Frankfurt Fever and pain-relieving juices for children are hard to come by in many pharmacies. While liquid preparations with the active ingredient paracetamol were initially affected, juices with the active ingredient ibuprofen are now also scarce.
The Federal Institute for Drugs and Medical Devices (Bfarm) does not expect an improvement until autumn. The main producer Ratiopharm, on the other hand, cannot give a reliable forecast at the moment. “We are working flat out to expand the production of fever juices and to meet the increasing demand,” says Andreas Burkhardt, General Manager Teva Germany and Austria. Since the takeover by Teva, the Ulm-based manufacturer Ratiopharm has been part of the world’s largest generics group from Israel.
Delivery bottlenecks occur again and again in Germany. In January, for example, the shortage of the cancer drug tamoxifen caused great concern among patients and doctors. Unlike back then, when a supplement was scarce for which there was no alternative, juices for children are about a specific dosage form. Paracetamol and ibuprofen are available in other preparations such as suppositories and tablets.
However, children in particular often need special dosage forms and strengths, as they are often not allowed or unable to swallow the tablets for adults. “Such a delivery bottleneck is therefore a particularly big challenge for pharmacies and parents,” says the German Pharmacy Association ABDA. According to the Federal Association of Pharmaceutical Wholesalers, there is still a certain range of antipyretic juices for children, but not enough for current needs.
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Increased influenza epidemic
A wave of respiratory diseases has been exacerbating the situation for weeks. Since the expiry of the Covid 19 protective measures, not only has the number of corona infections increased, but other respiratory diseases caused by flu or rhino viruses are also occurring more frequently, according to the Robert Koch Institute.
>> Read here: What the missing corona measures mean for the immune system
However, the bottleneck in fever juices goes back to a market development that arose weeks before the current wave of illnesses. In spring, the generics manufacturer 1a Pharma, which belongs to the Novartis subsidiary Sandoz, announced that it would withdraw from the production of paracetamol-containing juices for children from May for reasons of economy. The company had only offered the juice in Germany, as Sandoz confirmed to the Handelsblatt.
From May onwards, the manufacturer Teva/Ratiopharm, as the last remaining main supplier on the market, had to take on the brunt of supplying paracetamol-containing juices for children.
The industry association Pro Generika calls the situation “a dramatic narrowing of the market”. Twelve years ago there were still eleven suppliers of liquid paracetamol preparations. Today, in addition to the main supplier Teva/Ratiopharm, the manufacturer Bene also accounts for a small part of the market.
criticism of the fixed amount
According to Pro-Generika Managing Director Bork Bretthauer, the fact that the providers have withdrawn from the market is due to the fixed price: it has been at the same level for ten years, which means that the manufacturer receives just 1.36 euros per bottle. The prices for energy, logistics and active ingredients that had risen during this period could not be passed on.
The fixed amount of a drug is the maximum amount that the statutory health insurance companies pay for this drug. Fixed prices were first introduced in 1989 for drugs and medical aids to limit the increase in health care costs. If the selling price of a drug is higher than the fixed amount, patients with statutory insurance usually pay the difference to the fixed amount themselves or receive another, therapeutically equivalent drug without additional payment.
Constant fixed amounts with rising drug and production prices lead to a loss-making business in the production of drugs. “This is not an attractive model for companies and cannot be sustained in the long term,” says Teva Germany boss Burkhardt. The current example of paracetamol juices shows how price systems, which are continuously developing downwards, are driving the market tightening.
>> Read also: In the shadow of the pandemic: How the oncology leader is bringing hope to millions of cancer patients
Despite the low margin, Teva wants to ensure the supply of the drug and supply the market, according to Burkhardt. As a global corporation, Teva has the opportunity to compensate for any deficits that arise.
If the manufacturer Bene continues to offer its paracetamol juice at a price above the fixed price, Ratiopharm assumes that it will have to supply 90 percent of the market in the future. Before 1a-Pharma withdrew, it was around 60 percent. “We are already producing twice as much paracetamol fever juice as we did a year ago,” says Ulm. “But the need is even greater.”
Demand for ibuprofen is also increasing
This is exactly why doctors and parents have been switching to fever juices with the active ingredient ibuprofen for a few weeks, which also caused bottlenecks at times. According to industry information, the main supplier Zentiva has now significantly expanded its production here.
The Federal Institute for Drugs and Medical Devices sees the bottleneck in ibuprofen-containing dosage forms for children as largely resolved. In the meantime, many pharmacists also produce their own fever and painkilling juices as recipes. You can also switch to antipyretic suppositories.
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