Filenews 19 January 2023 - by Marilena Panayi
A request to increase their production to the maximum was put by the Pharmaceutical Services to the Cypriot industries after the shortages of antibiotics and antitussive preparations observed internationally, began to touch Cyprus, resulting in the need to fill the gaps that have been created in the market by domestically manufactured products.
At the same time, however, for Cyprus, which does not currently seem to have a problem with the quantities of raw materials available to local industries, the problems in the pharmaceutical market may be much greater in the coming days. This is because the over-prescription observed in recent months due to the ongoing outbreak of infections has led to a significant drop in the unit price on the basis of which pharmacists who ask for compensation are paid under the GHS and even warn by closing their pharmacies in case their requests are not met by the Health Insurance Organization.
Pharmaceutical services and the Ministry of Health are monitoring the situation, while the Minister of Health Michalis Hatzipantela sees today in his office, the Pancyprian Pharmaceutical Association and the HIO.
As far as the shortages are concerned, as the president of the Pancyprian Pharmaceutical Association Eleni Piera Isseyek told "F", they mainly concern paediatric medicines. In particular, a shortage was observed in recent days in a well-known prototype (imported antibiotic). "Pharmacists were replacing it with the corresponding Cypriot formulation, which, however, also began to disappear from the market." Shortages, he added, "we have seen in recent days also in antitussive preparations but as pharmacists we cannot know where the problem is caused."
Also, said the president of the PFA, "we have other kinds of problems. For example, a specific paediatric antibiotic comes in two sizes. Our doctors usually prescribe large size. In the market, however, only the small one is available. The HIO software does not allow the pharmacist to exchange one large for the two small ones and so either the pharmacist has to contact the doctor to change his prescription, and this is not always easy, or the citizen has to look for the size that he can obtain through the GHS from other pharmacies that are certainly not sure that they will have it".
"It is a fact that in recent months there has been over-prescription in these formulations. And to be more graphic, I will say that as we see it, every month we have drugs that in other cases we would need an additional week to dispose of," Ms. Isseyek said, indicating that "we have two facts ahead of us. One the international shortages and the second the outbreak of infections. We each had to make the right predictions so as not to create a problem and to see shortages in percentages beyond what was expected."
The detection of antibiotic shortages again alerted the Pharmaceutical Services of the Ministry of Health, which once again turned to the Cypriot pharmaceutical industries. As the director Elena Panayotopoulou told "F", "the pharmaceutical industries assured us again today that there is no problem with the quantities of raw materials we have in Cyprus and the shortages are probably due to production. Therefore, and after they had already increased their production in the previous period, we asked for the domestic production of medicines to be increased to the maximum in order to be able to fill the gaps that have been created".
That is, he explained, "raw materials in Cyprus exist and as we have been told the quantities are enough to cover the needs of one year. I can't say that at the moment there is cause for concern, but I have to say that there is a reason to monitor the situation very closely."
The president of the HIO was clear yesterday: "If the HIO and the Minister of Health do not understand the situation we are in then we will definitely take our measures. Pressure is already being exerted by our members to proceed with a work stoppage." "For some months now there has been a very increased prescribing. Suffice it to say that the number of packages disposed of is 20% greater than before. This means that on the basis of the GHS global budget, the price of the unit with which we are compensated has fallen very much and now many pharmacies are operating at a loss," Mr. Isseyek said.
As an HIO, he added, "we demand that the HIO take action, which should, as provided for in our agreement, monitor the situation and intervene in cases of over-prescription because we do not consider that all the increase observed is due to the outbreak of seasonal infections". For the pharmacists, the president of the PFA concluded, "the knot has reached the scallop because as professionals we have already made many concessions and the last drop in the unit price was for us just the icing on the cake".
The HIO admits the significant increase in prescribing and the significant drop in the unit price on the basis of which pharmacists are paid. As deputy director Athos Tsinontidis told "F", "we are looking at all the data at the moment and in a meeting we had with the pharmacists we have told them that if this is deemed necessary their budget for 2023 can be increased". "We don't think over-prescription is only due to seasonal infections, but as an HIO we can't tell doctors not to prescribe patients when they themselves deem patients to need some medication." The data "from the GHS software is currently under study and we will definitely discuss with the MFA and hope that we will find some solutions that will satisfy everyone. But it should be remembered that the budget is global, and therefore as activity increases, so does the unit price. In other words, nothing was done that is not provided for by the way the budget works."
The PFA had a preliminary meeting with the Minister of Health on Tuesday and during this meeting it was agreed that a meeting will be held today, under Michalis Hatzipantelas with the participation of the HIO, in order to discuss the problems raised by pharmacists and find solutions.
INTERVENTION
The inevitability
The fact that shortages of medicines internationally and in Europe would also affect Cyprus should not be surprising. Cyprus is not the exception on the planet or in the EU. At the moment, the Cypriot pharmaceutical industries assure that there are raw materials to fill the gaps and meet the needs of patients. Turning now to the differences between HIO and pharmacists, let us hope that they will find each other because otherwise it will be the patients who will pay for it. We certainly stress the fact that next week the local assemblies begin to vote on a new council of the PFA.
