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Of the recipients of the millions of prescriptions issued every day in Britain, it is unlikely that much thought will be given to the system that ensures everything is available, from painkillers to specialized drugs. Beyond the counter of pharmacists, however, is a network covering national borders and continents and involving multiple supply chains.
"Everything works so well because of the incentives and obligations in place," said one industry insider. "What will be really interesting to see, is what happens when there is pressure."
Basically, there are two types of drugs: branded and generic. Household names such as Glaxosmithkline and Pfizer derive their money from the discovery of new drugs and obtaining a patent for about 20 years. Prices drop a lot when the patent expires and other manufacturers produce copies. Eighty percent of written prescriptions are for generics.
Active pharmaceutical ingredients (APIs) are crucial for both clbades of drugs. These are largely manufactured in places such as India and China. Therefore, even if drugs are manufactured here, it is likely that the APIs will have been imported from abroad.
"Drugs from countries such as India and China can transit through continental Europe. If this happens, they will usually arrive by ferry from across the Channel. This could be a problem for Brexit, "said Warrick Smith, General Manager of the British Generic Manufacturers Association. "If they come directly from India and China and not via Europe, the supply will not be disrupted," he said. About 50% of medicines are routed via Europe.
In the United Kingdom, drugs cost significantly less than in other countries, as competition from more generics has led to lower prices. It is feared that in case of shortage, suppliers will choose to sell in Germany or the United States rather than in the UK, as they will earn more money.
Brand drugs are re-evaluated every few years as a result of negotiations between the government and major manufacturers. One industry participant described it as a well-oiled machine, balancing the need for corporate profit and the state's desire to be affordable.
Two categories of drug wholesalers come into play for most drugs: complete online wholesalers, which effectively guarantee a complete stock of a wide range of products and often deliver daily to pharmacists, and short line wholesalers, specialized in large volumes of at more interesting prices.
At the street level, big chains such as Boots and independent pharmacies are split 50/50.
Like supermarket food, a "just in time" system applies to the supply and storage of medicines. "That's why we really worry about the potential chaos in the ports," said Mark Burdon, pharmacist in Newcastle. "The government continues to talk about stocks for several months, but that potentially involves millions of items. On the one hand, managing this amount will be a challenge, but it will also take a lot of medicine to manage a very simple and efficient supply chain. "
Independent pharmacies of the type managed by Burdon generally receive several deliveries each day from several suppliers. "It's based on pretty thin margins, so if you distribute a package of something, you order another. You can imagine how one could feel the repercussions of any kind of problem in the ports. A slight delay would really be felt in the end. "
Burdon is especially concerned about providing items such as antipsychotic medications and antidepressants. Unlike badgesics and anti-inflammatories, it is often difficult to replace them with a generic alternative.
Warrick Smith, BGMA, noted that the government is considering increasing the capacity of ferries with different routes and giving priority routes for drugs if necessary. "The government has worked hard to prepare this and has put in place a lot of measures to ensure the continued supply of high quality drugs in the UK. However, the best way to ensure this is to stay in the European Medicines Regulatory System and not have problems at the border. "
Burdon has similar concerns. "These days I remember what they say about humanitarian crises. They occur when there is a shortage of food, water and medicine. The disruption of any of these things can very quickly lead to seizures. "
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