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The Good, the Bad and the Ugly of Medicine Procurement, Part III

By Karel Fucikovsky - Pierre Fabre Farma
BU Medical Care Director

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By Karel Fucikovsky de Grunhof Knap | Director Medical Care Mexico - Wed, 03/29/2023 - 13:00

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Sorry, not available for the moment, … we do not have this medicine for the time being, please come back tomorrow ... I'll have the distributor send it … apparently the pharmaceutical company has stopped making this product.

These are just a few responses among many others that we hear often enough when we go looking for medicine at a pharmacy in Mexico. This is a nightmare journey for patients and consumers. We jump from one pharmacy to another, trying to find our prescribed products, crossing our fingers and expecting that we will eventually hit the bull’s-eye and get the product! 

At times, this is a real struggle, a complete waste of time, money and, of course, accompanied with a high dose of frustration, though we understand that having 100% of product availability in all the private sector pharmacies is close to impossible due to the pulverization of the national drugstore  market, among other factors.

According to the National Institute for Statistics and Geography (INEGI), there were over 45,000 registered pharmacies in Mexico in 2022 of different sizes, formats, business models and capabilities. 

The other side of the coin are our doctors.  One thing they hate immensely is having patients coming back to them and saying that there is no way they can find the medicine just prescribed after visiting several pharmacies. Fortunately, our very well-trained physicians have a robust and vast arsenal of medicine options to re-prescribe in these cases.

When this nightmare patient journey turns into a real tragedy is when we look at what is happening at the public health sector service level.

Patients have to battle against a system that has been dismantled while the new one has not been able to comply with promises of 100% “free” medicine coverage for all. We see patients of all ages going up and down hospital elevators, crossing corridors, at times with critical walking conditions, in wheelchairs — they are all trying to get to the end point where the hospital pharmacy is located, only to find themselves attended to by harsh bureaucratic faces and sometimes with unfriendly and rude responses informing them there are no medicines,  and no date for availability. 

This phenomena is even worse when it comes to life-threatening diseases, such as cancer and other immune system pathologies that require not only specific products but also a rigorous sequence of dosages that cannot be stopped or else the treatments become inefficient, putting patients at  worse risk.

So, patients have to turn back to the private sector and pay out of pocket for the medicines that they were supposed to get for “free” from  the public system. Free is an ideological word, medicines and the entire public health system are designed to serve the population as one of the top government responsibilities, and the cost is not free at all as we taxpayers contribute to make it happen. 

During other administrations, we did suffer a lack of medicines and other hospital infrastructure deficits, so this is not new, but I cannot recall a crisis as big as that we have had for the past four years.

The Good

Our government is constantly trying to do its best to improve the public healthcare system. Our health officials are working by all means to do so, even trying new things, as we can recall with the failed UNOPS strategy and INSABI trying to pull all the right strings. 

By now, we should have on boarded to the system the talented professionals, know-how and resources that can lead to  turnaround of the status quo of this so-called  “free” public health system paradox.

Another good example of this, is the 2023-24 bI-annual tender process for medicines and other hospital requirements. This will allow a cost reduction and will help all pharmaceutical providers to plan accordingly to meet demand and requirements, thus avoiding the risk of non-delivery because of production issues. After all, like many other industries, the pharmaceutical companies need to plan ahead in their production, with at least a six- to eight-month time frame.

The Bad

Even though this bI-annual tender process has already occurred, in the case of medicines, not all therapeutic classes have been considered, with  quite a few cataloged products for specific therapeutic classes declared deserted, as if no participants attended the process despite having done so. 

As the year unfolds, we will surely start hearing about, and documenting, the lack of products and overall shortage in some public hospitals, not because the demand for medicines increased, but because the planning for purchases has had some leaks and failures.

The Ugly

As patients continue to demand drugs and medicines, and the media and social networks will continue to expose the situation, our authorities will surely engage in purchases and direct acquisitions outside the rules of the bi-annual tender, meaning that product availability will happen but at much higher costs, and sadly, what could have been a good strategy to secure production, distribution and prices, will remain in a limbo, making the system still quite inefficient and expensive for all taxpayers.

Photo by:   Karel Fucikovsky

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