For rural and regional pharmacists COVID-19 is “logistical nightmare”

IT’S going to be a long 10 days for regional Queensland pharmacist Karalyn Huxhagen as she waits for the next delivery of asthma medication, Ventolin, having run out of stock early last week.

“We have been told that it would be 10 days before we get our next supply of asthma medications, and we are in Mackay, so that’s not a tiny little back-of-nowhere place,” said Ms Huxhagen, who is cofounder of the Rural Pharmacy Network Australia.

“We have acute shortages of many medications in rural Australia, and certainly asthma medications are probably the most severe at this point,” Ms Huxhagen told InSight+.

Patient stockpiling in response to the COVID-19 pandemic had partly driven the shortage, Ms Huxhagen said, adding that some rural pharmacies had even reported instances of urban customers driving to rural centres to buy medications.

“Patients and customers are extremely frightened, they don’t know what is coming next,” Ms Huxhagen said. “We have had patients stockpiling, but we also had people presenting and asking for things like Ventolin or Asmol who have never had [these medications] in their life. They are trying to get it for loved ones, they are trying to get it because they have read on Facebook that they might get severe respiratory illness and they think they will need it.”

Ms Huxhagen said there had also been allegations of excessive orders by large pharmacy groups contributing to supply issues. In the Sydney Morning Herald on 18 March, Dr Katie Stott, also of the Rural Pharmacy Network Australia, called for an independent investigation into the “mass-buying event” with claims of major chains ordering up to seven times their usual amount of stock.

Toowoomba pharmacist Mary Sweeney, who has also been struggling to maintain supply of salbutamol inhalers, backed calls for an audit into the application of the Community Service Obligation (CSO), a funding pool to ensure all Australians have timely access to the full range of PBS medicines regardless of where they live.

“It’s just a disaster,” Ms Sweeney told InSight+. “What the Federal Government needs to do, because they pay the wholesalers this CSO, they need to do an audit to find out where the stock went.”

A spokesperson for the Pharmacy Guild of Australia said limits were introduced last week on dispensing and sales of some prescription medicines and some medicines available without a prescription, such as Ventolin.

“The Pharmacy Guild of Australia has welcomed the measures to curb stockpiling of essential medicines in the face of heightened demand caused by anxiety over the COVID-19 pandemic,” they said.

“This week some of those changes have been legislated, making it a legal requirement for pharmacists to comply with the new restrictions. It is important that patients understand that these measures are compulsory and designed to ensure continuity of supply for these medicines for patients who have a real need for them.

“These sensible and timely limits announced by the government will apply to particular classes of medicines which must remain available for patients in need. It is regrettable that such measures are needed, but these are unprecedented and drastic times.”

They said that with the extremely high demand and panic buying, it became clear supply interruptions would occur if nothing was done.

“We are determined that no patient in need of a medicine in Australia should be deprived of that medicine because of unnecessary hoarding by others.”

Ms Huxhagen said efforts to address patient stockpiling were important, but remote and regional pharmacies were still facing concerning delivery delays.

“We are told if people stop stockpiling that there will be enough medicines for everyone in Australia, [but] the major problem in rural and remote, and even regional, Australia is transport. There are great issues with stock just not getting to us due to transport issues, our wholesalers are extremely empty of just so many things, front of stock lines as well as medicines.”

Ms Huxhagen said enforcing the new limits was also proving challenging for rural, remote and regional pharmacists.

“Some of our patients only come to town once a month and they are wanting ‘extras’ as they live quite a distance from medical help. All weekend I was having to say to people, ‘no, you got all of these [prescriptions filled] yesterday,’ and they are very upset. The stockpiling by patients is acute, it’s as we have seen with the toilet paper debacle,” she said. “It’s full-on.”

CEO and Managing Director of Australian Pharmaceutical Industries (API) Richard Vincent said dispensing volumes were up 20–30%, so there was no doubt patients were concerned about the implications of COVID-19.

“Our pharmacy distribution business has been dealing with unprecedented demand with orders up more than 50%, so it is clear that pharmacists are carrying more stock in their dispensaries,” he said. “Community pharmacy is dealing with a national stock management issue and our out-of-stocks are running at levels I have never seen before.

“I want to be very clear that API hasn’t given preference to metropolitan over regional areas and we have taken some steps that prevent big groups from putting in large orders.”

Mr Vincent said from the start of the COVID-19 crisis, the company set some guiding principles, including supporting regional pharmacies and ensuring equitable access to medicines for API’s pharmacist partners.

“We are extremely concerned about medicines being available to our rural pharmacy partners. We have worked with the Health Minister to allow the CSO wholesalers flexibility that didn’t exist in the CSO rules so that we could achieve these principles.

“That has allowed us to implement constraints on life-saving and critical medicines that are in short supply, prioritise stock for our loyal wholesale customers and reject pharmacy orders where they are excessive. Our suppliers are also working closely with us to manage out-of-stocks and many of them are working with these same principles.”

A spokesperson for pharmacy wholesaler Symbion said no pharmacy brand, organisation or order was being prioritised over another at this time of unprecedented demand.

“Rural, regional and metropolitan customers are being managed equally,” they said. “Demand for medicines have, for certain lines, increased threefold over normal purchasing patterns driven by buyer behaviour by both pharmacists and consumers.

“The Symbion distribution centres are currently working to meet demand 7 days, almost 24 hours per day. To assist in the management of essential medicines, we have placed a wide range of primarily non-medical products (such as [fast-moving consumer good] products) on non-delivery for a defined period, allowing our teams in the distribution centres time to prioritise the distribution of essential medicines into both pharmacy and hospitals.”

Ms Huxhagen said she appreciated the unprecedented challenges confronting Australia’s pharmacy wholesalers and understood that they were doing their best to ensure equitable supply.

“I think it’s a complete logistical nightmare. As the Queensland Premier said the other day, the logistics are like ‘having 30 cyclones hit at once’. I am not going to say that the wholesalers are at fault, I think the size of the logistics is just so overwhelming and so unprecedented that no one really knows what to do.”

API’s Mr Vincent said the situation was likely to continue for some time.

“Unfortunately, the harsh reality is the current stock situation will continue for some time despite suppliers’ and wholesalers’ best efforts. That said, availability is starting to gradually increase this week, which has been helped by pharmacists returning to more typical ordering patterns.”

A spokesperson for GSK, manufacturer of Ventolin, told InSight+: “We are currently seeing unprecedented and unpredictable high consumer demand for Ventolin (salbutamol) inhalers across Australia, which is impacting availability in some areas of the country at a pharmacy level,” she said.

“We are working with government stakeholders to make sure the Ventolin inhaler supplies we have available are distributed to where they are needed most; while we do that, we have allocation procedures in place with our pharmacy wholesalers. In partnership with wholesalers, we are prioritising supply to hospital pharmacies.”