Serious Shortages of Medicines and Medical Supplies

[Keith Woolford]

The lack of drugs is becoming more evident in the pharmacies of the country

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Country Facing Drug Shortage

La Prensa reporters visited a number of pharmacies in both Panama City and the interior, and confirmed the shortage of a number of medications, including ones for high blood pressure and anxiety.

President of the Association of Representatives and Distributors of Pharmaceutical Products Lucas Verzbolovskis explained that the problem is due to delays within the Department of Pharmacy and Drugs of the Ministry of Health. That agency is currently revising 4,000 records for the issue or renewal of permits for drugs.

Verzbolovskis said they have proposed to the government that permits be automatically extended when the drugs originate from the same factory and without any changes to the formula.

In an interview, Director of Pharmacy and Drugs Jenny Vergara admitted that there are several aspects of the process that should be improved, but did not specifically mention the permitting process. She said that the problem is mainly due to a lack of personnel.

Nephrologist Arturo Wong said the matter is delicate, since, as he explained, the lack of drugs jeopardizes people's health.

http://www.prensa.com/in_english/encrucijada-farmaco_21_4547755181.html

 

 

 

Edited August 8, 2016 by Keith Woolford

[Bud]

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Buck passing as drugs run out

Posted on August 8, 2016 in Panama

Post Views: 169

PANAMA pharmacies are fast running out of  drugs with the hot potato issue being blamed on everything from a computer virus to administrative inefficiencies and outdated laws.

A La Prensa investigation .found that pharmacies in both Panama City and the interior, are reporting a shortage of a number of medications, including ones for high blood pressure and anxiety.

The President of the Association of Representatives and Distributors of Pharmaceutical Products Lucas Verzbolovskis said that the problem is due to delays within the Department of Pharmacy and Drugs of the Ministry of Health (MoH) which  is currently revising 4,000 records for the issue or renewal of permits for drugs.

Verzbolovskis said they have proposed to the government that permits be automatically extended when the drugs originate from the same factory and without any changes to The Director of Pharmacy and Drugs Jenny Vergara told La Prensa  that there are several aspects of the process that should be improved, but did not specifically mention the permitting process. She said that the problem is mainly due to a lack of personnel.

Earlier the MInister of Health Miguel Mayo had blamed a computer virus for the problem leading to thousands of documents having to be processed by hand.

“We had a problem in the Department of Pharmacy and Drugs a virus problem in the computer Processing dropped almost to zero and we had to work manually for two months. [This] aggravated the situation, but it  is already remedied,” Mayo said in a meeting with journalists, without giving further details about the incident.

The minister said , the present shortage is also due to the current outdated  law governing approval of  medicines.

“The law of medications is very good but you have to modernize it. When it became [the standard], there were drugs that had not been created so  were not included in how the approvals were granted,” he said.

http://www.newsroompanama.com/news/panama/buck-passing-drugs-run

[Bud]

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OPINION: Inepitude in drugs boondoggle

Posted on August 8, 2016 in Panama

Shortages developing

Post Views: 116

Hoyporhoy, La Prensa. Aug. 8

THE DELAY in medical records and a tangled state procurement process have left people  without essential medicines.

With a tax collection criterion sometimes suspiciously restrictive of competition, the Department of Pharmacy and Drugs of the Ministry of Health has about 4,000 cases awaiting its proper processing. Meanwhile, as acknowledged by the health authority, at least 50 important drugs are without their respective records, despite this  being a recurring and almost automatic process.

The bureaucratic morass combined with the exaggerated ineptitude of officials lacking the excuse of lack of resources, the responsibility for  enforcing the law is passed to  imaginary third parties or to the Office of the Comptroller General.

This is an important and vital matter of national security for all citizens. We can no longer accept justifications.

The therapy applicable to this condition is very clear: either procedures are changed, or get staff that really knows how to implement them and understands that what is in their  hands is the health of Panamanians.

http://www.newsroompanama.com/news/panama/opinion-inepitude-drugs-boondoggle

[Moderator_02]

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OPINION: Never ending medicines tragedy

Posted on March 26, 2017 in Health, Opinion, Panama

Post Views: 29

THE TRAGEDY  of drug shortages in the public health system is never ending.

Administration after administration, patients, especially those with chronic diseases, face the hard experience of having to spend huge sums of money to procure the necessary medicines to combat their afflictions.

To make matters worse, the lack of medication in private pharmacies is becoming increasingly  frequent.

More and more people have to resort to extreme solutions to get their medicines, even abroad. But shortages are not the only dilemma for Panamanian society, since in recent months there has been a big rise in the cost of medicines.

The State must take the necessary measures to ensure that, once and for all an effective solution to this situation is found. It is unforgivable that Panama has one of the best growth rates in the region and that a reasonable supply of medicine remains a further victim of bureaucracy.

 

http://www.newsroompanama.com/opinion/opinion-never-ending-medicines-tragedy

[JudyS]

Just hope that you are never in a situation here of needing morphine (such as terminal cancer).  The supply is limited, and it sometimes it is not available. 

Edited March 26, 2017 by JudyS

[Bonnie]

It is not limited in private hospitals, I have found. My husband had it around the clock for about nine days last summer at Hospital Chiriqui. I remember well because I looked at the IV bottle and saw that it was labeled "morphina" and that it cost $500 a bottle. He used four bottles in a 24-hour period. At that cost, I can see why it wouldn't be plentiful at the public hospitals. (This is another good reason to have private health insurance or be able to afford to go to a private hospital.)

[JudyS]

This is not always true.  a few weeks ago, there was none to be found in any hospital.

[Bonnie]

Where did you get this information, Judy?

[JudyS]

It involved a terminal patient.  I can't discuss it on an open forum.  You can call me, and I will tell you what happened.

[Moderator_02]

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Panama Buys Medicines for $241 million

The Social Security Department has approved the allocation of resources to purchase essential medicines, narcotics and controlled substances for various diseases.

Friday, April 7, 2017

From a statement issued by the Social Security Department:

Amounting to $240.941.853.07, the Board of Directors of the Social Security Department (CSS) approved, yesterday, in an ordinary session, spending on procurement of medicines as set out in resolution 01-2017.

The single price resolution 01-2017  has to do with the procurement of essential medicines, narcotics and controlled substances for various diseases.

With the expense having been approved by the Board, the National Purchasing Department will now proceed with the usual procedure of a call for provisions (PanamaCompra) to ensure supply of medicines in the 400 lines of which the resolution is comprised.

 

http://www.centralamericadata.com/en/article/main/Panama_Buys_Medicines_for_241_million

[Moderator_02]

http://www.prensa.com/in_english/Falta-cateteres-afecta-trasplantes-rinon_21_4765233432.html

[Moderator_02]

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Tender: $48 million for Medicines

The Social Security Fund in Panama is putting out to tender the supply, storage and delivery of medicines as needed at the national level, for a period of at least twelve months.

Tuesday, May 23, 2017

Panama Government Purchase 2017-1-10-0-08-LP-252737:

"Requirements are for the provision of 85 national lines of special drugs, controlled substances and narcotics (high sanitary risk) at the national level, for a minimum of 12 months, which covers the exercise of fiscal validity and extensions of the term.

All drugs supplied must have a minimum period of validity of twenty-four months starting from when they are received by the Social Security Fund."

Reference value: $47,506,400

The deadline for receipt of bids is May 31, 2017.

 

http://www.centralamericadata.com/en/article/main/Tender_48_million_for_Medicines

[Moderator_02]

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CSS patients protest medication shortage

Posted on June 6, 2017 in Panama

Post Views: 93

 WHILE DOCTORS at Santo Tomas Hospital, are mulling  a new strike over unfulfilled promises from the Ministry of Health, patients dependent on the  Social Security  (CSS) system  are protesting the shortage of medications.

Members of the National Federation of Patients with Critical, Chronic and Degenerative Diseases staged a demonstration on Tuesday, June 6, on the steps of the Social Security Hospital Complex on Via Transistmica.  demand greater access to medications.

They said shortages have threatened the lives of patients. For example, they reported that diclofenac sodium is needed at the pediatric hospital to relieve pain for those with sickle cell anemia

Meanwhile, Social Security officials said they are looking for solutions to solve, once and for all, the shortage of medicines.

Mirna Allen, one of the participants  mentioned the lack of erythropoietin, necessary to maintain the concentration of red blood cells in the blood.  

Patients with chronic and degenerative diseases have been waiting almost two years  for the CSS to conclude

a $76.8 million purchase , to acquire 45 lines of biological and biotechnological drugs  basic to treating  diseases such as rheumatoid arthritis, immunodeficiency virus (HIV), schizophrenia, hemophilia, sickle cell anemia and multiple sclerosis.

According to the Panama Compra portal, the tender began in October 2015 and was awarded in December

2016, but to date the patients have not received the medications

The Constitution, says : “it is the State’s essential function to ensure the health of the population’

Following the protest on the steps, the group went to the Social Security facilities in Clayton,  Where they met – for two hours – with Julio García Valarini, deputy director of Social Security.

García Valarini affirmed that there are already processes in process for the acquisition of the medicines, but they will speed up the mechanisms.

http://www.newsroompanama.com/news/panama/css-patients-protest-medication-shortage

[Moderator_02]

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Tender: Medicines for $7 million

The Social Security Department in Panama is putting out to tender the supply of biological and biotechnology medicines for a period of 12 months.

Monday, June 12, 2017

Panama Government Purchase 2017-1-10-0-99-LP-256310: 

"Fixed unit price, for the supply, storage, transport and delivery, according to need, of biological and biotechnology medicines set forth in the tender documents, their addenda and annexes for hospitals, polyclinics and other places established by the Social Insurance Fund nation wide during a term of at least twelve (12) months covering the exercise of the fiscal term and extensions of the term."

Reference value:  $7.279.253.  

Deadline for receipt of bids: July 19, 2017.

See Tender

 

http://www.centralamericadata.com/en/article/main/Tender_Medicines_for_7_million_2

[Moderator_02]

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Tender: Medicines for $5 million

The Ministry of Health in Panama is putting out to tender a supply of 3,189 vials of Trastuzumab 600mg / 5ml.

Thursday, July 20, 2017

"Proposals will be considered valid if presented in a unit of packaging that is equal to or less than 1,000 units in the case of pearls, capsules, pills, lozenges or tablets provided that the equivalent of the total amount required is met. Any amount surrendered in excess will be considered as a donation to the ION. 

The validity of the products subject to this Public Act is twenty-four (24) months minimum counted from the date verified and received by the National Cancer Institute according to each medication or material. This expiration date will be counted from each delivery."

Reference value: $5.060.943

The deadline for receipt of bids is August 7, 2017. 

See Tender

 

http://www.centralamericadata.com/en/article/main/Tender_Medicines_for_5_million_1

[Moderator_02]

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Panama: Medicines to be Re-Tendered

Due to the fact that no offers were received for 61 drug lines in the $240 million tender held on July 10, a new contest is being prepared for the coming weeks.

Monday, July 24, 2017

Medications for which no proposals were received include several commonly used drugs such as acyclovir, benzocaine, sugar-free expectorants, chloramphenicol, dapsone, and some types of anti-inflammatories, among others.  

The director of the Social Security Fund (CSS), Alfredo Martiz, told Prensa.com that "in the coming weeks a new tender is planned with these 61 drugs that were unfilled."

In the view of the president of the Association of Representatives and Distributors of Pharmaceutical Products (Aredi), Lucas Verzbolovskis, "... the causes that lead companies to not submit offers are multiple. He mentioned that both the CSS and the Ministry of Health have a history of breach of the payments, and also leaving accounts overdue."

 

http://www.centralamericadata.com/en/article/main/Panama_Medicines_to_be_ReTendered

[Moderator_02]

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$5 million Medicines Tender

The Ministry of Health in Panama is putting out to tender a supply of different types of medicines.

Tuesday, August 22, 2017

Panama Government Purchase 2017-0-12-11-08-LA-011768: 

"Delivery of 8,417 bevacizumab 25 mg / ml, concentrate for solution, vial." 

Reference value: $3.913.905

The deadline for receipt of bids is August 31, 2017.

See Tender

Government Purchase Panama 2017-0-12-11-08-AV-011779:

"Delivery of 379,800 capecitabine 500 mg, tablets or oral capsules" 

Reference value: $987.480

The deadline for receipt of bids is August 29, 2017. 

See Tender

 

http://www.centralamericadata.com/en/article/main/5_million_Medicines_Tender

[Moderator_02]

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Panama: New Procedures for Public Purchases of Medicines

A bill put forward by the Varela administration proposes a new mechanism to expedite the purchase of medicines, surgical medical supplies and sanitary technology.

Friday, September 29, 2017

From a statement issued by the Presidency of Panama:

The Cabinet Council approved at its weekly meeting a bill that creates the "General Directorate for the supply of medicines, surgical medical supplies, sanitary technology and other products for human health", which seeks to expedite purchases and decrease "shortages" in the public sector hospital units in the country.     

Erick Ulloa, deputy minister of health, stressed that this measure seeks an operational management structure, to develop supply management and ensure the availability of medicines and other products for human health, in addition to meeting demand by patients in health facilities for different levels of attention and degrees of complexity as part of the Public Health System, Social Security Fund and any other public entity that by its nature and functions provides health services.

Read full release (in Spanish).

 

http://www.centralamericadata.com/en/article/main/Panama_New_Drug_Purchase_Mechanism

[Panawanna]

What is the current experience on the ground in Boquete/David?  Has the drug shortage been resolved?  What do expats do when they need drugs that are not available in Panama?  Can prescriptions be purchased in the U.S. and successfully mailed or couriered to Panama?  

[Moderator_02]

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Tender: $3 million for Medicines

The Ministry of Health in Panama is putting out to tender a supply of different medical supplies.

Tuesday, December 5, 2017

Panama Government Purchase 2017-0-12-14-08-LP-014466:

"Reagent for the detection of HIV antigen antibody F / T 100398 R / 2-syphilis TPA JGO 100 PR 61392 R / 3-hepatitis C (antihcv) 100PR 61007 R / 4- hepatitis B core kit 100 PBS 100399 R / 5- HTLV 1 and 2 for the detection of antibody 100738 R / 6-hepatitis B architect 100pr 61006 R / 7-reagent for the detection of chagas 102325."

Reference value: $1.562.949.

The deadline for receipt of bids is January 16, 2018.

See Tender.

 

https://www.centralamericadata.com/en/article/main/Tender_3_million_for_Medicines

[Bud]

29 minutes ago, Moderator_02 said:

 

https://www.centralamericadata.com/en/article/main/Tender_3_million_for_Medicines

To my way of thinking, $3M is not even a drop in the bucket.

[Moderator_02]

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Figures in $266 million Medical Supplies Tender

The Social Security Fund of Panama held a public act to acquire 483 lines of medical supplies, an event attended by 49 companies interested in providing the products.

Monday, September 3, 2018

From a statement issued by the Costa Rican Social Security Department (CCSS): 

The auction was held in the auditorium of building 519, belonging to the Social Security Fund (CSS), in Clayton, for the Single Price Tender N0.02-2018 for supply, storage, transport and delivery, according to need and requirement of surgical medical supplies.

The call was attended by representatives from 49 companies interested in providing medical and surgical supplies to the CSS.

This is the public act for the supply of different health facilities of the SSC at national level, for a term of 2 years and comprises 483 lines for an amount of 266 million 454 thousand 389 balboas and 57 cents.

For his part, the National Director of Logistics, Ing. William Silen said that these surgical medical supplies include sterile and non sterile gloves, bed covers, robes, bandages, plasters, different forms of catheters, among others, and, because it is a MQ tender (surgical doctors) there are no medications as such.

"Since 2015 a tender for these inputs had not been made, for various reasons, this is the first and therefore, in recent years each executing unit has been buying their basic needs at a price much higher than what can be bought through the central warehouse, for which we want to eliminate this procedure by holding a single price tender of this type for the next 24 months," Silen said.

The event was attended by the general director of the CSS, Dr. Alfredo Martiz F., who offered a management report on the public events carried out during his 16 months of management at the head of the institution.

 

https://www.centralamericadata.com/en/article/main/Figures_in_266_million_Medical_Supplies_Tender

[Moderator_02]

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Businesspeople ask for solution to shortage problems in Panamanian health

Mon, 09/10/2018 - 11:42

The Chamber of Commerce, Industry and Agriculture of Panama (CCIAP) said today that "ignorance of the real needs" of public health institutions leads to problems such as the medicine shortage, and reminded the authorities they are responsible for solving the situation.

"Panamanians demand that their current leaders direct health towards solutions that recognize and empower it in the terms enshrined in the Constitution and the laws of the country," said this Sunday in a public statement the Chamber, which brings together more than 1,600 companies of 15 economic sectors.

On the medicine shortage, the Chamber blames the "ignorance in the entity of its real needs, hence poor purchase planning: very little is acquired from some items and many others".

Also the Chamber blames the delays in the payments to the suppliers or in the elaboration of the specifications of the bids, because "up to 517 days are given to hold a public act knowing of the lack of supply".

"Errors in contracts that delay adjudications, challenges that hinder the entire tender, rejection among institutions to receive recommendations from the private sector that would improve processes, and inefficient management of warehouses," are other points exposed by employers.

The CCIAP and the private sector as a whole "seek not to be part of the problem, but of the solution. We have all sat down at a work table aimed at correcting our differences, while waiting to sit down together with the authorities in the search for the best ideas and actions to benefit patients," the Chamber said in its public statement.

 

https://www.panamatoday.com/panama/businesspeople-ask-solution-shortage-problems-panamanian-health-7809

[Uncle Doug]

I think the problem is that the government is in charge.  Where are the problems in the US health system?  In the government-run veterans hospitals.  It's not that governments are evil and stupid (although some are).  It's that the incentives and competitions which reward excellence in the private sector are not present in a government agency.

[Keith Woolford]

2 hours ago, Uncle Doug said:

I think the problem is that the government is in charge.  Where are the problems in the US health system?  In the government-run veterans hospitals.  It's not that governments are evil and stupid (although some are).  It's that the incentives and competitions which reward excellence in the private sector are not present in a government agency.

Alex, I'm going to go with Big Pharma Profitability for $1000.

Researchers find 1 in 10 drugs sold in Canada are back-ordered or discontinued

Malone Mullin · CBC News · Posted: Jun 13, 2018 2:55 PM ET | Last Updated: June 15

A new report probing Canada's struggle to keep pharmacy shelves stocked has turned up a number of possible causes, and the authors say that without swift action, the problem will only get worse.

Jacalyn Duffin, a doctor and medical historian who co-authored the C.D. Howe Institute study, set out to chronicle the growing list of back-ordered drugs after hearing from patients who said they had to delay treatments or switch to inferior alternatives when they couldn't fill their prescriptions.

The report found one in 10 drugs in Canada has been affected since 2016, the first-year shortage data was aggregated and made publicly available on a Health Canada-mandated website.

Recently, EpiPens have been in such short supply that Health Canada has recommended using expired injectors. Meanwhile, a global antibiotic shortage threatens even the most mundane treatments.

While there is no obvious, overriding cause, Duffin cited a number of possibilities. It could be that per-dose generic prices are simply too low for a company to turn a profit, for instance.

Or it could be a supply concentration issue, meaning any setback could cause delays that reverberate through the supply chain. For example, Hurricane Maria, which hit Puerto Rico late last year, affected manufacturers as power-deprived factories switched to diesel generators, slashing their production. U.S. media outlets reported that the disaster greatly reduced medical shipments from the island.

"People want you to point a finger at the evil drug companies, but it's more complex than that," Duffin said.

Something 'truly amiss'

Health Canada doesn't currently analyze shortage reports like these, so the task falls to curious academics like Duffin, a professor emerita at Queen's University.

She founded a website for shortage information in 2010, which for years served as one of Canada's only resources on that issue.

Christine Caroppo came across Duffin's website, Canadadrugshortage.com, after her own panicked encounter with a shortage. Caroppo's elderly mother had only a day's supply of acetazolamide, an epilepsy and glaucoma medication, when her usual pharmacist told Caroppo the drug was out of stock.

The 61-year-old Caroppo recalled buying up the last remaining pills from multiple pharmacies, all of which were running out of acetazolamide. She needed enough to keep her mother's severe hydrocephaly, a disorder that causes the  skull to fill with spinal fluid, at bay. Had Caroppo not discovered other supplies, she said her mother would have fallen into a coma and potentially died.

"Something is truly amiss in this system," Caroppo said, noting that her family has encountered two more distinct drug shortages since her mother's ordeal in 2015.

Caroppo said "you might expect" these kinds of shortages in a developing country, but as Canadians, "we've been lulled into a sense of complacency that if you need it, it's here. And that's not true."

Health Canada said in a statement that plans were in place to "analyze and identify trends" on shortages in the future, and explore ways to distribute warnings, but it would not provide details.

Could Canada make its own generics?

Duffin's conclusions echo those in a report to the World Health Organization earlier this year by the International Generic and Biosimilars Medicine Association (IGBA).

"Globally, medicines likely to be in short supply have a low [profit] margin, are difficult to formulate or produce (high-cost), have a short shelf life, and/or have few or only one manufacturer," the report said, noting that communication between drug companies and health authorities is the best way to navigate market fluctuations.

Duffin said there's little we can do about these shortages without a worldwide action plan.

"It's a global problem. It didn't originate in Canada and it can't be solved in Canada," she said, pointing out that 85 other countries have reported drug deficits.

A quick fix could take the form of a national essential medicines list, Duffin said, which would give health authorities the ability to track a few hundred of Canada's most-needed medications and prioritize getting them to pharmacy shelves.

After that, she proposed a publicly controlled generic manufacturing company could fill gaps in the national supply.

"The drugs that are missing are the ones that have been around forever, and are not difficult to make. As a good Canadian, I think, why don't we just start our own company and start making these drugs?"

Amir Attaran, a health law professor at the University of Ottawa, sees another solution.

"The reason shortages happen is because there is no requirement not to let them happen," he said. "If Health Canada made it a requirement to supply the drug or to lose one's [drug identification number], then that would be a different story."

In response, the regulator said in a statement that it "cannot compel a company to market and supply a product." 

Duffin said that whatever action they eventually take, health authorities need to stall the apparent increase in shortages.

"Being a very old doctor, I can say that we never used to have shortages like these," she said. "We'd have one here or there, but not to the extent we've seen in the last eight years."

https://www.cbc.ca/news/health/canada-drug-shortage-report-1.4597574

Edited September 10, 2018 by Keith Woolford