[MGSA-L] Greek Crisis Dries Up Drug Supply

June Samaras june.samaras at gmail.com
Sat Jan 14 15:14:34 PST 2012

January 10, 2012 10:01 PM text size: TT


Greek Crisis Dries Up Drug Supply as Even
Aspirin Can't Be Found

Jan. 11 (Bloomberg) -- For patients and pharmacists in financially
stricken Greece, even finding Aspirin has turned into a headache.

Mina Mavrou, who runs a pharmacy in a middle-class Athens suburb,
spends hours each day pleading with drugmakers, wholesalers and
colleagues to hunt down medicines for clients. Life-saving drugs such
as Sanofi's blood-thinner Clexane and GlaxoSmithKline Plc's asthma
inhaler Flixotide often appear as lines of crimson data on
pharmacists' computer screens, meaning the products aren't in stock or
that pharmacists can't order as many units as they need.

“When we see red, we want to cry,” Mavrou said. “The situation is
worsening day by day.”

The 12,000 pharmacies that dot almost every street corner in Greek
cities are the damaged capillaries of a complex system for getting
treatment to patients. The Panhellenic Association of Pharmacists
reports shortages of almost half the country's 500 most-used
medicines. Even when drugs are available, pharmacists often must foot
the bill up front, or patients simply do without.

The financial crisis is brewing a “Greek tragedy” of slowing access to
medical care and worsening outcomes for patients, Martin McKee, a
professor of European public health at the London School of Hygiene
and Tropical Medicine, wrote in an October article in The Lancet.

The Greek Ministry of Health didn't respond to repeated requests for comment.

‘Many Difficulties'

“It would be unrealistic to deny that there are many difficulties
regarding all public services due to the financial crisis,” Nicolaos
Polyzos, secretary general of the Ministry of Health, wrote in a
response to McKee's article posted on the ministry's website.
“However, this cannot justify characterizing the current picture of
(the) health sector in Greece as a ‘tragedy.'”

The reasons for the shortages are complex. One major cause is the
Greek government, which sets prices for medicines. As part of an
effort to cut its own costs, Greece has mandated lower drug prices in
the past year. That has fed a secondary market, drug manufacturers
contend, as wholesalers sell their shipments outside the country at
higher prices than they can get within Greece.

Strained government finances only make matters worse. Wholesalers and
pharmacists say the system suffers from a lack of liquidity, as public
insurers delay payments to pharmacies, which in turn can't pay
suppliers on time.

“Wholesalers simply do not have the money anymore to play bank to the
pharmacies,” Heinz Kobelt, secretary general of the European
Association of Euro-Pharmaceutical Companies, said in a telephone

330 Million Euros

Public insurers owe pharmacists some 330 million euros ($422.1
million) for drugs bought since April, Dimitris Karageorgiou,
vice-chairman of the pharmacists' association, said in an interview
last month. Payment can take three months to up to a year, pharmacists
said. Some are turning to patients to pay up front.

“They're saying you pay me now, and then you'll get the money from
your social security fund,” said Ioannis Theodorakis, chairman of the
Association of Persons with Multiple Sclerosis.

Theodorakis said he already knows a few patients who can't afford to
pay and aren't on treatment. If non-payment by public insurers
continues, more will discontinue treatment, he said in an interview in
his office in Athens, a few steps from where protesters lob Molotov
cocktails and pelt police with rocks at Syntagma Square.

‘Dysfunctional' System

“The whole system is dysfunctional,” said Aggeliki Matsouki, who
opened her first pharmacy in Athens in 1981.

Chain-smoking in her tiny back office, Matsouki described calling
other pharmacies to track down London-based Glaxo's oral herpes drug
Famvir. “If I can't find a prescription drug, I try to borrow it from
colleagues. We exchange medicines.”

Austerity measures imposed to address the financial crisis may
paradoxically be making matters worse. Greek wholesalers now have more
incentive than ever to sell drugs outside the country after Greece
implemented a law last year further reducing prices. The law sets
prices of medicines according to the average of the three lowest
charges in 22 European Union countries, part of an effort to trim a
health bill that in 2010 totaled more than 13 billion euros, or about
5 percent of GDP.

Parallel Trading

Parallel imports peaked in 2004, then flattened out about two years
ago once drugmakers imposed quotas of the maximum amount of medicines
they think the Greek market will need, said Kobelt, whose
Brussels-based association represents companies engaged in the trade.
Still, if pharmacies can't pay, it makes economic sense to ship the
drugs back out again rather than let them languish on wholesalers'
shelves, he said.

Kobelt said he's seen boxes of Bayer AG's Aspirin in Poland that
originated in Greece, suggesting that the medicine fetches higher
prices in eastern Europe.

“Even Polish people pay more than Greeks for Aspirin,” he said. “That
is the recipe for parallel trade, I'm sorry to say.”

Novo Nordisk A/S, based in Bagsvaerd, Denmark, is a case in point.

“We are competing with our own products,” said Mike Rulis, a spokesman
for the company.

Novo stopped selling some of its higher-priced insulins in Greece for
about a month in 2010 after the government cut prices by about 25
percent. The drugmaker now ships in the same volume as before the
cuts, yet pharmacists are running short of insulin, Rulis said in a
telephone interview.

Special Deliveries

“There are cases where pharmacies will call our Greek affiliate and
say, ‘We are out of stock, can you help us,'” he said. “Then we will
call the wholesaler to make a special delivery.”

Reimbursement fraud compounds the drain on the country's health
resources, Richard Bergstrom, director-general of European Federation
of Pharmaceutical Industries and Associations, said in an interview.
Drugs shipped elsewhere yet submitted for reimbursement to public
insurers as if they had been prescribed to patients cost Greece more
than 500 million euros a year, Bergstrom said, citing figures he said
he got from the Ministry of Health.

In a later e-mail, Bergstrom said he had personally seen packs of
drugs with Greek reimbursement stickers on the market outside of
Greece, suggesting that exporters were reimbursed and able to ship the
packs abroad.

“If the pack is exported, the exporter is obliged to 'cancel' the
code, a bar code, by using a black pen,” Bergstrom wrote. “But this is
not monitored.”

Up-Front Payment

Not all pharmacists can afford to pay up-front for costly drugs in the
hope of being reimbursed by insurers.

An invoice provided to Bloomberg News shows Roche Holding AG
requesting a 926-euro payment in advance from a pharmacy for
NeoRecormon, a medicine used to treat anemia in chemotherapy and
chronic kidney disease patients.

The Swiss drugmaker switched to a payment-on-delivery policy for
hospitals with a history of nonpayment last year after accepting 400
million Swiss francs ($426.7 million) in Greek government bonds for
unpaid hospital debts. The Greek government announced in December 2010
it would issue more than 5 billion euros of non-interest paying bonds
to hospital suppliers for unpaid bills from 2007 to 2009.

Roche extends a credit to pharmacies and in some cases has extended
credit limits to ensure patients can get drugs, Daniel Grotzky, a
company spokesman, said in a telephone interview. “This might be a
pharmacy which has used up its credit line,” he said.

Difficult Decisions

A year ago, the Health Ministry advised MS patients to buy medicine
through state hospitals, Theodorakis said. Those hospitals often don't
have enough drugs, so patients go to pharmacies instead, he said.

Theodorakis stopped taking Merck KGaA's Rebif in 2006 because he
wasn't satisfied the drug's benefits outweighed its side effects in
his particular case. The frustrating process of obtaining medicine
contributed to his decision not to start taking another drug, said
Theodorakis, who uses a wheelchair and has an assistant to type his

“It's a difficult decision to make because you can't play dice with
your health,” Theodorakis said.

--With assistance from Albertina Torsoli in Paris, Tom Stoukas in
Athens and Makiko Kitamura in London. Editors: Kristen Hallam, Rick

June Samaras
2020 Old Station Rd
Canada L5M 2V1
Tel : 905-542-1877
E-mail : june.samaras at gmail.com

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