February 1, 2023

UK pharmacies say they are being forced to hand out antibiotics to treat Strep A infection at a significant loss due to rising wholesale prices as health chiefs denied there were any shortages.

An unusually early rise in group A streptococci, mainly among schoolchildren, has increased demand for penicillin and amoxicillin, the main antibiotic treatments, in recent days, straining already overstretched pharmacies.

In the week ending November 20, a total of 851 cases of Strep A were recorded by the UK Health Security Agency, compared to an average of 186 over the same period in recent years. The bacterial infection, which usually causes mild symptoms including a sore throat or skin rash, has led to the deaths of 16 children in the UK, according to UKHSA.

In response to the outbreak, health officials lowered the prescription threshold for penicillin and amoxicillin and even considered allowing preventive antibiotics to close contacts of infected individuals, leading to an increase in demand.

Consequently, pharmacies have reported difficulty getting the drugs from wholesalers and, on the rare occasions when the antibiotics were available, said the wholesale price was higher than the reimbursement they received from the NHS, meaning they lost money on every recipe.

“All these things that were taken for granted – that you press a button, order amoxicillin, it arrives the next day, the pharmacy makes a little bit of money and the patient gets their medicine – that’s all gone,” said Olivier. Picard, CEO of Newdays Pharmacy and board member of the National Pharmacy Association (NPA). He added that several parents had told him they had called more than a dozen pharmacies and found no antibiotics in stock.

Leyla Hannbeck, managing director of the Association of Independent Multiple Pharmacies, said the situation was unsustainable. “We need more visibility into the supply from the wholesalers and manufacturers, and we need pharmacists who are adequately compensated for these drugs as they cannot afford to spend them at a loss.”

Health officials insist there are plenty of antibiotics, but acknowledge taking the time to get to the pharmacy.

“We have enough antibiotics,” Stephen Powis, NHS medical director, told the BBC. “Obviously we’ve been asking people to prescribe them a little earlier. That means pharmacies need extra supplies, so the government is working with wholesalers to make sure those supplies become available.”

Three pharmacies told the Financial Times the minimum they paid for amoxicillin or penicillin in liquid solution in the past week was £5, which is more than double the amount they will receive in compensation under the NHS drug tariff scheme.

Alliance Healthcare, a wholesaler, declined to comment. Phoenix and AAH did not respond to a request for comment.

Sigma Pharmaceuticals briefly set its wholesale price at over £19 for liquid amoxicillin solution, almost 10 times the reimbursement cost paid to pharmacies by the NHS. Hatul Shah, CEO of Sigma, blames the high price on an “IT glitch”. “It was a total mistake,” he told the FT. “We solved the problem within a few hours and no one charged this price.”

Andrew Lane, chairman of the NPA, urged the Department of Health and Social Care to update the favorable price for amoxicillin and penicillin “as soon as possible” so that pharmacies don’t have to “foot the bill” for the Strep A outbreak.

If a drug is added to the concession list, pharmacies are compensated for any price increase.

A total of 158 drugs were on the November concession list, indicating that there were drug shortages. Janet Morrison, chief executive of the Pharmaceutical Services Negotiating Committee, which negotiates concession lists with the health department, said pharmacies were at a “breaking point”.

She said they were “helpless against the market forces working against them, and they urgently need the government’s guarantee that all medicines will be available, and not at exorbitant prices”.

The Ministry of Health did not respond to a request for comment.

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