Direct-to-pharmacy distribution is a pain
From Mr G. W. Dobson, MRPharmS
Recently, I received a prescription for a particular type of insulin. I tried to order it from a wholesaler but it was repeatedly out of stock.
Two days later, I queried this with the wholesaler and it said that stock would not arrive until 25 November and it would not be checked in until 26 November (2008), meaning that I might not receive it until the day after that. I then telephoned the manufacturer to try to source it direct.
The manufacturer did not believe that the wholesaler was out of stock and said that it would have to confirm this before considering a direct supply. It confirmed this, telephoned me back and faxed me an order form. However, it said that it would not release the stock until I had faxed an anonymised copy of the prescription (to prove that I required the stock), which I did.
Last Friday, 21 November, the distributor delivered my order except it was the wrong insulin: it had delivered £1,000 worth of random insulin that was intended for a hospital in London. After numerous telephone calls, I discovered that my order had gone to the hospital.
The manufacturer asked me to store the wrong insulin in my refrigerator and that it would arrange to collect it on Monday. I was pleased that it also promised to deliver my insulin before close of business at 12:30pm on Saturday. Alas, nothing arrived.
On Monday morning, the manufacturer telephoned to make sure that the order had arrived and everything was fine. I said that things were as far from fine as they could be. It said that it would speak to the distributor and that the insulin would definitely arrive on Tuesday 25 November.
One hour later, the insulin arrived but I was concerned that it had not been refrigerated over the weekend and, while I was trying to establish this, the distributor telephoned me to say that it had indeed not been refrigerated and that I should not dispense it. It also promised to deliver my order on Tuesday 25 November.
As I write, I look forward to the arrival of the order. Fortunately, because the mother of the patient in question is organised, the nine-year-old patient has enough insulin.
Does anyone else remember the good old days when pharmacists used to be able to order routine medicines from wholesalers, the wholesalers delivered them and they were supplied to patients? Happy times — until someone invented direct-to-pharmacy distribution and others jumped on the profit bandwagon.
Gavin Dobson
Kinross
Template for those frustrated by direct-to-pharmacy distribution
From Mr M. Bennett, FRPharmS
Further to the letter from Gavin Dobson (PJ, 29 November 2008, p621) relating to the frustrations of direct-to-pharmacy distribution, I can relate to the scenario and I am sure many other community pharmacists can as well.
I have devised a template for a letter to be sent to the patient’s MP whenever this problem occurs, in the hope that political pressure may produce some action.
Martin Bennett
Sheffield, South Yorkshire
Editor, The Pharmaceutical Journal, replies
To see the template letter, please visit www.pjonline.com/mpletter
Time for a rethink
From Mr M. B. Hutchison, MRPharmS
I agree with Ross Ferguson (PJ, 18 April 2009, p452) about products being out of stock at wholesalers. I have had to order four items direct from manufacturers in the past month after being told by my wholesaler that they are “manufacturer can’t supply”.
When I telephone the manufacturer I am told there is not (and never has been) a supply problem and that my wholesaler has not placed an order for that product. When I telephone the wholesaler it tells me it cannot get the product. Who are we supposed to believe?
As for the products “on quota”, it seems that, if I order one pack more than I used the previous month, my wholesaler will not supply it. However, if I telephone the manufacturer, I can get the product sent direct without problems.
The whole system needs a rethink because it seems it will take the death of someone not receiving an essential medicine for wholesalers to get their act together and the Government to order a reappraisal of direct-to-pharmacy schemes.
Michael Hutchison
Alloa, Clackmannanshire
Lack of availability of some medicines a growing concern
From Mr M. James
If there is one thing we can all agree on, it is that the lack of availability of some essential medicines is a growing cause for concern.
In that context, the Pharmaceutical Services Negotiating Committee is to be commended for its initiative in bringing together wholesalers and manufacturers to try to forge an agreed way forward.
After many meetings and much debate, the result is a proposal that the PSNC and the British Association of Pharmaceutical Wholesalers have jointly put to manufacturers. In truth, the proposal will not solve the issue of shortages, but it would be an improvement on the current situation.
At present, the arrangements for obtaining product direct from manufacturers are the worst of all worlds: bureaucratic, confusing, costly and slow. Processes vary from one manufacturer to another. It involves manual intervention and invoicing, which results in additional cost. It consumes valuable time that should be used to deliver patient care.
The joint proposal, where wholesalers would hold additional buffer stock on consignment and release it on authority from manufacturers, would at least make supply more responsive and use the existing distribution infrastructure.
Can a solution be found to the wider issue of availability? Will we be able to get back to a situation where patients no longer have to wait several days for their medicines to arrive? Having had countless discussions on this subject, I am not optimistic. The bottom line is that manufacturers will not increase supply into the UK if they then see supplies flow out to mainland Europe.
We can — and regularly do — argue with manufacturers that they have set the wrong quota levels between wholesalers, that dynamic changes in demand mean quota assumptions have been overtaken by events and that forecasts, based on historical data, often bear little resemblance to market realities.
However, manufacturers can see a picture of the UK domestic demand through NHS Prescriptions Service data and IMS figures. Armed with that information, they have been able to persuade the UK’s health departments that they are supplying sufficient stock to meet UK patient demand.
As a result, all the main wholesalers have had to introduce new stock management measures to try to ensure that all our customers get fair and equitable access to the stock we receive.
However, I recognise that this is cold comfort when a pharmacist is trying to explain to a distressed and angry patient why he or she cannot find any wholesaler with the medicine that patient urgently needs.
There are, of course, several reasons why availability problems arise: a manufacturer’s chosen prewholesaler may simply not turn up with stock one week, there could be a production problem, or stock is being “skimmed” and exported.
On the last point, the risk for pharmacy is that the focus shifts on to it — exactly the point Sue Sharpe, PSNC chief executive, made at the local pharmaceutical committees annual conference (PJ, 21 March 2009, p317). Also, within the past week or so, we have seen articles in newspapers linking pharmacy exporting with shortages.
Of course, pharmacies have a legal right to export and the UK has benefited for years from parallel imports. However, unless we move the argument forward, we will remain caught between Scylla and Charybdis — an increasingly uncomfortable and risky position for all of us.
Mark James
Group Managing Director
AAH Pharmaceuticals
Frustrated with stock quota systems
From Mr P. J. Reeder, MRPharmS
Am I alone in getting increasingly frustrated with the stock quota systems set up by some companies?
Hardly a day goes by now without a patient having to wait for medicines or to have alternative prescriptions organised because manufacturers have set quotas and our wholesaler has no stock.
The needs of patients appear, to me, to be of no concern to these companies and they do not seem to realise the disruption that is caused to the operation of a busy pharmacy. Calls to customer service lines are not dealt with because there is nobody to answer the telephone or I am promised a call back from the commercial manager, which never materialises.
Having been a pharmacist for 35 years, maybe I am just becoming a grumpy old man, but I care about the patients I serve and they rightly should expect the best service.
Phil Reeder
Lincoln
Mud slinging at the competition
From Mr E. A. Goran, MRPharmS
I was flabbergasted to receive a letter from John Geddes, sales director, Alliance Healthcare, bemoaning the poor level of service we might receive when the Lilly UK supply chain model starts in July 2009.
I quote: “Supplier two can only offer a service which is not in line with current market standards in terms of the afternoon cut off times and the delivery windows not being fixed.”
I can only assume that Mr Geddes is completely out of touch with the service level that his own company has imposed on its agency customers. In particular, the cut off time of 11.15am, which is imposed on a large proportion of its customers, is far too early to be of practical use, and a delivery window that is anything but fixed (both morning and afternoon).
Also, “in stock” levels are poor and becoming worse, and there are persistent problems with products that are available, but are not delivered.
I can safely say that the service level I receive from Alliance Healthcare is, without doubt, the poorest and most frustrating I have encountered in the 20 years that I have been trading.
I advise Mr Geddes to stop whingeing and put his own house in order before slinging mud at his competition.
Elliot Goran
York
Alliance Healthcare responds
From John Geddes, sales director, Alliance Healthcare
Alliance Healthcare is not attempting to stop or obstruct the implementation of Lilly UK’s direct-to-pharmacy model. We simply have concerns about some of the proposals that we have been made aware of to date and the recent letter sent to our customers is a reflection of this.
Should Mr Goran have issues regarding the service he receives from Alliance Healthcare, we would ask that he contacts us. We would be happy to discuss these concerns directly.
ABPI committed to developing a solution
From Mr D. Fisher
We note with some alarm your article on medicines shortages (PJ, 30 May 2009, p631) that contains misleading and inaccurate information, and I would like to expand on my comments that you helpfully added to your online article.
First, let me say how much we welcome the unequivocal statement from Sue Sharpe of Pharmaceutical Services Negotiating Committee, who has condemned the practice by pharmacists of diverting stock intended for UK patients, to other countries, purely for profit. Responding to her comments in the article itself, as she is aware, we do share her concerns about medicines supply.
However the Community Pharmacy Scotland spokesman quoted is wholly wrong to state that UK medicines going abroad “represents a tiny proportion of UK supply”. IMS published data have demonstrated that 4 per cent of medicines supply for UK patients is being diverted abroad, and this figure is growing rapidly.
Over 200 of the leading products in the UK are now being exported and, in nearly 30 cases, over 20 per cent of individual products’ volumes are being exported. One truly life-saving medicine is currently experiencing over 70 per cent of its UK supply being exported. The same analysis demonstrates that this trade, which is putting UK patients at risk, is being carried out by 11 per cent of pharmacy outlets in the UK.
Unfortunately some of the “hot spots” from where UK medicines are being exported are in Scotland. So the action of a minority of pharmacists in Scotland is artificially creating shortages for other pharmacists who decline to take such risks, and have the needs of their patients as their sole aim.
Manufacturers have in place systems to supply medicines directly in an emergency when such shortages occur. Regrettably these systems are now having to be used on a frequent basis due to the diversion of UK medicines by some pharmacists.
I agree that this is creating extra bureaucracy and cost to us all, both manufacturers and NHS. However, our main concern remains to ensure adequate supply for UK patients.
If we are to find a solution, then we must be clear about the root cause of the problem. Having identified and quantified the problem, the Association of the British Pharmaceutical Industry is fully committed to working with the PSNC, Department of Health and others to develop a sustainable solution.
David Fisher
Commercial Director
Association of the British Pharmaceutical Industry
Why the surcharge?
From Mr J. R. Ahmed, MRPharmS
Currently, I only use Alliance Healthcare for agency lines. I declined to sign up for a full wholesaler account when its representative asked me to do so shortly after the order agency scheme was set up.
Alliance Healthcare informed me in February 2009 that I would be surcharged for low spend to the sum of £250 (plus VAT) per month if I ordered non-agency lines.
The area representative rang me to say that, in order to avoid this surcharge, I would have to sign a form to stop any non-agency lines being ordered, but she did not know why she had previously registered me as a full-line account when I had declined to do so. No letter of response arrived.
In April and May (2009), I have been surcharged for ordering Xenical, a product that is termed a “reduced wholesaler item” and not an agency line. I have refused to pay the surcharge and will continue to do so since I did not sign up for a full wholesaler account so should not receive non-agency lines.
Alliance is responsible for this situation and appears to be trying to cream off whatever it can from customers. If I am receiving other agency lines daily, then why the surcharge? Roche products can only be ordered from Alliance or AAH, so why is this not classed as an agency line?
Jawaid Ahmed
Birmingham
Tiny proportion of UK supply
From Mr H. McQuillan, MRPharmS
I note with interest the “alarm” David Fisher, commercial director, Association of the British Pharmaceutical Industry, expresses in his letter with regards to “misleading and inaccurate information” contained in a News item on medicines shortages.
Community Pharmacy Scotland stands by its statement that exporting, a completely legitimate trade in the EU, represents a tiny proportion of UK supply. I am also not so keen to rely on contractor-supplied IMS data to draw conclusions.
As for “hotspots” within Scotland being responsible for creating shortages for Scottish pharmacists and patients, I think this is beyond belief and a red herring. Consider the following scenarios:
I agree with Mr Fisher’s statement that “we must be clear about the root cause of the problem”. What I disagree with is that branded stock shortages are being created by pharmacists’ actions. I am sure that Community Pharmacy Scotland will be one of the “others the ABPI is fully committed to working with to develop a sustainable solution”.
Harry McQuillan Chief Executive Officer Community Pharmacy Scotland