"We administer drugs constantly behind." That's how it always sounds when you talk to pharmacists about the birth situation.
That you can not have everything in stock and so that something is ordered, it is clear. The fact that, from time to time, drugs must be purchased elsewhere in Germany is not new. However, the fact that wholesalers can no longer afford a certain amount of money increases enormously. The Federal Institute of Drugs and Medical Devices (BfArM) currently lists 470 medicines, for which delivery problems will occur for weeks or months in 2019. Common antibiotics, analgesics, antihypertensives are among them.
As many pharmacists see it, the dilemma began in 2007, when health insurance companies began to make price-cutting deals with drug companies. That's how it works: the insurance companies specify the contracts, the pharmaceutical manufacturers say a significant discount on the official price of the pharmacy. In return, the sickness fund uses the drug of these providers only for its insured. The lowest price wins. The mandate is two years. According to the Federal Ministry of Health, health insurance received 4.4 billion euros in 2018. According to the Pro Generika lobbying association, sickness funds paid manufacturers only six cents per daily ration of a generic, while a patented medicine with 4.38 euros to reserve.
Generics are generic drugs that are offered much cheaper than the original after the patent expires. Eight of the ten prescribed drugs are generic. A good third of the reduction contracts conclude the funds with a single supplier. For generic pro, this leads the industry even further into monopolization. According to Managing Director Bork Bretthauer, the price-cutting agreements had "put considerable pressure on costs and a threat of market tightening". For example, 97% of methotrexate used in the treatment of cancer and rheumatism is produced by only three manufacturers. In addition, the lack of oxytocin supply, which is necessary for women in the delivery room, is due to the "shrinking market to only two providers" – one among they were temporarily unable to deliver. Another problem: manufacturers who have not been awarded a contract significantly reduce their production or postpone it to the next tender. This means that no substitute is available if the discount partner of the health insurance company should not be able to deliver.
The boss of a pharmaceutical company wants a ban on reduction
For the Federal Association of Pharmaceutical Industry also, "the principle of the cash register consisting in achieving the largest possible savings involves more and more critical situations for the supply," said the general manager, Martin Zentgraf. He calls for a rebate of supply-side substances, that is, substances proposed by three or fewer companies.
Health insurance companies see things differently. AOK says that "global drug distribution problems have nothing to do with remission contracts". Choke bottlenecks usually have technical causes in the production process. President Kai Behrens gives the example of ibuprofen, an analgesic. The delivery problem is the result of a production shutdown due to a defective part at BASF in Texas, which is why the other five manufacturers should absorb the failure. In addition come the needs of flu waves.
Of the 63 active ingredients that were listed as being in short supply this spring, there were only seven discount contracts. Behrens admits, however, that in the case of very frequently prescribed active substances, the AOK has in part passed from one to three manufacturers in order to minimize the problems. According to Behrens, in the generic market, 161 prescription active ingredients are offered by fewer than four companies. According to Roland Berger, more than 80% of antibiotics come from third countries, mainly from China and India. Sometimes there are only two or three producers involved. The reason is the price war.
For Friedemann Schmidt, President of the Federal Association of German Pharmacists Associations, problems are piling up in the supply of medicines. "That worries us a lot."