The price is part of the problem. At least for the manufacturers, the parents would probably pay for everything right now. A 100 milliliter bottle of the fever juice Ibu-ratiopharm from the online retailer Shop-Apotheke costs less than five euros on Thursday. However, like many other juices, it is currently not available. The shortage has been panicking parents for weeks, and concerns are growing with the cold season. What if the child gets sick? How to bring down the fever? There are bottlenecks not only with juices with the active ingredient ibuprofen, but also with those with the active ingredient paracetamol. With suppositories doesn’t look any better. Benuron, Nurofen, Dolormin, Ibuflam, all juices not available. Or just sometimes.
Annemarie Hungbauer, pharmacist, has just received a delivery, “the first in weeks.” You can see how happy she is. “A few bottles, we could use more. Demand is high,” says Hungbauer. “Many children are sick, the parents come with a prescription from the doctor.” Hungbauer used to belong to the Robert Koch pharmacy in Munich. She often helps out. Now the parents are worried that the child could get sick over Christmas and they won’t be able to get an appointment with the doctor. The fever juices are only available in pharmacies, anyone can buy them. Even without a prescription. If you have a prescription for your sick child, you pay nothing. The health insurance pays the bill.
For the juices without a prescription, they could charge more now. “But we stick to the Lauer tax,” says Hungbauer. The reference book lists the selling prices for pharmacies. The prices for the 100 milliliter bottle are well under ten euros. “The price is not the problem at all at the moment,” says the pharmacist: “Some parents would pay for everything if they were in need.” She and her colleagues advise customers not to stock up. “The juice could then be missing for the really sick children,” says Hungbauer. “We usually don’t sell more than one pack.”
With the exception of the original preparation Benuron from the Munich family company Bene Arzneimittel, the fever juices mentioned are generics, i.e. imitations of medicines whose patent protection has expired. The whole dilemma of this market is revealed in the fever juices: the price pressure that has been in this system for years.
“It’s an extremely unfortunate situation,” says Hubertus Cranz, Managing Director of the Federal Association of Drug Manufacturers (BAH). A lot comes together with fever juices. There are the structural problems due to discount agreements and fixed prices, as well as the current problems caused by disruptions in the supply chains. And then there are the higher costs, for example for energy, packaging, tools. “There is also a lack of staff,” says Cranz. The manufacturers negotiate discount agreements with the statutory health insurance companies. As a rule, only one would be awarded the contract, namely the one with the lowest offer, complains Cranz, himself a pharmacist and economist.
Demand exceeds inventory
There are fixed prices for medicines such as the fever juices, which is the maximum amount that the health insurance companies paid the manufacturer for the medicine. In view of the increased costs, production is no longer worthwhile. “Actually, the fixed price should be made dynamic, at least by the inflation rate,” says Cranz. According to him, in the case of discount agreements, several manufacturers would have to be awarded the contract in order to spread the risk of a failure.
Twelve years ago there were still a good ten suppliers of fever juice with the active ingredient paracetamol, according to the Pro Generika association, which represents the manufacturers of imitation products. “Today there is only one main supplier left.” The market share of Ratiopharm, an Ulm company that belongs to the Israeli Teva group, is 90 percent. The Berlin company Zentiva is the market leader for ibuprofen juices with a share of around two thirds. The situation worsened after 1A-Pharma gave up the production of the juices in the spring – slogan: “1A portfolio 1A prices 1A partners – because the business is no longer worthwhile. Like Hexal, the generics manufacturer belongs to Sandoz, a division of Schweizer pharmaceutical company Novartis.
At the moment, demand continues to exceed inventories, Teva responds to written questions from the SZ: “The fever juices can currently be delivered successively.” With paracetamol fever juice, Ratiopharm is increasingly managing to compensate for the loss of the competitor, “even if we cannot fully meet the extraordinarily high demand.” The manufacture of medicines such as paracetamol fever syrup is already a loss-making business for Teva.
It is a bottleneck, not a demolition and certainly not a supply bottleneck, says an authority
Behind the ongoing delivery problems of individual medicines are fundamental problems that affect the entire industry. Shortage of skilled workers, absences due to illness, delays in delivery, problems in global supply chains. According to Teva, there are always procurement problems not only with their active ingredient manufacturers, but also with materials such as filters or cleaning agents. Some bottlenecks, for example with paracetamol fever juice, are “concrete consequences of the current pricing policy in Germany.” While the costs for production and purchasing continue to rise, the fixed prices would stagnate. They could not compensate for high fixed costs and inflation. In addition, long-term discount agreements with health insurance companies would not allow price adjustments in some cases.
The Federal Institute for Drugs and Medical Devices (Bfarm), which keeps the list of bottlenecks, speaks of “restricted availability”. The situation is so tense that the Advisory Board for Delivery and Supply Shortages of the Bfarm met for a special meeting at the end of November. It has become clear that the “available data cannot be used to draw any conclusions about a disruption in delivery,” it said in a statement a few days ago. The authority describes the situation as a bottleneck, not a demolition and certainly not a supply bottleneck. According to the Bfarm, medicines are continuously being brought onto the market. Nevertheless, it is “clearly evident” that the currently increased rate of respiratory infections in children leads to an increased need. This cannot be compensated in full.
Many of the active ingredients for drugs are produced in Asia, paracetamol mainly in India, says Cranz. But that’s not the problem. “The global division of labor has proven its worth.” In principle, it is possible to produce such active ingredients in Germany, explains Cranz. However, the pharmaceutical industry, which is characterized by medium-sized companies, shy away from this because they cannot keep up with the manufacturing costs of Asian suppliers, also because the regulatory requirements for such production facilities in Germany are much higher. “At the current prices for generics, the production of active ingredients in Germany is almost impossible.”