The first thing to note is that it tells us the drug is going short from a particular date. By the time this letter arrives into my inbox, via snail mail, the drug is already short (even though we haven’t even arrived at this particular date). This is due to an information asymmetry. Other pharmacies had been in this news loop long before I was and had swept up all available supplies. Yet, this was not the most egregious part of this letter. On the first page under the bulleted summary points was the clincher — the company kindly requested that we made patients aware of this issue; switched them to suitable alternatives based on our clinical judgment, and, wait for it, market availability.

Now, I’m not sure if the company have a sense of humour, or they deliberately wanted to get a rise from us, but it is fair to say, if it was the latter, it worked. What alternative? A gastric bypass surgery in the consultation room? The stablemate of Saxenda is Ozempic. It would be fair to say that no drug to treat diabetes has ever caught the imagination of both the prescriber and the patient more since the introduction of insulin. As every self-respecting TikTok generator knows, Ozempic has become the new weight loss drug of choice for the rich and famous. You cannot buy such publicity. It has created an enormous pressure on the supply chain for this medicine. There have been several attempts at creating a choke on this demand, to ensure continuity of supply for patients with diabetes, yet it is now obvious that these efforts have failed. Even at its most basic, there is  little evidence, other than tokenistic letters, that any prescriber has held back on prescribing this medicine for weight loss patients.

There hasn’t been a single item that has taken up more of my personal time in the last month, than the non-supply of Ozempic. My pharmacy hasn’t received a single pen, of any strength, in seven weeks. Particularly fraught conversations have been had when dealing with patients who are attempting to continue a long-existing course; new potential patients with diabetes, who are finding glucose control particularly difficult; or simply a phone call from a surgery or a patient who are asking if we have stocks. This time vampire has been sucking the lifeblood of availability from my working day. Drug shortages are nothing new, and everybody has read, and in my case written, extensively about this issue. But to use that lovely, resonant phrase, ‘this time it’s different’.

Of particular concern is the growing evidence that the allocation model, which has been increasingly adopted by manufacturers and wholesalers, is somehow no longer fit-for-purpose. The last decade has seen an unprecedented level of drug shortages. Most of the common reasons for this are well known. Supply chain ‘blah de blah’ is constantly quoted. Yet, it is increasingly obvious that the substantial pressure being placed on the prices of pretty much all older medicines, is a factor. This is particularly noticeable in so-called ‘first world’ countries where governments have put sustained massive reductions on older molecules, to release funds for newer much more costly therapies. For patients, it is a double whammy: The first is that it means they can’t get what used to be a commonly used drug; the second is that traditionally inexpensive and widely available drugs can now be only sourced outside the country as unlicensed products, at multiples of the previous price. Frequently these are no longer covered under community drug schemes, consequently placing enormous pressures on the patient to pay more or, if they are lucky, the non-scheme hardship model might come to their aid, and the associated transfer of the administrative burden is passed to the pharmacist and the prescriber.

Yet, I am digressing from what is a broken distribution model. It is important that we all have confidence that the supply chain of critical medicines is equitable. It is a fundamental requirement that distribution of medicines, particularly in a small country like Ireland, has the disinfectant light of clarity thrown over it. To quote a recent high-profile visitor to Ireland, we are at an inflection point. It is no longer clear that our current medicine distribution models are working properly. While Ozempic is a particular case, it is merely representative of a greater competitive malaise. It is now time that the State grapples this thorny issue with both hands.