Pharmacists now find themselves in the deeply unenviable situation of being the fall guys for the frequent unavailability of this drug. High visibility programmes on television and radio feature weight loss patients as victims of some sort of conspiracy, one where the State has plotted against people who feel it is their right to get whatever medicine they feel they need. At the coalface, the pharmacist is depicted as ‘patronising’ patients by asking what the medication indication is. The message about licensing is being lost, particularly in light of the strong guidance sent to us. While pharmacists, and the public, are told that we are casualties of the great semaglutide rush, the reality, on the ground, is a little more complex. There has been a welling dissatisfaction in the pharmacy world surrounding the distribution of the Ozempic allocation in the country. This malaise is understandable. We do not have enough of the drug to meet demand. Rumour and innuendo abound. People start to lose confidence in the fairness and equity of the distribution system. Frustration devolves into anger, where rationality is often in short supply.

The allocation of medicines in Ireland is not unique to this country, in fact quota systems are now common across most European countries. In my opinion, it is a symptom of two major issues: genuine shortages and differential pricing across various geographies. We know that you can purchase a pen of Ozempic in Dubai for about $300, if you travel to the States the same pen will set you back $900 — on prescription in both cases. There is an obvious pressure to supply to markets where margins may be higher.

The profusion and growth of online GP services are posing distinct challenges to pharmacists. The variety of issues straddle a number of domains. It is not clear that oversight of the prescribing habits of a very small number of medical practises are coming under the level of scrutiny that they should. So, we are seeing a very small number of surgeries being responsible for the issuance of deeply problematic prescriptions. For instance, not just controlled drugs, but medicines that have special monitoring requirements in relation to safe use. This is a situation that was never envisaged. One of the standard pieces of advice that we have been given is that we should only dispense controlled drugs to patients from prescribers that are close geographically. This is broken. While we have not reached, nor probably ever will, the level of the pill mill as featured in the good old USA, there are concerns. I am not only talking about controlled drugs. It would be fair to say that national antibiotic prescribing guidelines appear to be unknown to some prescribing practises. For instance, in my pharmacy, there are some practises where almost every prescription we receive is for an antibiotic Like all of us I worry about antibiotic stewardship. I worry about a world where the antibiotics that have treated the last few generations will still be useful for the ones coming. I find it difficult to reconcile responsible prescribing with the practices of a small minority of surgeries. Yet there appears to be no mechanism, nor will, to ensure prescribing quality.

Something has started to become a little more blatant in community pharmacy in the last year. This is the creeping issue of PCRS reimbursement price being completely out of line with actual purchase price. This became obvious recently where some staples of the pharmacy world, items like Silcocks Base, 100ml carbocysteine liquid, Acidex all have wholesale prices that are considerably greater than reimbursement price. What is particularly galling is that many of us are oblivious to this issue. For a number of years, we have grown used to the concept that the reimbursement price is lower than the wholesaler price to the pharmacy. This is a fixed percentage, the clawback, of around 8 per cent. While utterly unacceptable, we have worked around this unreasonable imposition on our finances. If we thought that this was the agreement, think again. It is becoming increasingly obvious that we need to check, on a more systematic basis, all reimbursement prices against wholesaler. I personally find this galling. We already exist in enormously complex community pharmacy world. We’re dealing with multiple difficult issues every day. It is, to my mind, unreasonable that we are placed in this situation. Generally, we are talking about traditionally inexpensive items. Yet, dispensing at loss is a sure formula for a very unhappy and unhealthy business. This is a growing issue, which needs to be addressed now.