Access to medicines in Britain is at its most fragile point in years, leaving patients at risk of stroke, heart attack and seizures unable to obtain essential medications. Experts attribute the crisis to global supply chain disruptions and overly complex funding processes within the UK, which they claim are costing patients' lives.
Systemic Funding Issues
The NHS reimburses pharmacies a fixed price for each drug dispensed, which pharmacies are expected to match when sourcing the medication. However, with around 230 medications currently on price concession—where the drug's wholesale price exceeds the NHS reimbursement rate—pharmacies are struggling to afford adequate stock. This has led to serious delays and sudden shortages for patients.
Since the conflict in Iran began, the cost of several key medicines taken by millions of Britons, including cancer treatments, has soared due to disrupted air freight routes and higher shipping costs. Pharmacists fear that existing shortages of blood pressure, epilepsy, and cancer drugs could worsen because of the war.
Record High Price Concessions
In April, the number of drugs on concession reached a record high, with hundreds of pharmacies experiencing price hikes for some of the most commonly prescribed medications. According to the National Pharmacy Association (NPA), some prices have risen tenfold since February, and the NHS is struggling to cover the additional costs. This forces pharmacies to operate at a loss, as the NHS reimburses them far less than they paid for the drugs.
Dr. Leyla Hannbeck, chief executive of the Independent Pharmacies Association, stated that the list of affected medicines is extensive. "Medicines for thinning the blood, some allergy medications, epilepsy medicines, and cancer drugs are in short supply, and the list goes on," she said. She added that some ADHD drugs are also affected by the supply chain breakdown, leaving patients unable to work, while others suffer preventable seizures that could be life-threatening.
Systemic Breakdown
When hundreds of everyday drugs are in short supply, it indicates a systemic problem. Olivier Picard, chairman of the NPA, told Pharmacy Magazine that the gap between supply and demand has widened so much that pharmacies are sending patients to other locations, often miles away, to protect their bottom line. "We are in a position now where we cannot afford to dispense at a loss. The system is simply not working," he said.
Picard noted that while there are no immediate shortages directly linked to the Middle East conflict, manufacturers warn that supply breakdown is "inevitable." He explained, "Even if medicines are available, the conflict in the Middle East is pushing production and transportation costs of drug manufacturing to such a level that the price the NHS is willing to pay for the drugs simply doesn't cover the cost of manufacturing them." He expects this issue to worsen as the situation develops.
Supply Chain Vulnerabilities
Ingredients sourced from the region are also in short supply, affecting the availability of petroleum-based solvents used in many pharmaceutical products, Dr. Hannbeck added, with transportation costs significantly higher than before the conflict. Other drugs taken by millions of patients are already under severe pressure, including apixaban (a blood thinner to prevent clots and strokes), blood pressure drugs like bisoprolol and carvedilol, and heart medications.
Cancer drugs currently affected include Creon for pancreatic cancer and Efudix, a topical chemotherapy cream. Oxybutynin, used to manage menopause symptoms in those on hormone replacement therapy (HRT), is also largely out of stock.
Government Response
Last month, the Department of Health issued a "serious shortage protocol" for ramipril, one of the most widely prescribed blood pressure medications, with three million prescriptions issued monthly. The protocol limits patients to one month's supply at a time, but many pharmacists are already struggling to meet this requirement.
The UK imports around 75% of its drugs, and even those from Europe often contain ingredients shipped from China, India, or the Middle East. Furthermore, the government spends less of its health budget on medicine per patient than many EU countries like France and Germany, making the UK a less attractive buyer.
In response, a Department of Health spokesperson said: "The vast majority of the UK's licensed medicines are in good supply, and we are working hard to keep it that way. We have established processes to respond to sudden market price increases of medicines. This includes adjusting reimbursement prices based on current market conditions, which helps ensure that pharmacies can continue to obtain medicines for their patients."
