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Fears over prescription drug prices

Reducing affinity to brand names: Ricky Brathwaite

A number of factors including Brexit could be driving up prices on some prescription drugs in Bermuda, it is feared.

Pharmacists said medication recalls and manufacturing issues also played a part, after one patient reported that the cost of his treatment had soared by more than five times.

A wholesaler explained that it was not unusual for access to supplies to be limited by events in other countries.

The Bermuda Health Council confirmed it was aware of challenges and hoped to improve the prescription drug industry “in the near future”.

One drugstore customer said: “I went to renew a prescription and the cost of the prescription that I normally obtain had risen from $13 to $71.

“The pharmacist actually drew my attention to it, explaining that this was an impact of the Brexit events, that their supplier in the UK was stocking up on this particular type of medication and was not able to provide it, so they had to source it from the US initially and that resulted in the increase in cost.”

He added: “Given that people were interested in the cost of health at the moment, I thought this is something that was a bit beyond the reach of our government to control.”

The Government Employee Health Insurance scheme member wrote to Kim Wilson, the Minister of Health.

A health ministry spokeswoman confirmed that the customer’s concern had been raised.

She added: “We are observing the situation as it has not been a problem across the board.”

Ricky Brathwaite, the BHeC acting chief executive and health economics director, said: “The health council is aware that there are sometimes challenges with getting prescription medications from the international market.

“As a small country with a population of 63,799, Bermuda is sometimes not the priority for the manufacturers and suppliers that have the inventories. And to make the situation even more complicated, when there are times when the world is buying up certain medications because of political or economic uncertainty, the demand leads to higher global prices.

“During those times we do not have the buying power by ourselves to combat those increases in prices or the ability to negotiate to the best of our ability because of the relatively small quantity of those medications we want to purchase.”

Dr Brathwaite said the council’s recommendations included consolidating orders and reducing an “affinity” towards brand name medications.

He added: “We understand that many of the issues in the world are out of our direct control.

“The council will continue to work with our pharmacist, hospital and physician partners to make improvements to our prescription medication industry in the near future so that we can do our local part to reduce the costs of medications to our consumers and their families.

“We will also work with our international partners ... on better procurement strategies to mitigate the rollercoaster that can exist in medication pricing.”

David Ugwuozor, the Bermuda Pharmaceutical Association president, believes stockpiling took place before the original date for the UK’s exit from the European Union, which was March 29.

He added: “In Bermuda, people did buy in anticipation that Brexit was going to go wrong.”

The pharmacist at Robertson’s, in St George’s, said: “I don’t think it was everyone, but some pharmacies did panic buy for sure — the last thing we want is to be short here.”

Mr Ugwuozor explained that the UK sourced much of its medication from Europe, so changes in regulations, tariffs or trade relations could affect the purchase of drugs, which would create problems for Bermuda because it orders from the British market, among others.

He added: “We’re a small island, the knock-on effect would be significant.”

Mr Ugwuozor said various factors appeared to be affecting a number of drugs.

He added: “This fluctuation is quite bad for the patients, especially if they’re struggling to pay, so I can understand the concern.

“They would not really understand why it’s happening ... not just Brexit, there are tons and tons of issues — supply issues, manufacturing issues, stockpiling — those are just three factors that would affect distribution of drugs, which in turn affects price.”

He added that concerns had been raised with the BHeC and the industry would keep watch in the coming months as the new Brexit date of October 31 approaches.

A UK Department of Health and Social Care spokeswoman said that “robust contingency plans” were in place and if they were followed there should be no interruption to medical supplies when the country leaves the EU.

She advised that suppliers were asked last August to stockpile six weeks’ supply on top of their usual buffer stocks ahead of a possible “no deal” Brexit but that should not impact the ability to meet demand from other countries.

Jon Turner, who covers pharmaceutical supplies at BGA Wholesale Distributor, said: “There’s always something that’s causing problems for supply for pharmaceuticals to Bermuda.”

He added: “We have had challenges and we have done our best to divert supply to other jurisdictions to resolve those.”

It was unclear if disruption caused by Brexit was the cause.

Mr Turner explained: “I wasn’t really getting a specific message from my suppliers, the order comes through unfulfilled so BGA, with it’s experience and expertise, makes alternative arrangements as best as we can to maintain supply for pharmaceuticals in the community, but that can be a demanding task.

“I would say it’s the normal ebb and flow of supply.”

Terry-Ann Waite, at People’s Pharmacy, said the issues were also linked to “global shortage and several manufacturing companies having problems with their plants”.

She added that the FDA had recalled some hyper- tensive medication, which had become “extremely hard” to source.

Ms Waite said: “For the ones you can get, the prices have gone up.”

Although a finance ministry spokeswoman said the GEHI scheme had no “specific carve-out” for generic prescription medication, the programme’s benefits schedule suggested policyholders paid 20 per cent of the total cost.

In comparison, most Argus, Colonial and BF&M policyholders are covered 100 per cent for generic prescription drugs and 80 per cent for brand name medication.

An Argus spokeswoman said: “While we generally see an upward trend in medication costs, we have yet to experience any unusual spikes in our prescription claims.”

A BF&M spokeswoman added that the company was not aware of cost increases that could be attributed to Brexit.