The pressure is likely to increase further in the coming weeks. Recently, for example, the representative of the wholesalers, PHAGO President Andreas Windischbauer, emphasized to ORF.at that it is already clear from information from manufacturers that delivery bottlenecks will increase significantly from January.
This prognosis is also supported by the fact that China recently abruptly abandoned its zero-Covid policy and since then the infections there have increased dramatically – and with it the need for medicines. Along with India, the country is the most important producer of the individual components of many medicines. Exports are likely to decline given domestic demand.
Equal distribution to pharmacies
Because of the current delivery bottleneck, pharmaceutical wholesalers are organizing an even distribution of antibiotics to local pharmacies. This means that pharmacies cannot place unlimited orders, so everyone is supplied. This should also prevent hamster purchases by healthy people, as they already exist according to the pharmaceutical industry association (Pharmig). However, these would have exacerbated the situation, and countermeasures must be taken.
In any case, given this situation, it sounds logical for a country to try to increase imports by paying a higher price. Because there is no joint European procurement – as happened with the CoV vaccines. The national healthcare systems and thus the respective drug prices are too different at the moment. So far, no country has really wanted to be “interfered” with this, that is, to delegate competencies to Brussels.
Magic word or red rag
A quick solution is currently not in sight – all the more so since it is a structural issue. Germany, the Ministry of Health emphasizes, has a completely different pricing system. There the prices are linked to the active ingredients – keyword prescription of active ingredients. In Austria, “pricing is tied to the product in question”. In both cases there are state requirements or a state price commission.
Health Minister Johannes Rauch (Greens) – like some of his predecessors – has long wanted doctors to prescribe active ingredients instead of certain medications. Then it would be possible for pharmacies to independently dispense a generic drug with the same active ingredient.
Currently, a pharmacy can only do this after consulting the doctor who issued the prescription over the phone. This takes time, which is lacking – especially in times of waves of illness like the current one. If several drugs with the same active ingredient are used, it is less likely to become bottlenecked, so the logic goes.
hardened fronts
Similar to the supply bottlenecks in 2019, a conflict over the prescription of active ingredients, which has existed for many years, is now boiling up in view of the shortage of medicines. The fronts are correspondingly hardened: the Austrian Health Insurance Fund (ÖGK), the Ministry, patient advocates and pharmacists are in favor of this system changeover, the Medical Association and the pharmaceutical industry – including the generics producers – are against it.
According to Rauch, Austria is the only EU country in which active ingredient prescriptions do not yet exist. Rauch had announced a corresponding regulation in September. Of course, they don’t exist yet.
Social security applications
In the short term, there is only one screw that can be turned: The prices for prescription drugs, the costs of which are covered by health insurance, are set by the social security agencies in the private sector. According to the Ministry of Health, pharmaceutical companies can apply for price increases. According to the ministry, this also happens “continuously”. The social security system then examines applications from pharmaceutical companies for price increases “particularly with regard to security of supply”.
And the ministry refers to measures already implemented to prevent supply bottlenecks. For example, an export ban is imposed on prescription drugs if they are in danger of running out. This prevents parallel exports to countries with higher price levels for these drugs.
No quick fix
Of course, the first question in times like these is what can be done to make more medicines available in the country. There are many ideas, from joint European purchasing to bringing outsourced drug production back to Asia to a national emergency storage facility for drugs. And, of course, drug prices are an important factor in supply bottlenecks.
From the point of view of the German Health Minister Lauterbach, too much attention has been paid to “economisation”, i.e. keeping costs down, as he emphasized according to the “Süddeutsche Zeitung”. The “main thing cheap principle” endangers the supply, seconded the German pharmaceutical industry. The cash registers, on the other hand, see a “considerable Christmas present for the pharmaceutical companies”. Incidentally, the German Foundation for Patient Protection does not expect any major short-term effects from Lauterbach’s legislative plans either.
