‘Not sustainable’: Medicine shortages in focus

There are currently more than 330 medicines in short supply according to the Therapeutic Goods Administration (TGA), with almost 80 more prospective shortages.
 
With the TGA also now listing 44 medicines as critically low or completely unavailable, GPs are urging more to be done to address supply issues and the knock-on effect on vulnerable patients.
 
‘That’s a really long list of medications and it’s very impactful on general practice and our patients,’ RACGP Victoria chair Dr Anita Muñoz told newsGP.
 
‘Unfortunately, there’s an expectation from Government at the moment that GPs and pharmacists come up with solutions to the shortages, including medication substitution or withholding medications for use only in certain subsets of patients.
 
‘Although we can sometimes substitute a medication for others temporarily, there are many instances where we have very limited options to do so.’
 
‘Patients genuinely go without or receive sub-optimal care for a period of time while they’re waiting for the supplier to resume.
 
‘And that really isn’t a sustainable way to solve this issue.’
 
It is a view shared by the National President of the Pharmaceutical Society of Australia (PSA) Dr Fei Sim who told news.com.au that ‘more needs to be done to ensure a consistent supply of PBS medications’.
 
‘Many people rely on these essential medicines for their health and wellbeing,’ she said.
 
Dr Sim also acknowledged that shortages are a long-term issue that has been exacerbated by the pandemic’s impact on supply chains. She said the entire health sector is working with the Department of Health and Aged Care (DoH) on minimising disruptions.
 
Shortages have been reported for a range of medications, including off-the-shelf cold and flu medications and the diabetes drug Ozempic.
 
Managing conditions such as diabetes in the face of medicine shortages is of particular concern to Dr Muñoz.
 
‘Diabetes is such an important topic and getting good control can be so difficult for patients and their doctors,’ she said.
 
‘If we’ve got medications that are working with minimal side effects for someone, it really is problematic to have to change those regimens even temporarily because of the impact on control, or because of the impact on side effects.’
 
Marnie Peterson, CEO of Generic and Biosimilars Medicines Association (GBMA), this month said that the medicines industry sector is working towards building greater supply security.
 
She pointed towards new strategic agreements with the Federal Government, which she says will help the situation.
 
Under so-called Minimum Stockholding Requirements set out as part of the agreements, manufacturers will be required to hold four to six months’ supply for many medicines listed in the Pharmaceutical Benefits Scheme (PBS) that are prone to shortages.
 
‘While these measures will not prevent shortages that are outside of the control of Australian companies, they will help to ensure that Australian manufacturers are better placed to continue supply when global disruptions occur,’ the PBS website states.
 
‘Greater buffers will allow time for supply disruptions to be resolved and ensure better continuity of supply for Australians, including through identifying alternative sources of supply (where possible).’
 
However, for Dr Muñoz, that arrangement feels a long way away.
 
‘There’s many months of pulling rabbits out of hats to come up with solutions for patients and to work with pharmacists to choose alternatives,’ she said.
 
She warns that changing medications increases the likelihood of mistakes and urged for as much action as possible to ease the disruptions.

‘We are far enough into this pandemic that we have had sufficient time to come up with upstream solutions for these kinds of issues, rather than plugging the system with downstream temporary measures,’ she said.
 
‘Chopping and changing and making last-minute changes can confuse patients, and only increases the chances that medication misadventure will happen.
 
‘We really cannot rely on this as a strategy.’
 
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