Insulin Rationed by Pharmacy Supplier

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BigIan

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Relationship to Diabetes
Type 1
Hi all
I wondered if anyone else had come across a similar issue to this? And if so, how it was resolved.

I have been T1 diabetic for 29 years; about 5 year ago I was put on an insulin pump. This requires lots of vials of insulin. My diabetic team via my GP issue me with 3 months worth at one time. I have always received 3 months supply since I was diagnosed in 1993, whether using insulin for pumps or the previous versions for pens and syringe delivery.

Recently the pharmacy have consistently failed to issue me with the total amount of insulin on my prescription. The only time I think they have done it successfully was during the height of the Covid pandemic. After trying to fob me off with the usual 2 or 4 vials out of 16 on my prescription I pointed out as a diabetic I was supposed to be self isolating, and visiting the pharmacy every few days in the hope the rest of my prescription was going to be available was not good for my health and against the government recommendations at the time.

One of pharmacists told me today there is "a quota" on what they can be supplied with at once. This strikes me as nonsense, and I have no proof of the existence of any such quota. If I have a prescription for 16 vials that is what I expect to receive. I have spoken to my diabetic nurse and she agreed there should be no limit on what is on my prescription; that is between the diabetic team and my GP.

The pharmacy's suppliers should surely have no say whatsoever on when and how much medication I need? What happens if they receive orders for 8 vials each from 2 people? Does this "quota" apply again and 2 people are left with a shortage? What happens if half a dozen diabetics order insulin on the same day? I've asked the pharmacist about this and I received no helpful reply except for a repeat of "there's a quota". I don't understand why this keep happening, or the pharmacist's unhelpful attitude in trying to get this resolved.

I don't believe the pharmacy is strictly at fault with this, after all there is nothing for them to gain by not supplying my full prescription, although they could be more helpful. But I find it very, very frustrating that I am made to feel I am being unreasonable in just requesting that my prescriptions are supplied in full.
 
Hi
Sorry to hear that you are having problems with your insulin supply. Is it possible that the insulin you are using is in short supply at the moment and the pharmacy can only get their hands on so much stock at a time so they have to ration it between customers to ensure everyone gets some. I believe that there were some problems with Lyumjev recently in this respect, so just wondering if that is the insulin you are using or if it is one of the more commonly available insulins?

Are you able to use another pharmacy service? That said, 3 months supply of insulin at one go seems like a lot. We were recommended to keep a months supply in stock during the pandemic but I think many of us probably order monthly. Does it not take up a lot of space n your fridge? And if you had a power cut or fridge breakdown, it seems like a lot of insulin to potentially jeopardize or if you popped your clogs a lot of insulin that would get wasted..... Not suggesting that is likely but we are all mortal and it can happen at any time.
I will be interested to hear what other people with pumps do as I am on MDI and generally just reorder when I get down to my penultimate cartridge.
 
I understand your frustration with the messaging you are getting from your pharmacist. Is there an alternative pharmacy you can use?

That said 16 vials is a lot of insulin and I can understand a small pharmacy may have storage issues, especially as they have to store it in the fridge and the number of people with diabetes they need to supply has been growing in recent years. Maybe the "quota" is related to the size of their fridge? Is there a middle ground that you could agree with them - such as 6 weeks worth of insulin per prescription or requiring extra notice to order extra in?

Many pharmacies in my area have a texting service - I request my prescription on line, my GP sends it to my nominated pharmacy and the pharmacy text me when they have dispensed it. There is no need to visit the pharmacy every few days, especially as I try to order far enough in advance so I am not going to run out.

It sounds as if a small volume per prescription would enable the pharmacy to dispense your insulin fast and would require less visits to them overall.
 
rebrascora said:
That said, 3 months supply of insulin at one go seems like a lot. We were recommended to keep a months supply in stock during the pandemic but I think many of us probably order monthly. Does it not take up a lot of space n your fridge? And if you had a power cut or fridge breakdown, it seems like a lot of insulin to potentially jeopardize or if you popped your clogs a lot of insulin that would get wasted..... Not suggesting that is likely but we are all mortal and it can happen at any time.
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As I said, I've had 3 months supply since I was diagnosed back in 1993. And I don't see that it's the pharmacist's (or their supplier's) business how much I need. For all they know I might be going abroad with work for 10 weeks. Surely their job is just to supply what they've been asked to.

And no it doesn't take up a lot of room in my fridge - the vials are fairly small.

Also they haven't said that it is an issue with storage - they just repeat ad naseum that their suppliers apply a quota. Which is what I want to get to the bottom of.
 
BigIan said:
As I said, I've had 3 months supply since I was diagnosed back in 1993. And I don't see that it's the pharmacist's (or their supplier's) business how much I need. For all they know I might be going abroad with work for 10 weeks. Surely their job is just to supply what they've been asked to.

And no it doesn't take up a lot of room in my fridge - the vials are fairly small.

Also they haven't said that it is an issue with storage - they just repeat ad naseum that their suppliers apply a quota. Which is what I want to get to the bottom of.
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Your 16 vials would be about 2 years worth of insulin for me :( that aside if that's what's on your prescription then it should be provided end of story.
 
Why don't you believe your pharmacist when they say there is quota system in place? There is a quota system for many medicines; not just insulin. Why would your pharmacist put you (and them) through the same hassle every three months? Do you not imagine they want a quiet life too? The medicines supply chain is broken and has been for many years. There are many occasions when pharmacists have to discuss supply issues and discuss alternatives with GPs ; something they have little time for.
Please consider your dispensary team, they are stuck in the middle! Yes, you should expect to get all the medicines prescribed, and I am sure your pharmacy orders the correct quantities, but what can they do when they are sent only 3 or 4 vials of insulin when they ordered 16? They are simply told there is a quota system and there is nothing they can do about it.
You are free to try alternative pharmacies, even online services, but I suspect you will have similar issues wherever you go.
It is a very frustrating situation for all concerned and there is no easy solution when the supply chain misfires as it has been for many years.

PS I am diabetic type 1.5 ....and a pharmacist.
 
16 vials is a huge amount of insulin isn’t it? How many units ish are you using per day? Have you looked at alternatives like higher strength insulin, or adding something like metformin or increasing exercise to improve your insulin sensitivity? Does your username suggest you could look at losing weight to reduce your insulin requirements, or is that just that you’re very tall?
 
Sorry to hear about your frustrating situation @biglan.

As someone who gets 3 vials at a time any quota is not something I have encountered! But I can completely see how irritating it must be having had that insulin supply for many years suddenly to have to make extra trips to the pharmacy. :(

Would it be possible to put your order in and then have the pharmacy call you when they have the full amount set aside for you? Presumably the warehouse delivers daily, so it should only delay be a day or two?
 
I've never, ever in my life with Diabetes so that's almost 50 years had more than 1 month's worth of insulin ie 2 vials ar the moment. though I actually need one and a half - on my repeat prescription list. If I already have plenty in the fridge, then I'll not order it with stuff like tablets which have to be ordered every 28 days. When we were going abroad for months at a time - well I had used to order 3 month's worth, but over a fortnight - ish. Because I never usually ordered massive amounts of anything and my GPs have known that - I've never had a prob. I don't want shedloads of insulin in my fridge thanks - and can't understand frankly why ever anyone else would? Hasn't anyone else ever had a fridge decide to suddenly pack up, or an unexpected power cut when some clot digs through a cable or a pylon comes down somewhere? - we certainly have.
 
I hear your frustration. It’s not unusual for us to not be able to pick up a full prescription of insulin when we go in and that’s for much smaller amounts. Because it needs to be refrigerated they don’t like it hanging around in pharmacies and so there is some choking of the system to stop large amounts being in a pharmacy where it might not be used. For our pharmacy they order it and it comes within a day, two at most.

Our GPs are only allowed to prescribe 2 months of meds per prescription (less than that for some medications). I still have one drug on an older 3 months worth of drugs and that’s getting increasingly hard to get the full amount each time. So I think there are wider supply issues even aside from refrigerated meds.

You could ask the pharmacy what amount they are likely to get in at one go and ask for your prescription to be adjusted to monthly or two monthly but even that may not sort the issue. Unfortunately everything is under strain at the moment with covid and Brexit so things won’t be the same as they have been.
 
The other thing of course is that at various times in the last 50 years using insulin - and other long term conditions needing drugs - when things have changed about me or different, better products have become available - I've needed changes to the drugs - like having to stop taking some due to side effects I've suddenly got etc - and so I wouldn't want to see more than a small amount of whatever having to be destroyed - such a waste of money. And of course - we ALL pay into the NHS whether we think we do or not.
 
When you think of all the treatments now available on the NHS which were never imagined as being possible when it all started. I was born by Caesarean section and it was so unusual that it was a teaching case for the doctors at the hospital but now very common place. People just used to 'put up' with conditions for which now there are successful meds and outcomes.
The expectation of what the NHS can do for people is huge and that comes with cost. Don't forget that doctors are always learning throughout their career, it doesn't end after their 5 years at med school and 2 years of further training before they choose a speciality.
At the moment they are exhausted by the extra pressure of COVID.
 
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