Like many of its European counterparts, Hungary is suffering from medicine shortages. Vaccines, vitamins, and orphan drugs are some of the most affected areas and oncology patients are now also at risk.
An Increasing Burden
Over 14,000 types of pharmaceuticals are unavailable in Hungarian pharmacies, which is placing an increasing burden on Hungarians’ health, as well as their finances.
Treatments for hypoglycaemia, meningitis, tick-bone encephalitis and varicella are lacking, and the country is now facing shortages in oncology medication. These issues can usually be solved with a generic substitution or individual importation from other European countries, but this raises the cost and increases the risk of potential side effects.
This burden is even heavier for multidrug combination treatments, as in the case of lymphoma. As an alternative, oncologists are resorting to modified treatment plans – which can mean longer waiting periods – or are using alternative experimental drugs.
In the long run, these workarounds can increase recurrence rates. In the case of bladder cancer in Hungary, the recurrence rate increased from 16 to 43 percent after the shortage. Hungary already has the highest rate of cancer-related deaths in the OECD at 275 per 100,000 people in 2017 compared to the EU average of 175; a situation that these medicine shortages are exacerbating.
The Bigger Picture
There are mounting reports of scarcities across the whole of Europe and the US. In 2018, a survey by the European Association of Hospital Pharmacists (EAHP) showed that 92 percent of participants in 33 countries reported weekly problems associated with shortages which lasted over several months.
The policy of payers towards cancer drugs has been to try and get the lowest price possible; resulting in a consolidation of manufacturing. The number of suppliers has declined and, subsequently, the past five years have seen global shortages of at least ten essential oncology drugs: bleomycin, carboplatin, carmustine, cisplatin, fluorouracil, gemcitabine, irinotecan, methotrexate, mitomycin and etoposide.
The producers of medicines will sell their drugs to countries that pay more. The economic power of a country influences availability and accessibility, hence countries with more patients and more money get what is left. When countries like the US or Germany are in the same predicament as Hungary, Hungarian patients lose out.
New EU packaging regulations are also driving the shortages. The adoption of the EU Directive on Falsified Medicines in October 2015 has caused a 15-30 percent reduction in productivity for Hungarian pharmaceutical manufacturers, with companies investing HUF 20 billion (EUR 61.1m) to upgrade their systems to meet the new regulations and an extra HUF 4 billion (EUR 12.2m) per annum to operate them.
The regulation imposes new packaging and labelling standards, including various identification numbers and codes, to curb counterfeiting and illegal purchasing of medicines. However, the additional costs that pharmaceutical manufacturers, distributors, and wholesalers are incurring is spilling over to patients.
Other factors restricting the supply of medicines in Hungary are poor assessment of demand and large quantities of batches that need to be withdrawn.
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