In the cupboards at home, in warehouses, in hospitals, outside Bulgaria, where are the missing medicines?

Patients report that they cannot find drugs to treat coronavirus in pharmacies. Pharmacists complain that they cannot meet the increased demand and their suppliers do not comply with requests submitted in the requested volume. Oversupply, supply disruptions, inadequate planning and policies, exports – these are some of the answers to the question why there have been shortages of some drugs in pharmacies in recent weeks.

Pharmacists and distributors agree that recently there has been an over-demand and consumption of several important groups of drugs: antibiotics, antithrombotic agents and corticosteroids, used in the home treatment of coronavirus. However, patients with chronic diseases and pregnant women are also dependent on the same medications, further compounding the problem.

Overstock and over-prescription

Pharmacists insist that there is an overstock by patients, as well as an excessive prescription of the products in question.

In recent weeks the use of medications containing azithromycin (an antibiotic), dexamethasone (a synthetic glucocorticosteroid that suppresses the immune system and has anti-inflammatory and analgesic effects), low molecular weight heparins (medications used to prevent or reformat), has increased in recent weeks. dipyridamole (an antithrombotic drug) and other drugs that are widely recommended by doctors for home treatment of Covid-19. Pharmacies find it difficult to supply these products due to their increased consumption and are often rejected by wholesale sales. “ President of the Bulgarian Pharmaceutical Union Prof. Asena Serbezova told Mediapool.

He declared that the dissemination of treatment protocols on social media was unacceptable, since the drugs in them should be taken only after an individual examination and prescription by a doctor. Treatment must be tailored to each patient according to their comorbidities and other medications due to the risk of serious contraindications and side effects. Some people stock up, and any pharmacist with enough professional experience and intuition can judge this while communicating with them, says Serbezova.

His colleague Anton Valev from the National Chamber of Pharmacy is of the same opinion, commenting on Bulgarian National Radio that people go with such people in droves. “lay lists”distributed on the Internet and buy drugs in pharmacies.

Covid-19 and overuse of antibiotics

At the same time, there is the practice of prescribing patients six boxes of a certain drug, which they cannot drink with the idea that the whole family will receive the drug with a prescription.

“The practice of over-prescribing packaging has caused an excessive deficit. The system is not planned for this population of eight million to buy a package and put it in a closet … The overuse of antibiotics generates resistance, this is a problem”.says Valev.

Professor Serbezova also warns that the overuse of antibiotics in the current situation could exacerbate the problem of antibiotic resistance.

“Only 8% of hospitalized patients with Covid-19 have a bacterial or fungal infection, but 72% of these patients are treated with antibiotics. This practice will not only lead to increased inappropriate use of antibiotics worldwide, but which will also lead to further development of antimicrobial resistance “she says.

Stocks for hospitals

According to the participants in the supply of medicines, part of the current problem is the replenishment of hospitals with medicines. In order to provide them with amounts over a longer period of time, this has reduced the supply in pharmacies. Yet at the same time, some smaller hospitals are also struggling to stock up.

Dealers Report Higher Demand, But Also Stock

Distributors confirm that there is an over-demand for certain products, but generally report that they have a stock in stock, with the exception of a specific brand of antibiotic azithromycin. The Bulgarian Association of Medicines Wholesalers (BATEL) told Mediapool that they currently have stocks of medicines containing azithromycin, but there is an increased demand. They expect more deliveries from manufacturers. There is currently no stock of a specific brand of this antibiotic, Azax, and deliveries are expected in early December.

However, a problem for patients is that when their doctor has prescribed a specific brand, by law replacement is not allowed at the pharmacy. In other words, the prescription must be changed or the replacement must be done in violation of the law.

In general, distributors say they have no reason to expect a shortage of products with azithromycin, as well as vitamins – Selenium, Zinc and vitamin D and maintain a rhythmic supply. They say they are trying to satisfy requests from pharmacies.

They also report an increased demand for blood oxygen meters, which have so far not been sought out. Delivery of them is expected next week.

Problems with imports and exports

In recent weeks, problems have again arisen in finding some antithrombotic agents in pharmacies, in particular Fraxiparin and Clexan, which are used not only for coronavirus patients but also by women with problem pregnancies. In general, these are products with periodic systemic shortages, including exports. In this case, there are also problems with imports, which in combination with increased consumption due to the coronavirus, leads to the rapid exhaustion of pharmacies. Part of the problem is that Fraxiparin maker “Aspen Pharma” is pulling out of Bulgaria, and deliveries should keep up with their usual pace for at least another year. However, according to the patient organization “Diabetes, prediabetes and metabolic syndrome”, the company has reduced imports, so patients have switched to the other product. Discussions are ongoing with the Ministry of Health, BDA and the other manufacturer to provide the necessary quantities.

The Minister of Health, Kostadin Angelov, did not rule out the possibility that some of these drugs will be exported, but assured that this possibility will be reduced. “I can’t say for sure, but these drugs are probably being re-exported out of the country. This is something we are stopping. These drugs are allowed. These are antimicrobials, corticosteroids, and low molecular weight heparins. There are such drugs nationwide.” in pharmacy warehouses in sufficient quantities. It’s mainly about logistics and people gathering. “he told Nova TV today.

Poor planning and control

Here again the question arises as to why it is still possible that drugs are available in warehouses and that people cannot find them in pharmacies. This practice, as well as the export of scarce medicines, had to be stopped by the electronic system for monitoring the shortage of medicines. It was supposed to work two years ago, but it is not fully operational yet. It is currently being developed and is in the testing phase, as some of the participants in the drug supply chain – pharmacies, distributors, drug manufacturers, are entering data into it. However, it is not yet performing its functions effectively to see where “quantities are lost” in the chain and which products to stop exporting.

This makes proper planning difficult, and according to Professor Serbezova, shortage management is key to solving the problem.

For example, in early planning and risk assessment, larger quantities of imports can be requested, exports can be stopped, and a more uniform quantity of drugs can be monitored in the country, both regionally and between hospitals and pharmacies. Whether this process is better managed is up to you. The Ministry of Health and the Executive Agency for Medicines (BDA) do not answer specific questions about the availability and causes of the shortage.