Jeremy Main, the independent chair of the Healthcare Distribution Association (HDA), has said his organisation will embark on an awareness drive to enlighten pharmacists on the reasons drug shortages occur amid concerns that “rumours” and “disinformation” are being spread through the pharmacy profession.

Main (pictured), who recently became the first independent chair of the HDA, the representative body for pharmaceutical wholesalers, told ICP he wanted to work with pharmaceutical manufacturers, pharmacists, regulatory bodies and other stakeholders to explain why shortages happen and explore potential remedies.

He said the difficult situation pharmacists found themselves in regarding shortages, which could be worsened post-Brexit, was being compounded by disinformation that was adding confusion to frustration.

“What we want to do at the HDA is spend some really serious quality time looking at shortages which is an industry issue and doing two things. One is explaining why they happen better because there’s a lot of reasons,” Main said.

“Secondly, how we can explain that better, make people aware of why these things are happening and thirdly, think about ways in which we can improve the situation by working collaboratively across the industry.”

When asked if the HDA will explain to pharmacists directly and more clearly why shortages happen, Main said: “Exactly. We want to explain why they happen. (There was) recently a list and there’s probably at least 50 to 70 different reasons why there can be a shortage in the marketplace. And it varies all the way through from the manufacturer to the dispensing point.

“To give you some examples, it can be a change in regulation for the manufacturer, it can be a change in manufacturing location, it can be logistics problems, it can be a bottle-up at Calais, it can be stock forecasting. There’s a lot of reasons.

“At the HDA, we want to make all stakeholders more aware because I think the problem is a lot of rumours go around the place and a lot of disinformation which we want to correct.”

He added: “There is not enough knowledge and information about why a shortage is happening and then also there is quite a lot of disinformation which goes around as well. Transparency would be a good thing…as much as possible.”

When asked where the disinformation has come from, whether it was being perpetuated by the national press or even the pharmacy press, Main said: “I think it’s easy to pick on something specific or a moment in time. It’s a bit like the generics stuff about ‘oh suddenly prices have gone up.’ In the media you only get a certain piece of information at any one time. I think you find that in the national press don’t you.

“There’s a specific piece of information that’s valid today, it may not be valid tomorrow. It’s (about) trying to get some of the more holistic messages across, the bigger picture and the whole context in terms of what is really happening.”

Main conceded the HDA did not “have a blueprint” for improving its communication to pharmacists on the reasons behind shortages but insisted he wanted “to work with all stakeholders and partners to think about ways to make people more aware of why shortages happen and have more visibility and more communication.”

He also denied that pharmaceutical wholesalers were making large profits from generic drugs.

A report in June by the National Audit Office said the price of some generic medicines increased “unexpectedly” in 2017-18, marked by an “unprecedented” rise in the number of requests from pharmacies for concessionary prices.

The price increases, the report concluded, generated unforeseen costs for clinical commissioning groups, the net spend on concessionary-priced medicines reaching £315 million in 2017-18, seven times more than in 2016-17.

The report also cited analysis by the Department of Health and Social Care that found pharmaceutical wholesalers enjoyed “unexpected” increases in their margins in 2017, albeit something “it could not fully explain.” 

“There is no question that wholesale margins are under pressure, not only here but on a global basis, and I think you can see that in share prices. You can see some of that happening in the (United) States as well,” Main said.

“The supply chain is always under pressure. Generics are a relatively small part aren’t they. They are 4.3 billion out of branded drugs which are about 14 billion. The thing about generics is it is a fairly fluid market.

“It’s a commodity market, it works on supply and demand. There’s big financial benefits for pharmacists and the government out of that and it varies quite significantly.

“So I’m not sure one snapshot actually shows you too much about margins. But I think in general they are under pressure.”

He added: “I certainly don’t think that suddenly, wholesalers are making huge amounts of money from generics that they weren’t making before.”