Struggles Accessing Essential Medication
"It's just terrifying," Chloe says. "I get panic attacks."The 29-year-old, who has epilepsy, is facing significant difficulties obtaining the medication she requires to prevent life-threatening seizures.
Her medication, based on Lamotrigine, is among hundreds of commonly prescribed drugs that have become increasingly difficult to access in England.
While Chloe can obtain some of her other medications without issue, the one critical to her safety and ability to work remains elusive.
"In the last few weeks I haven't been able to get the right medications and my seizures came back. I fell and hit my head and have a big scar across my back now from it," Chloe explains.
Widespread Impact of Medicine Shortages
Access to medicines in England is currently at its most precarious point in years. Individuals with various conditions including heart disease, stroke risk, eye infections, bipolar disorder, and ADHD are among those unable to obtain essential medications.
Supply chain issues are causing many patients, like Chloe, to leave pharmacies across the country without the drugs they need.
These shortages are partly due to rising global prices but are also worsened by the complex funding system for medicines in the UK.
The NHS reimburses pharmacies a fixed amount per medicine dispensed, expecting pharmacies to source the drugs at or below this price.
When drug prices exceed the NHS reimbursement, the medication is added to the government’s price concessions list. In April, this list reached a record 210 named medications.
Pharmacies then receive automatic reimbursement at the updated price for these drugs.
However, sudden market price increases—often exceeding both the original tariff and the concession price—force pharmacies to dispense medicines at a loss.
This situation limits pharmacies’ ability to maintain adequate stock for all patients, increasing the likelihood of delays and shortages.
Patients 'Going on Patrol' for Medication
For patients, this often means repeated phone calls and heightened anxiety. Chloe describes spending hours on buses "going on patrol" to find her medication.
The Epilepsy Society has identified three deaths over the past two years where medication shortages were a contributing factor.
Pharmacies Under Financial Pressure
Pharmacy owners are also feeling the strain.
In Shepperton High Street, Surrey, pharmacist Akash Patel is preparing a monthly prescription for another epilepsy patient.
This month, he cannot complete the prescription as some items are unavailable. The pills he can supply will result in a nearly £9 loss for the pharmacy.
Pharmacists often keep low stock levels of such medicines to minimize losses, which means more patients may miss out.
Since 2017, 1,500 High Street pharmacies in England have closed, with 27 closures so far this year. The total number of pharmacies is now at its lowest in 20 years.
"It's been getting worse in the last few years but now is the worst I've ever known it," says Patel.
Rising Costs and Supply Challenges
Medicine prices are increasing due to higher costs and difficulties in manufacturing and supplying medicines to the UK. Global tensions have driven up energy and transport expenses, and many medicines rely on oil-derived ingredients, which have also become more expensive.
Some manufacturers report that UK prices have been kept so low that distributing certain drugs in the UK is no longer financially viable, leading to shortages that further increase wholesale costs for pharmacies.
Patient Perspectives on Uncertainty
For those with long-term conditions, the uncertainty is distressing. Chris Henry, 49, who takes Co Careldopa for Parkinson’s Disease, has seen his medication added to the government’s concessions list.
After learning about shortages, Chris placed his next order and hopes it arrives before his current supply runs out.
"This is genuinely concerning," he says. "I have four children and work full time, and I know that if I don't take my correct medications then my body control and dyskinesia will be far less predictable, and less manageable."
"Trying to manage medication for Parkinson's Disease is a nightmare at the best of times, so thinking there is a shortage is incredibly worrying and scary. These medications make my life liveable," Chris adds.
Venlafaxine, a commonly prescribed antidepressant, is also on the concessions list. The government has set its reimbursement price at £3.89, yet Patel can only purchase it at a minimum of £5.25.
"It's a big loss-making drug so we only ever order small amounts in the hope the price will come down when we order it next," Patel explains. "And even when I order it, there's no guarantee it will actually come."
Financial Strain Limits Stockpiling
The UK government allocates a smaller proportion of its health budget to medicines per patient compared to many Western European countries, including France and Germany.
This pricing dynamic means manufacturers may prioritize selling medicines in countries where profits are higher.
Last year, Patel’s pharmacy lost £140,000 on NHS medicines dispensed. His father, Gaurang, who founded the pharmacy, expresses concern about the business’s sustainability.
"Maybe it's time we just gave up as well, our pension has already been swallowed up in losses," he says.
Shepperton now has only one pharmacy, down from three. The other two closed after years of losses.
Some pharmacists have reported to the BBC that they have had to remortgage their homes or use their pensions to keep their businesses afloat while awaiting reimbursement adjustments.
Gaurang notes that rising global costs, especially oil, will soon impact medicine prices.
"This is a long supply chain and so the war hasn't impacted supplies yet, but prices to make medicines have gone up, and so have transport costs," he says. "I'd stockpile if I could, but I don't have the cash flow."
Calls for Reform and Market Viability
Experts warn that without reform, medicine shortages will persist. They argue the reimbursement system is too slow to adjust to price spikes, forcing pharmacies to dispense at a loss.
Dr Leyla Hannbeck, chief executive of the Independent Pharmacies Association, states many members are
"struggling to afford supply and often dispensing at a loss."The IPA has requested that medicine supply be added to the National Risk Register but has yet to receive a response.
Experts also emphasize the need for the UK to become a more attractive market for manufacturers by increasing medicine prices overall to ensure supply resilience.
Olivier Picard, chair of the National Pharmacy Association and a practicing pharmacist, describes the current system as broken:
"I lose money on over 300 medications, and they are standard everyday items like blood thinners, blood pressure meds and painkillers - the medications that people need every day. The government wants to pay very low prices for medicines but it is backfiring now."
"No one is winning here - and it's the patients who suffer most."
Government Response
A spokesperson from the Department of Health and Social Care stated:
"The vast majority of the UK's licensed medicines are in good supply, and we are working hard to keep it that way.
We have established processes to respond to sudden market price increases of medicines. This includes adjusting reimbursement prices based on current market conditions, which helps ensure that pharmacies can continue to obtain medicines for their patients."
