UK pharmacies say they are being forced to dispense Strep A antibiotics at a loss

Pharmacies in the UK say they are being forced to dispense antibiotics to treat Strep A infection at a steep loss because of soaring wholesale prices, as health chiefs denied that there were shortages.

An unseasonably early surge in Group A Streptococcus, mainly among schoolchildren, has pushed up demand for penicillin and amoxicillin, the main antibiotic treatments, in recent days, heaping pressure on already stretched pharmacies.

A total of 851 Strep A cases were recorded by the UK Health Security Agency in the week ending November 20, compared with an average of 186 during the same period in recent years. The bacterial infection, which typically causes mild symptoms including a sore throat or skin rash, has led to the deaths of 16 children across the UK, according to UKHSA.

In response to the outbreak, health officials have lowered the prescription threshold for penicillin and amoxicillin, and even considered allowing preventive antibiotics to be given to close contacts of infected individuals, leading to an increase in demand.

Consequently, pharmacies have reported struggling to obtain supplies of the drugs from wholesalers and, on the occasions the antibiotics were available, said the wholesale price outstripped the compensation they received from the NHS, meaning they were losing money on each prescription.

“All these things that were taken as a given — that you press a button, order amoxicillin, it arrives the next day, the pharmacy makes a little bit of money, and the patient gets their medicine — that has all gone,” said Olivier Picard, managing director of Newdays Pharmacy and a board member of the National Pharmacy Association (NPA). He added that several parents had told him they had called more than a dozen pharmacies and failed to find antibiotics in stock.

Leyla Hannbeck, chief executive of the Association of Independent Multiple Pharmacies, said the situation was unsustainable. “We need better visibility on supply from the wholesalers and manufacturers, and we need pharmacists to be adequately reimbursed for these medicines as they can’t afford to give them out at a loss.”

Health officials and wholesalers insist that there are sufficient supplies of the antibiotics but acknowledged they were taking time to get to pharmacies.

“We have plenty of antibiotics,” Stephen Powis, NHS medical director, told the BBC. “Clearly, we’ve been asking people to prescribe them a little bit earlier. That means that pharmacies have needed extra supplies, so the government is working with wholesalers to make sure those supplies get out.”

Three pharmacies told the Financial Times that the minimum they had paid for amoxicillin or penicillin liquid solution from wholesalers, including Alliance Healthcare and AAH, in recent days was £5, which is more than double the amount they will receive in compensation under the NHS drug tariff scheme.

Martin Sawer, executive director at the Healthcare Distribution Association, which represents wholesalers, said the higher price directly reflected the amount wholesalers were having to pay manufacturers. He denied there was a shortage but said the supply chain was having to adjust to the “sudden huge demand surge”.

Sigma Pharmaceuticals apologised for setting its wholesale price at more than £19 for amoxicillin liquid solution, nearly 10 times the reimbursement cost paid by the NHS to pharmacies, blaming the mistake on an “IT glitch”.

Andrew Lane, NPA chair, urged the Department of Health and Social Care to update its concessionary price for amoxicillin and penicillin “as quickly as possible” so pharmacies don’t have to “foot the bill” for the Strep A outbreak.

If a medicine is added to the concessions list, pharmacies are reimbursed for any price increase.

A total of 158 medicines were on November’s concessions list. Janet Morrison, chief executive of the Pharmaceutical Services Negotiating Committee, which negotiates the concessions lists with the health department, said pharmacies were at “breaking point”.

She said they were “helpless against market forces that are working against them, and urgently need government assurance that all medicines will be available, and not at wildly inflated prices”.

The health department said there was “no supplier shortage”, explaining that “prices can fluctuate” because of surges in demand for certain antibiotics. “But no company should use this as an opportunity to exploit the NHS.”