Challenges in accessibility to medicines difficult to source

Abstract

Shortages of medicines are experienced worldwide, with the cause being both supply and demand related. Both BREXIT and COVID-19 presented challenges in accessibility to medicines. The aims of the study were to conduct an evaluation of the situation in Malta regarding out-of-stock medication and to identify challenges in accessing difficult-to-source medicines. A questionnaire consisting of 3 sections; Participant Details, Experience with medicine shortages and Case Studies, was developed and validated. The questionnaires were disseminated to community pharmacists chosen by convenience sampling. Interviews with national health service pharmaceutical procurement officers were then held to obtain further insight on difficult-to-source medications. A total of 125 pharmacists answered the questionnaire (35 male, 90 female). Pharmacists listed 131 medications in the private sector and 44 medications at the national health service POYC level when asked for items being in shortage. In such cases, pharmacists either contacted the prescriber or else dispensed an alternative. An alternative medication was offered to 188 patients, 47 of which did not accept alternative due to concern to their wellbeing. Interviews held with procurement officers at local pharmaceutical wholesalers that supply the private patients’ needs, revealed 3 main challenges in sourcing medications: 1) Malta, being a small market. Suppliers many times prefer to supply medicines to other countries having a larger population. 2) By grouping small orders together, the supply would reach our country however at a delay. These 2 challenges cause short-term shortages. Certain medications are short in supply due to the lengthy process involved in engaging alternative suppliers willing to deliver to Malta. In justified health needs, medications with foreign labels are accepted by wholesalers. Having to add English labelling adds up to the cost of the medication, which is the third main challenge faced by procurement officers in Malta. Solutions offered include actively searching for alternative suppliers, making and maintaining relationships with procurement officers worldwide and having at least a 6- month buffer stock for the projected consumption. Results highlight the need of long-term mitigation strategies to avoid medicine shortages, in view that even when a replacement is available, patients do not always accept an alternative.