After paracetamol and corticosteroids, it is now amoxicillin, the most prescribed antibiotic for children, which pharmacies in France are sorely lacking. So much so that some pharmacies have started to manufacture it in an attempt to make up for shortages at the national level. And the list of medications for stressful situations continues to grow. According to the National Medicines Agency, all classes of drugs are affected by stockouts or tensions. Three types known as “of major therapeutic interest” are more particularly exposed: anti-infectives, drugs for the nervous system (antiparkinsonians, antiepileptics) and those for the cardiovascular system.
According to the latest ANSM report, the bar of 3,000 molecules out of stock and at risk of rupture has been exceeded. Between January and August 2022 alone, the tension rate, i.e. the impossibility of supplying a pharmacy for a week or more, almost doubled: it went from 6.5% to 12.5% according to the GIE Gers , a data processing group created by pharmaceutical companies.
If the situation of shortage is not new, since it has existed for ten years, its magnitude is unprecedented, especially in France. At issue, according to some players in the sector: the too low prices set by the French State for the purchase of drugs compared to other markets, including among our more attractive European neighbours.
French prices too low?
“There are shortages of medicines which are linked to the price difference practiced by France, which is among the countries which buy the cheapest in Europe”, assures Pierre-Olivier Variot, pharmacist in Plombières-lès-Dijon ( Côte d’Or) and President of the Union of Community Pharmacists (USPO). In recent days, several journalists, including our colleagues from Figaro, have found: many French people flock to Swiss and Italian pharmacies, which do not seem to lack paracetamol or amoxicillin. The reason ? These two countries would put more into their pockets for these drugs, sometimes paying twice the French price. “Industrialists therefore tend to favor more profitable markets, to the detriment of France”, continues Pierre-Olivier Variot. Compared to France and its 3,000 drugs in tension or out of stock, the shortage of drugs affects – only – 650 products in Switzerland, according to the Federal Office for Economic Supply.
“On the drug market, France is one of the most vulnerable European countries in Europe, observes Eric Baseilhac, director of economic affairs at Leem, the pharmaceutical companies union. Several studies, including one from the Swedish health authorities, show that France has the lowest prices, with the exception of Greece and Poland”. But according to Nathalie Coutinet, health economist, the gap between prices on the French market and other European markets has tended to narrow in recent years. “Our partners serve as references, benchmark.“Nevertheless, she adds, “on generics, the price paid by France is estimated at 10% less”.
The problem of the economic viability of generics
On the drug market, a universal tacit rule persists despite the danger it can cause for many essential productions. “In France, as everywhere else, the policy of the health authorities is to grant high prices for recent drugs, i.e. innovations, and lower prices for old drugs, including generics,” explains Nathalie Coutinet. Of all the shortages of recent years, most of the drugs concerned are indeed “old”, often generic, which have seen their prices drop over time. “Until the question of the viability of their production arises, adds Eric Baseilhac. Today the economic factor exists in most shortages. And it can sometimes be the initial factor.”
According to several pharmacists interviewed by L’Express, the price of amoxicillin, which fluctuates around 70 cents per jar when it leaves the factory, should have fallen in 2023. A decision framed by the forecasts of the economic committee of the products of health. However “in the context of the current shortage, they have abandoned the idea”, breathes a pharmacist. The situation could become even more complicated with competition from our German neighbours, the country also being faced with a shortage of medicines, especially pediatric medicines. So to respond to the emergency, Health Minister Karl Lauterbach authorized health insurance funds to buy certain drugs from manufacturers, including generics and pediatric antibiotics, 50% more expensive. An attempt which, he hopes, will bring suppliers back to the national market.
Medicines to the highest bidder
Because on the drug market, the principle of the “highest bidder” is far from being ignored. This is how certain shipments of products, initially intended for France, sometimes end up in Italy or Germany. “This is called the parallel export market”, points out Eric Baseilhac. According to several studies, this intra-European market, which functions thanks to the free movement of goods, is estimated at 5.5 billion euros in the EU. “The European market being open, this sometimes leads some speculators to buy drugs in countries where they are inexpensive, and to resell them in countries where the price is higher, Germany for example”, notes the business director. economies of Leem. And to add: “In times of tension, this phenomenon is harmful because it is at the expense of patients.”
Should we therefore raise the prices of drugs, especially generics, like Germany? The question divides among professionals in the sector. “It’s a totally individualistic and relatively dangerous solution, comments economist Nathalie Coutinet. If everyone does the same thing, it will end up in one-upmanship, which, ultimately, weighs on patients and health organizations. ” For his part, Eric Baseilhac, from Leem, pleads for “urgently raising the prices of certain drugs of major therapeutic interest, today too low to allow industries to continue to produce them”.
Nathalie Coutinet and Eric Baseilhac agree, however, that the price factor is not the only cause of the current shortages. “This economic argument is to be taken with a lot of tweezers, because there are structural causes”, judges the first. “The question of price is major, even if certain shortages are initially linked to an imbalance between supply and demand, as is currently the case with amoxicillin”, admits the second. “We are going to set up a mission to overhaul the process of setting the price of drugs”, recently declared Roland Lescure, the Minister Delegate in charge of Industry, who wishes to “reindustrialize the France of health”. Ambitious goal.