“The shortage of drugs is an inevitable scenario that is happening right now and will certainly be a challenge for patients, the health system and all participants in the supply chain in the coming period,” said the president of the Association of Wholesalers of Medicines and Medical Devices of Bosnia and Herzegovina, Faruk Hadžić.
With 20 members, this association is responsible for more than 80 percent of the import and distribution of medicines in Bosnia and Herzegovina.
In the European Union, there is a shortage of more than 15,000 proprietary names of medicines, while many antibiotics are already on the list of shortages in more than 20 countries of the European Union, it was said at the European conference of distributors held in November in Brussels.
“In 2023, the Agency for Medicines and Medical Devices of Bosnia and Herzegovina recorded 171 shortages, reported by 24 approval holders. However, according to information from the market, the number of shortages is significantly higher. This trend indicates the need to update regulations and improve monitoring of the situation on the market,” said Hadžić.
According to him, the European Medicines Agency (EMA) has published a list of key medicines as an initial guideline in ensuring the availability of medicines. Most of the EU countries, stated Hadžić, have already established or launched commodity reserve programs, as a concrete response to the challenges of drug supply.
“The importance of commodity reserves was especially emphasized during the COVID-19 pandemic, where we had more luck than wisdom in preserving the stability of the health system, which necessarily depends on the timely availability of medicines. Given the global challenges, it is a matter of days when the commodity reserves of medicines will be of vital importance for the inhabitants of BiH. Commodity reserves of drugs and medical devices must be a priority at all levels of government, in order to ensure the availability of drugs,” Hadžić points out.
He emphasizes that, although the global supply chain is not subject to direct influence, there is a possibility of improving the priority of delivery of medicines in BiH.
“The current perception of the drug market in BiH is characterized by administrative complexity and insufficient attractiveness in terms of consumption and prices,” said Hadžić.
Wholesalers do not influence the price of medicines
Although different for all participants in the supply chain, challenges in business are directly reflected from manufacturers to wholesalers, then to pharmacies or hospitals and finally to the patient.
“After the COVID-19 pandemic, the biggest challenge for the supply chain is inflation and the enormous growth of all costs – all input prices, energy, transport, interest, etc. A large amount of internal debt, global disruption in the supply chain and continuous downward pressure on prices and almost non-existent “margins are the challenges that are piling up and that wholesalers face every day. The distribution of medicines in this kind of environment is not sustainable in the long term, which is deeply worrying because it threatens the continuity of the supply of medicines,” explains Hadžić.
Distributors in health care represent key partners in the European Union, with formal recognition of part of the critical infrastructure, which emphasizes the exceptional importance of this sector in health care.
“The public should know that wholesalers do not influence the wholesale price of medicines. We generally sell at the purchase price, which is determined by the Rulebook on the method of price control, price formation and the method of reporting on the prices of medicines in BiH, i.e. the prices on the lists of medicines that are financed from the funds of the mandatory health insurance,” says Hadžić.
He pointed to the necessary changes to the Rulebook adopted in 2017, which, as he stated, does not follow the newly emerging circumstances on the world market.
“The purpose of the Rulebook is to limit the arbitrariness of manufacturers in shaping prices, which in the case of Bosnia and Herzegovina are directly related to the cluster of countries Croatia, Serbia and Slovenia. However, the Rulebook defines that the maximum price of a medicine includes a wholesaler’s margin, which should not be the case and is not the case in countries of the region. In practice, this means that the wholesalers are unprotected and left to the decision of the manufacturers, who arbitrarily determine their margin percentages, and who now settle their losses by constantly reducing the margins. It is extremely important that the changes in the Ordinance make a difference between the manufacturer’s and the wholesale price and thus reduce the dependence of the wholesaler on the manufacturer,” emphasizes Hadžić.
As he said, financial stability is further undermined by the debt of the state and health institutions towards wholesalers, which according to current estimates is around 400 million BAM. Regardless of the above claims, wholesalers still have the obligation to pay their suppliers on time.
“The business of drug and medical supplies wholesalers is currently the most vulnerable link in the supply chain. Wholesalers ensure continuous supply, but unfortunately, at the same time, they also act as the main financiers of the entire pharmaceutical market,” concluded Hadžić.
He emphasized that the Association of Wholesalers of Medicines and Medical Devices of BiH is at the disposal of all relevant institutions, with the aim of achieving solutions and preventing unwanted scenarios, BHRT writes.