Out of stock medicines: what to do if your medicine ‘disappears’ from the shelves

Felipe Terrezo owns two pharmacies in Rio de Janeiro, but when his granddaughter got sick last week, he didn’t have any novalgin solution in his stores to give the girl to lower her fever.

“I haven’t found it on the market for about ten days, and I haven’t been able to buy it. Luckily, I had an open bottle at home that solved the problem this time”, says Terrezo, who is president of the Pharmaceutical Products Retail Trade Union of River.

The businessman says he has recently noticed that it is exceptionally difficult to find some antibiotics to supply his pharmacies.

“When clients arrive and the drug is out of stock, we try to help and replace it with another brand or a generic one, but what about what has no replacement?”

Situations like this have been frequently reported in different parts of the country. In Paraná, for example, there were 500 medicines in short supply at the beginning of May, according to the union of pharmaceutical retailers.

The shortage in pharmacies is also a concern in at least 17 other states and the Federal District.

The lack of medicines has already been reported in Alagoas, Bahia, Ceará, Espírito Santo, Goiás, Mato Grosso do Sul, Minas Gerais, Pernambuco, Pará, Piauí, Rio de Janeiro, Rio Grande do Norte, Rio Grande do Sul, Santa Catarina, São Paulo, Sergipe and Tocantins.

“Although there are no data that allow us to say categorically that there is an exceptional shortage, we have heard many reports of lack of specific medicines, especially very cheap ones, which the industry is not interested in producing, as is the case with some antibiotics”, says lawyer Matheus Falcão, a researcher at the Health program of the Brazilian Institute for Consumer Defense (Idec).

Falcão explains that the reason for the problem is usually not in the stores, but in the manufacturers.

“Brazil has a structural problem of production capacity and depends on imports of the drug itself or active pharmaceutical ingredients [o principal ingrediente de um medicamento]and, in 2022, the lockdowns in China because of covid and the war in Ukraine affected the supply”, says the researcher from Idec.

Sérgio Barreto, president of the Brazilian Association of Pharmacy and Drugstore Networks (Abrafarma), says that, in addition to the greater difficulty in the arrival of inputs to the country, the pharmaceutical sector faced a kind of “domino effect”.

“Other products that were missing demanded more dedication from the industry, leading to a reduction in the manufacture of other products”, he says.

The increase in cases of flu at the same time that infections by the coronavirus have started to grow again in Brazil are also pointed out as reasons for the shortage.

There was a greater demand for certain antibiotics at the beginning of this year, according to the Pharmaceutical Industry Union (Sindusfarma), which claims that they are specific problems and that manufacturers are adjusting their production to meet the market.

The National Health Surveillance Agency (Anvisa) explained to BBC News Brazil that, despite being responsible for regulating and monitoring this market, it does not take care of commercial relations in the sector, such as the acquisition and distribution of medicines, and says that it has no means legal requirements to oblige manufacturers to guarantee the supply of medicines in the country.

But companies have some obligations to comply with in case of shortages, and the consumer can take some measures if they come across a drug that is out of stock at the pharmacy.

1. Contact the company

The first step should be to call the customer service of the laboratory that manufactures the drug to verify if there is really a problem in the supply, says Anvisa.

If the manufacture or import of a product has been temporarily or permanently interrupted, the company must inform the reasons and dates on its websites and service channels.

“The company also has a duty to inform where consumers can get the drug in the region where they live”, says Matheus Falcão, from Idec.

2. Consult Anvisa

But there are cases where the product is simply not available on the market, and it will not help to go from pharmacy to pharmacy in search of it.

Consumers should consult Anvisa to confirm if this is the case, because manufacturers are required to notify the agency that a drug will be permanently or temporarily discontinued at least six months in advance.

The agency maintains a list of notifications on its website. If a drug is in it, the consumer must check the date the notice was given, because the agency mandates that supply must be guaranteed for at least six months thereafter.

When the discontinuation can generate a risk of shortages, as is the case when there is only one drug of a certain type available or this product accounts for a large share of the market, the notice should be given a year before, according to Anvisa.

3. Report

If a drug is out of stock because it is no longer manufactured and this has not been notified to Anvisa, the consumer can report the company at the agency’s call center, by calling 0800 642 9782, or at its ombudsman.

The agency informs that this can constitute a sanitary infraction and lead to the opening of an administrative process against the laboratory, which can be punished.

The complaints also help the agency monitor whether there is a shortage or risk of shortages and take the necessary measures to try to guarantee the availability of the drug on the market.

“Anvisa can ask other suppliers for information and inform the population of the shortage of a specific drug”, says Falcão.

There are cases where the lack of a drug can generate a public health crisis. In such cases, it may be necessary to turn to the Ministry of Health.

“The ministry can take specific measures and go after the producers, articulate with Anvisa to negotiate for the product to be manufactured again”, says Falcão.

Sought by BBC News Brasil, the Ministry of Health said that it works to keep the public network supplied, but did not address the shortage reported on the private network in its response to the questions sent by the report.

4. Activate Justice

Often, someone needs short-term treatment, and it’s not worth going to court to get access to a remedy.

But there are other cases, such as high-cost and long-term medicines, in which shortages can imply a violation of a person’s right to health.

Matheus Falcão explains that, in these cases, it is possible to resort to a lawsuit.

“The person can go to court for the company to justify why the product is not being made available and to get the drug”, says the Idec lawyer.

5. Look for a health professional

When there is a shortage of a particular product, the consumer should seek a health professional to replace the drug that was originally indicated by the doctor.

This can be done in some cases by the pharmacist responsible for the pharmacy, who will indicate a product of another brand or generic.

But there are situations in which the doctor indicates in the prescription that a drug cannot be replaced by a generic one or there is no equivalent product from other manufacturers.

In these cases, the patient should look for the doctor so that he can make the most appropriate replacement of the medication that was prescribed.