Increased drug purchases by pharmacies from wholesalers in the week before the Covid-19 lockdown

In February 2020, the novel coronavirus (COVID-19) developed into a pandemic, with the number of COVID-19 cases increasing dramatically in many countries [1,2]. Television and newspapers reported daily on the spread of the pandemic, quickly triggering fears among the population of an impending economic crisis and recession [3].
As early as February 2020, numerous reports appeared online suggesting that the spread of COVID-19 could jeopardize the global supply of pharmaceuticals, as many of the medicines used worldwide are manufactured in China and India, where production has come to a standstill due to disease outbreaks [4]. The German Minister of Health feared that the COVID-19 pandemic could lead to drug shortages in Europe, although there was no concrete evidence of short-term supply bottlenecks [5]. Reports were published in various countries that shelf-stable foods such as flour, pasta, and canned goods were quickly sold out, leading to shortages [3]. At the same time, pharmacies reported shortages of the fever-reducing painkiller paracetamol due to strong demand during the coronavirus pandemic. Demand for over-the-counter vitamin supplements was also significantly higher than usual in March [6]. To date, no studies have been published on pharmacy sales of various medications for the treatment of acute and chronic illnesses during the pandemic. It can be assumed that patients will purchase larger quantities of medications and request more prescriptions if they fear longer quarantines. The aim of this study was to investigate the development of pharmaceutical purchases during the coronavirus crisis.

>> The outcome of this study was the development of pharmaceutical purchases by packaging unit between calendar weeks 6 and 16. The analyzed indication groups were selected based on the anatomical classification of pharmaceutical preparations of the European Association for Pharmaceutical Marketing Research (EphMRA) and divided into cardiovascular drugs, psychotropic drugs and neurological drugs, as well as analgesics and phytopharmaceuticals. Cardiovascular medications included diuretics (ATC: C03), beta-blockers (ATC: C07), calcium channel blockers (ATC: C08), angiotensin-converting enzyme inhibitors (ACE inhibitors) (ATC: C09A, C09B), angiotensin II antagonists (ATC: C09C, C09D), lipid-lowering agents (ATC: C10), vitamin K antagonists (ATC: B01A), and new oral anticoagulants (NOACs) (ATC: B01E, B01F, B01X). Psychotropic and neurological drugs included antidepressants (ATC: N06A), antipsychotics (ATC: N05A), hypnotics and sedatives (ATC: N05B), tranquilizers (ATC: N05C), antiepileptics (ATC: N03), anti-Parkinson drugs (ATC: N04A), and antidementia drugs (ATC: N07D). Analgesics included ibuprofen, paracetamol, diclofenac, and acetylsalicylic acid. The most commonly purchased herbal
Anti-infectives were also analyzed as a group and included “Angocin”, “Bronchicum”, “Bronchipret”, “Gelomyrtol”, “Prospan”, “Sinupret”, “Soledum” and “Umckaloabo”.

Statistical analyses
This study is descriptive and no hypotheses were tested.
Results
Figure 1 shows the number of packs of cardiovascular medications purchased by pharmacies during calendar weeks 6 to 16, with a spontaneous significant increase in week 12. Compared to week 11, the increase in week 12 was 43% for vitamin K antagonists, 39% for ACE inhibitors, and 37% for beta-blockers.
Figure 2 shows the same analyses for psychotropic and neurological medications. Although this figure also shows a significant increase in week 12, it is less pronounced than for cardiovascular medications. The largest increase was for anti-Parkinson's medications and sedatives (24% each), followed by antiepileptic drugs (23% each). Purchases of antidementia medications increased by 16% between weeks 11 and 12.
Figure 3 shows the development of purchases in packaging units for non-prescription (over-the-counter) medicines in Germany. The strongest increase (99% increase) was observed for paracetamol. For ibuprofen,
No increase was recorded. The development of
However, sell-in data in this market differs from these results. The largest increase was seen in week 10 compared to week 9 (248 pp for paracetamol, 51 pp for acetylsalicylic acid, and 42 pp for ibuprofen).
discussion
To the best of our knowledge, this is the first study to examine the impact of the COVID-19 pandemic on pharmacy purchases of various medicines used to treat acute and chronic diseases. In our study, we showed that pharmacy purchases were significantly higher in calendar week 12 than in the previous week. Although there were differences between the different therapeutic classes studied, the trends were very similar across all classes.
Social media has recently played a crucial role in disseminating public health information. In addition to fears of contracting the virus themselves, many people prepared for potential quarantine as the virus began to spread. If a family member contracts the virus, the quarantine period is at least two weeks. In severe cases, treatment and quarantine times may be longer. People with chronic illnesses may have tried to stock up on the medications they need to treat their conditions (e.g., antidiabetic or cardiovascular medications).
Another possible reason for the increase in purchases could be fear of drug shortages, as many drugs are manufactured in countries where the pandemic began earlier than in Germany (e.g., China). As a result, people tried to buy the medicines they needed from pharmacies while they were available. Finally, there is the possibility that consumers are fearing the closure of all shops and pharmacies, as well as private medical practices.
practices have made panic purchases.
Panic buying is not a unique German phenomenon. For example, in mid-March, when the epidemic was spreading but there were no official confirmations yet, there were signs of panic buying of antiviral drugs in Guangdong and Beijing [7]. Similarly, reports in the Chinese media that dried forsythia fruit extracts inhibit SARS-CoV-2 in vitro triggered panic buying of this traditional medicine both online and in stores [8]. Similar behaviors were observed in other countries in March 2020, including Japan, Australia, Italy, Spain, the UK, and the US [9].
Missing or inaccurate information can lead to hysteria and panic buying [10]. From a psychological perspective, there are several explanations. This behavior, which leads to taking measures to protect oneself and family, may be a way of coping with a stressful, previously unknown situation. But it could also be a manifestation of the conflict between the desire for routine and the uncertainty about how long the pandemic will last [9].
From a healthcare perspective, such panic buying could have a positive impact on adherence. By purchasing medications to cover a potential quarantine period, patients avoid treatment gaps and continue taking their prescribed medications for as long as recommended by their doctors. Interestingly, in Germany, the significant increase in purchases of fever-reducing medications such as paracetamol was observed shortly before the WHO declared COVID-19 a pandemic, while the increase in sales of long-term medications for the treatment of chronic diseases occurred shortly before the lockdown was declared. However, it should be noted that the treatment of chronic diseases such as diabetes or hypertension requires continuous monitoring, including blood pressure and HbA1c measurements. Therapy often needs to be adjusted by changing the dose, switching medications, or prescribing additional medications [11, 12]. This therapy monitoring could become rare if patients do not visit their physician because they have purchased enough medications to last for several months. It is therefore important to examine patient visiting behavior over the coming months of the Covid-19 crisis.
The smallest increase was observed in purchases of antidementia drugs.
There are several possible explanations for this, but currently none of them is supported by clear evidence. The population with dementia is, on average, older than all other population groups. At the same time, this population group has the highest mortality rate from COVID-19 [13,14]. However, the majority of these patients are supported by healthcare professionals (nurses) or live in nursing homes [15]. There are several factors that influence medicine purchases in this population group, as it is often not the dementia patients themselves but several other people and institutions that may be responsible for pharmacy visits. However, in a study conducted in the United Kingdom, older people described themselves as less likely to self-isolate than younger people [16].
The results of this secondary data analysis should be interpreted against the background of several limitations. First, the database does not contain information on patients, diagnoses, or prescriptions. It can be assumed that there is a high degree of correlation between the purchasing and sales data of pharmacies in Germany. Since the packaging units cannot be assigned to specific patients, it is not possible to stratify the analyses by age or gender.
The results of this retrospective cross-sectional study suggest that the Covid-19 lockdown in Germany was associated with a significant increase in purchasing behavior in pharmacies for various markets (including cardiovascular drugs, antidiabetics, psychotropic drugs, and neurological and antipyretic drugs).
Further studies are needed to examine sales data and estimate differences in panic buying by age and gender.