It is even more serious if no alternative active ingredient is actually available, but the patient still needs urgent care. This is usually achieved through individual imports, splitting into multiple packs or changing therapy intervals.
In order to really reduce or even prevent delivery bottlenecks, politicians must address the actual causes and create more transparency about delivery routes, which are often only known in detail to the respective pharmaceutical companies. The focus is on: reducing dependencies on contract manufacturers in Asia and strengthening remaining locations in Europe as well as monitoring delivery bottlenecks more consistently so that measures can be taken at an early stage and prevention is possible in the future.”
