Around 400 delivery bottlenecks are currently reported
If you need a medicine, you may hear the pharmacy say: “Not available”. The problem is not new, but it has gotten much worse in recent years.
That occupies one Register, in which the Federal Institute for Drugs and Medical Devices (BfArM) collects the manufacturers’ voluntary reports on delivery bottlenecks. In 2013 there were only 42 reports, currently there are around 400. Currently frequently affected: fever juices for children, antibiotics and cancer drugs.
What patients can do themselves
Pharmacy employees try to help in the event of a shortage by exchanging medicines that are not available for a suitable substitute. It becomes easier if the customers plan with you:
- bring recipes early. If you regularly need medication for chronic diseases, you should submit prescriptions early – not just when the current pack has been used up. This gives the pharmacy staff time to obtain the required medication if necessary.
- Hausapotheke bestücken. It makes sense to have some useful non-prescription medicines at home, for example against pain, fever, colds, diarrhea and for wound disinfection (for more see medicines for the medicine cabinet).
- limit stock. The supply should be small – for the good of the general public.
How to replace missing fever juice
Juices with the active ingredients ibuprofen and paracetamol have been difficult to obtain since the summer of 2022. They are mainly used in small children when they have pain or fever.
Tips: Depending on what’s available, parents can use either juice with ibuprofen or acetaminophen. Alternatively, children’s suppositories with the two active ingredients are also possible – but currently also often in short supply. Older children can also get divisible tablets. Divisible paracetamol tablets can be used from the age of four, divisible ibuprofen tablets from the age of six. With all remedies, you should observe the age-appropriate dosage according to the package insert.
Pharmacies can produce fever juices individually as a recipe. According to the drug authority BfArM, this should only be done with a doctor’s prescription “if the child’s medical condition requires treatment with the active ingredients in question”.
When antibiotics need to be changed
Since autumn 2022, the BfArM has also been increasingly reported to the BfArM for delivery bottlenecks in antibiotics – especially for children. This is where the knowledge of the doctors is required – especially in the event that the pharmacy calls them and says that an antibiotic that has been prescribed is not available.
Specialist societies provide guidance recommendations publishes which alternative antibiotics are possible when the standard therapy for a disease – such as amoxicillin or penicillin V – is not available.
Great need for cancer drugs
In January 2023, medical specialist societies reported in a joint opinion points out that the number of shortages of cancer drugs has increased significantly in 2022. The drugs that have been used successfully for a long time, including tablets containing the active ingredient tamoxifen, are particularly affected. Many breast cancer patients take it for several years after surviving therapy to prevent the tumor from returning.
From January 2022, delivery problems on the part of the manufacturers increased, and since February 2022 there has officially been a supply shortage. In other words: the market was practically empty – with no equivalent alternatives. The situation did not stabilize until April, also due to a special production of tamoxifen tablets from the supplier Hexal.
The main reason: cost pressure in the healthcare sector
The fact that medicines are becoming scarce can be due to increased demand. In the past few months, respiratory infections have increased and a corresponding number of those affected need the right medication. Added to this is the difficult overall economic situation with a pandemic, the Ukraine war and the energy crisis.
Experts see cost pressure in the German healthcare system as the main reason for the bottlenecks. Generics are usually affected – i.e. drugs with active ingredients whose patent protection has expired. Their prices are capped by legal regulations, including fixed amounts and discount agreements:
- A Festbetrag is the maximum amount that health insurance companies reimburse for a drug.
- Both Rabattverträgen health insurance companies write out active ingredients. Those manufacturers who grant the highest discount are awarded the contract and supply the insured persons of the respective health insurance fund. Pharmacies may then only dispense preparations from other companies in exceptional cases.
Six cents a day is no longer economical
The regulations serve to curb expenditure by health insurance companies and thus also for contributors – but may go too far. Generic manufacturers receive an average of 6 cents per daily dose of their medication, writes the industry association Pro Generica. This is no longer economical for many providers.
Possible consequences of the low prices: German pharmaceutical companies are getting out of the supply. In addition, many now have active ingredients produced abroad, especially in India and China. Production there costs less than in Germany, also because of the lower wage level and lower environmental standards. However, it can lead to problems – for example, if a single particularly cheap supplier supplies many customers and suddenly cannot deliver.
Tipp: You can read background information on the production conditions for medicines in the Far East and answers from large pharmaceutical manufacturers to our questions about their commitment to quality, social standards and environmental protection in our article The Silence of the Pharmaceutical Industry.
Test knowledge about medicines and pharmacies
In our Drugs in Test database, you can find more than the Stiftung Warentest ratings 9 000 medicines read – for young and old.
If you Order medicines online you will find ratings for eleven mail-order pharmacies in our test of online pharmacies. Only one does well.
As Store medicines properly and if you expired funds can still take is in our special Expired medicines: throw them away or use them?
Planned law against delivery bottlenecks
Federal Health Minister Karl Lauterbach is currently planning a generics law to combat the causes of the supply bottlenecks. vertices are already available. Among other things, there should be no more discount contracts and fixed amounts for important children’s medicines. In addition, health insurance companies should increasingly consider suppliers who have active ingredients produced within the EU in discount agreements. It will probably take a few more months for the law to be finalised.
Fixed prices suspended for many children’s medicines
An urgent step has already been taken: since the beginning of February 2023, the fixed prices for various children’s medications have been suspended, including ibuprofen juices, paracetamol suppositories and antibiotic suspensions. This was decided by the GKV-Spitzenverband, the association of statutory health insurance companies in Germany. The regulation is initially valid for three months. It remains to be seen whether this will lead to pharmaceutical companies being able to provide more children’s medicines in the short term.