YOUR MEDICATION IS UNAVAILABLE AT THE MOMENT TRY AGAIN LATER

Well, here’s another topic where we do not intend to get anywhere: Medications and sold out devices.

At any moment we have a list of, at least, half a dozen medicines (or other products) that, being part of our usual stock, have run out. Here I am today to expose our view about this situation, and, spoiler alert: it is extremely frustrating for us, as well. In the various possibilities of heartbreak, this topic is at the top.

I know I’m not just talking about myself when I say that we work in a pharmacy to help the people who are going there to ask for advice, certainly, and also to supplement the health care provided by their doctor. But these situations completely divert our focus by introducing huge obstacles to the provision of this care.

But, after all, why do medicines run out?

There are many reasons, and many levels of “running out.” As for reasons, there may be a drop in production or a fall in distribution: that is, in the medicine factory, or in the distribution of the laboratories to the distributors, or to the pharmacies.

Sometimes a new drug with an unpredictably successful marketing campaign ends up having a demand greater than the produced quantity.

Sometimes whole batches have to be destroyed due to production problems. Sometimes raw materials run out … The causes are many, and of a nature so diverse that it is impossible to prevent against all of them.

The medicine may still be sold out for a week, a month or several, or until its production has been completely discontinued. Sometimes,

The supply is only reduced, and the number of packages that each pharmacy can acquire is controlled, or sometimes even the warehouse cannot get any package…

Unfortunately, there is still the possibility of parallel export. This means to “divert” some medicines to other countries, and it is legal within certain parameters. In a country like Portugal, where the price of medicines is highly regulated and subject to narrow margins, it sometimes becomes economically unfeasible for laboratories and distributors to sell all their products here.

This would not be a problem if there were enough for everyone, but sometimes there isn’t, and they run out in Portugal. I do not know the magnitude of the effect, and I know that legal measures are taking place to prevent this from happening and compromising the supply of the country. For this reason, fueling the belief that all the problems of medicine running out are due to parallel exports is to oversimplify the issue. We cannot start from this assumption if we want to establish a minimally productive relationship with laboratories.

What do we do?

As I said before, the sold out medicines are a big headache for us behind the counter, too. They imply that we create lists of medicines that are sold out, or that can be sold out (there are some that seem to have a greater tendency to run out); it means calling the warehouses every day to know if they have some package that they can dispense us to one of our customers; it implies entering into direct contact with the laboratories and spending hours on the waiting line, hoping to create some kind of SOS supply… But worse than anything, it often implies facing the customer in the eyes and telling them that we cannot solve the problem that our profession says we should be able to solve.

Infarmed already has a system in place to handle this. They regularly receive a list of medicines that pharmacies are asking the distributors for and are not receiving. When some medicine runs out completely, with long waiting periods, Infarmed even comes in contact with doctors’ prescribing systems so they are also informed (the drug is no longer part of the prescription possibilities).

It does not work perfectly, but it already works quite well… Even if, by means of manual prescriptions, we sometimes see prescriptions with medicines that “the doctor could not prescribe on the computer…” and that, of course, we are also incapable of making possible.

What solutions do we have for the user?

Behind all the complications of production, distribution, and prescription, there is one person who is actually harmed: the customer. But there are some possible solutions.

• If the drug in question is an over-the-counter product, the pharmacist will certainly advise you on an alternative. It often contains the same substance in the same dosage, but even if the substance and dosage are different, it will certainly be indicated for the situation that interests you. It is an opportunity to experience something new, which may even have a better result than the other.
• If the medicine has a generic… take the opportunity to try it! Buy the generic. I understand that there may be laboratory preferences (though I personally do not have them), but in a situation of a medicine currently sold out the need overrides a preference, right?
• If the medicine has an available package that has a different (but divisible) dosage, a different amount of length, or a different presentation, discuss the possibility of a change with your pharmacist and then confirm with your doctor. It may take a little longer, but at least the situation has a reasonable solution.
• If the medicine has no therapeutic alternative on the market … These are the truly problematic situations. Only the doctor can indicate an alternative that can adapt to your situation, and sometimes that may not exist.

And then, after making it possible and impossible to try to get some package, we resign ourselves to waiting. There is little more we can do. And yes, we can call all the names we want to the laboratories, but we do not know what happened, so we can only trust that they also have an interest in reinstating the supply and pray that they do so as soon as possible.

Finishing on the skeptical note with which I said I would finish,

Right.