Rybelsus availability

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maryjaneholland

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Survey has revealed challenges faced by pharmacists and risk of harm to patients as key drugs are unavailable

www.theguardian.com

Medicine shortages in England ‘beyond critical’, pharmacists warn

Survey has revealed challenges faced by pharmacists and risk of harm to patients as key drugs are unavailable
www.theguardian.com www.theguardian.com

This is the Community Pharmacist take on the reported medicines shortages made worse in the UK due to Brexit and alongside the Physicians Associates issues reported on the forum, the future of the NHS looks very bleak.

I have personal update to make after making my own enquiries with the Manchester Integrated Care Board regarding medicines shortages of Type 2 Diabetes drugs my GP refuses to prescribe, but are available on private prescription from private doctor based on patients ability to pay!
 
maryjaneholland said:
Type 2 Diabetes drugs my GP refuses to prescribe, but are available on private prescription from private doctor based on patients ability to pay!
Click to expand...

That’s pretty scandalous :(
 
The Guardian piece mentions a report from the Nuffield Trust: https://www.nuffieldtrust.org.uk/ne...mpered-by-supply-issues-and-impact-of-eu-exit

“We know many of the problems are global and relate to fragile chains of imports from Asia, squeezed by Covid-19 shutdowns, inflation and global instability. Officials in the UK have put in place a much more sophisticated system to monitor and respond, and used extra payments to try to keep products flowing. But exiting the EU has left the UK with several additional problems – products no longer flow as smoothly across the borders with the EU, and in the long term our struggles to approve as many medicines might mean we have fewer alternatives available.”

Professor Tamara Hervey, of the City Law School, said:

“There is nothing inevitable about this ‘new normal’ where Great Britain is isolated in efforts to manage fragilities in global supply of the products and people we need to run the NHS. It is the consequence of policy choices and those could be different. If the Covid-19 pandemic taught us anything, it is that the world is an interconnected place, and having cordial relations with our near neighbours will help us to deliver the health services our population deserves."


Increased shortages really are a global problem - eg here in Oz: https://www.abc.net.au/news/2023-09...s-shortage-not-easing-despite-rules/102815510

Things don't seem to be as severe here as in the UK, but I don't get why not. A smaller market than the UK, not part of any bigger grouping, also reliant on govt doing deals with manufacturers etc ....

I've yet to find an explanation of what's going on with the shortages detailed enough to explain the difference. "Fragile supply chains increasingly disrupted due to increased global instability" seems to be the common story, as far it goes. Eg: Most inputs come from China and India, I think, and anything which disrupts shipping in the Gulf will likely have an impact on supply from European manufacturers, and maybe Oz relies on them less than the UK does.

And so on. But I don't find a really comprehensive narrative anywhere.
 
everydayupsanddowns said:
That’s pretty scandalous :(
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Thing is, on a private prescription, the pharmacist names their price for whatever it is they are supplying, so where necessary, they can go to foreign (hopefully reliable) markets, and price themselves accordingly.

I take T3 for my errant thyroid. I am prescribed it on the NHS. Many are not (there are something like 20 in my whole area being prescribed it by the NHS.

The lengths some folks go to to get their private prescriptions at reasonable prices are astonishing.

On a slightly different tack, for prescriptions being fulfilled via an NHS script, the pharmacy is paid a fixed amount, per item, irrespective of the underlying costs of the drugs the pharmacists has to buy in in order to dispense it. This means some prescriptions are paid fine, and maybe the pharmacist makes a loss, on more expensive medications.

I take a drug, which is £32 per capsule, and I take 2 a day. Thankfully, it is a hospital only drug, so my prescriptions are fulfilled by a specialist pharmacy and the nice man (based in Watford) delivers them to my front door.

In my commercial mind, I cannot discount the potential that some pharmacists claim medication unavailability where they are horribly unprofitable for their businesses.
 
I think it is time that the NHS undertook a review of the procedures our pharmacies are using as they do not provide patients with a twenty first century solution. My pharmacy has had my Creon Prescription since 29 April. I've just called to see when it would be ready. It would appear that when a prescription is received, if it is not filled straight away it requires manual daily intervention to check stock with the supplier and to then order the drugs. If they check too late in the day any stock is likely to have been snapped up, if they miss your drug when checking the many out of stock drugs, then hopefully they will check you drug tomorrow. When I called she was adamant that the issue was with the manufacturer....... I am beginning to think that this is just an easy cop out for the pharmacy. If they implemented modern systems it would remove manual intervention, your automated digital prescription could stay active on the database as outstanding, allowing prescriptions to be resolved on a first in first out basis rather than being dependent on someone remembering, or having time, to check if the drugs are back in stock.
Having got an understanding of the pharmacists issues with obtaining Creon, she then added a cherry on top - she'd had half my prescription for 2-3 days but hadn't got round to doing anything with it. Is it any wonder my water bill is 3 times that of my neighbours?🙄
 
@everydayupsanddowns well the twisted logic after many phonecalls with NHS management and my GP goes something like this...

Medicines Regulator Pharmacist sounded shocked when I gave full account of all the problems getting diabetes drugs such as semaglutides on NHS prescription since 2023 from my GP Surgery, and I was advised to book an appointment with the Pharmacist based at the GP Surgery as there is no "official ban" on GP's prescribing semaglutide drugs appropriately to patients living with Type 2 Diabetes, then my GP appointment today where my GP has slightly changed her tone when I mentioned making my own enquiries with Pharmacists and Integrated Care Board...

So the medicines shortages translate to my GP Surgery still refusing to prescribe injection "kwikpen" versions of semaglutide drugs such as Mounjaro, and instead the GP has prescribed Rybelsus tablet version of semaglutides manufactured by Novo Nordisk, and I have been told this can be looked at again during medication review, and when I looked up this drug online, it's clearly and statistically far less effective at lowering BG levels and assisting with weight management and doesn't offer the added bonus of decreasing the risk of stroke cardiovascular events and death from these complications, as diabetes diagnosis massively increases the risk of cardiovascular disease, which I guess explains the shortened life span by at least ten years!

Overall small victory, but it's very frustrating knowing I will have to struggle with all the side effects of semaglutide drugs whilst taking the lowest dose tablet version which is least effective for managing diabetes and assisting with weight management, but that's another battle for another day to get NHS prescription for Mounjaro, and I can see why people living with chronic medical conditions just snap and have public meltdowns in Pharmacies when they are told their prescription drugs and lifeline are unavailable out of stock no info for restocking, and unfortunately this will become more common as there's no UK stockpile and apparently no government policy or desire to improve these medicines shortages at all - wave your flags, got our country back from the EU's clutches, but it feels poorer and worse off for younger generations struggling with all these issues, end of rant!
 
maryjaneholland said:
So the medicines shortages translate to my GP Surgery still refusing to prescribe injection "kwikpen" versions of semaglutide drugs such as Mounjaro, and instead the GP has prescribed Rybelsus tablet version of semaglutides manufactured by Novo Nordisk
Click to expand...

Offering Rybelsus as an alternative is pretty standard I think.

This page gets updated as the situation is changing across the country

www.diabetes.org.uk

Our response to serious supply issues of drugs for people with type 2 diabetes

UPDATE, 21 JUNE 2024:The World Health Organisation (WHO) has issued a warning over fake versions of semaglutide which have been identified in the UK. The WHO has advised that semaglutide treatment should only come through a healthcare professional, and that semaglutide should not be bought online.
www.diabetes.org.uk www.diabetes.org.uk

“In January this year, an increase in supply of Rybelsus meant that people could be newly initiated on a GLP-1. And we are now pleased to see NHS England opening up Mounjaro as a treatment for people with type 2 diabetes. ”

and

“There is still intermittent supply and shortages of some GLP-1 analogues including Ozempic, (injectable semaglutide), and some of these are expected to run into 2025. But there is now good supply of Rybelsus (oral semaglutide) and Mounjaro (tirzepatide).”

I’ve read from other accounts on the forum from other members being started on Mounjaro (I’m not sure why your area is having such a hard time initiating treatment) that Kwikpens of lower doses seem to be available, eg 2.5 - 5.0, but not the 10.0 ones. Which must be very frustrating for folks started on an initial dose and trying to get to a more effective dose.


These shortages seem likely to continue for some time, and as part of that it seems that there’s something of a postcode lottery in availability of any at all :(
 
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@everydayupsanddowns thanks for useful links and info, I imagine the GP has to factor in the costs of the prescription drugs as others on the forum pointed out there are roughly 400 different diabetes drugs, and Mounjaro costs around £220-250 on private prescription for month's supply depending upon dosage and Pharmacist, but I could really do with the added bonus of reduced risk of strokes cardiovascular events and undoing fatty liver damage promised by the injectable semaglutides, so this is compromise for now!

I would encourage everyone to be more assertive and blunt about symptoms and quality of life with GP's and Diabetic Nurses etc, as my situation of not responding to Metformin and being left to feel the next step would inevitably be Insulin has caused me massive distress and days of feeling housebound giving up and feeling powerless considering the only future of private healthcare and treatment until I can't afford any more, really dark place and not nothing as the government response is to seemingly deny there are any medicines shortages causing any problems!

Oh well, I'm chilling out with half frozen bottle of sugar free diet Orange Crush like fizzy diluted orange juice with Stevia sweetener and distracting my self with Eurovision performance hoping my new meds will arrive sooner rather than later, self-care for the win! 😉
 
The Semaglutide Saga Continues...

Never had this experience with any NHS prescription, yesterday afternoon my GP stated they would prescribe Metformin (repeat prescription) and the semaglutide drug Rybelsus, one hour later my online pharmacy app notifies me of new prescription to confirm for processing and delivery - but it's Metformin only! Stupid me then waits patiently 24 hours for the Rybelsus prescription to appear, nope, so I call my GP Surgery requesting them to review the prescriptions submitted by my GP, and I get call back just before closing from admin staff stating the prescription has been submitted to my Pharmacist, and yet no sign of any new prescription appearing curiously in digital format which is as fast as the internet connection (fibre broadband 70 megs!), so out of desperation I have contacted Diabetes UK and requested callback from helpline adviser next week and left feeling lied to and dismissed and ignored...

I wanted to add that the way the "global shortages" of semaglutides for Type 2 Diabetes has made me feel since I first requested them is like stigmatised prescription drug addict, begging pleading for another script, oh pretty please, expressing my frustration and desperation and being degraded by GP with all the power casually saying "No" repeatedly, making up exaggerated excuses, misrepresenting the situation, making no enquiries with Pharmacists about the latest update on semaglutide drugs and leaving me in hopeless state unnecessarily as patient not responding to Metformin, and this is played out every day in GP Surgeries and Pharmacies all over the UK, POM drugs to treat diagnosed medical conditions are made taboo like patient hustling for methadone, tranquilisers, benzos, trammies, oxys, gimme more!

I am now researching ferries to Portugal where I already know I can get private script for B12 injections and will try my luck for high dose Mounjaro Kwikpens and see how far I get as I'm basically being left for dead by the NHS and our wonderful government, what would you do in such desperate situation??
 
After huge amounts of time effort energy and strained tense phonecalls, I now have prescription being processed by Lloyds Direct, which is now defunct as part of Pharmacy2U, for the generic lowest dose of the tablet version of Rybelsus (unbranded) 3mg, with possibility of moving to higher dose after medication review in month as they only offer 30 tablets, which is breakthrough, but I have also booked Pharmacist appointment at my GP Surgery to ask questions about the current availability of the semaglutide drugs on NHS Prescription as my GP is far too busy to make any enquiries and really loves the dramatic cover-all of stating "global shortages" without making any checks, as progression from "due to COVID no, no we can't do that, because of coronavirus, computer says no"... Tiny small baby steps of progress, not dead yet...
 
Glad you’ve managed to get some Rybelsus at last @maryjaneholland

Hope it works well for you, and the chat with the pharmacist is fruitful.
 
Popped in to the local pharmacy this morning just to get some paracetamol and they didn't have any. Other painkillers available but seems odd that they'd be completely out of such a standard item.
 
Rob Oldfield said:
The perspective of one pharmacist.

www.theguardian.com

I love being a pharmacist, but the UK’s drug shortage makes me want to give up – and Brexit makes it worse | Mike Hewitson

Telling patients I can’t get their life-saving medication is awful. The government must act to prevent a real tragedy, says pharmacist Mike Hewitson
www.theguardian.com www.theguardian.com
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Interesting that he does not include the processes and procedures implemented by our pharmacies as a contributing factor to the stress and anxiety caused to patients. A repeat prescription is a piece of digital information, if there is stock that prescription is automatically fulfilled. If there is no stock the prescription reverts to being a manual prescription dependent on a pharmacist checking a database every morning and then resubmitting the order. Pharmacists are busy and there are hundreds of drugs in short supply that they may need to check, however if they allowed a central database and fulfilled the digital prescriptions in date order they would have less to do in a morning and we as patients would not get rightly irritated when someone posts that they have received a drug with no delay whilst you have been waiting 10 / 20 days. Its all too easy to blame the manufacturer, the nhsc, brexit all may play a part but better processes and procedures would help...............as would a return to the old days where your pharmacy would hold enough stock to cover all repeat prescriptions so that when you walked in with your paper prescription your drugs would be bagged up and waiting.
 
@everydayupsanddowns thanks again, not trying to compete with George Lucas' "Star Wars" Universe of Sagas, but wow, I must be cursed with bad luck, so Lloyds Direct Pharmacy has now been fully closed and taken over by Pharmacy2U and when I requested an update from Lloyds Direct about the generic Rybelsus tablets, they just stated they were handing back all prescriptions to Customers and Pharmacy2U is fully automated "march of the robots" experience where I was forced to nominate them as my new pharmacy to process one prescription with no human beings or listed email address or contact form, just "webchat" which is big red flag to me when anything goes wrong, so nominated Boots Pharmacy Online Presciption Services instead, who confirmed they had branded Rybelsus tablets in stock but Prescriptions are not interchangeable between branded or generic versions, so still waiting for my Prescription to be filled and processed over week later, ugh...
When I mentioned lack of UK Medicines Stockpile, I also meant I had been repeatedly informed that online pharmacies hold very small amounts of limited stock and nearly all Prescriptions are ordered in from suppliers and manufacturers on demand, instead of say vast warehouses full of the most popular common repeat prescription medicines available from NHS, which I had naively imagined...
So not responding to Metformin, but have at least three month supply for 2000mg (four tablets) per day, waiting patiently but nervously for Semaglutide tablets, and my next practical steps are going back to GP Surgery next week for new Prescription for branded Rybelsus tablets from my new nominated Pharmacy, Boots Online Prescription Services, if I don't receive the generic Semaglutide tablets shortly, I think I can say this is all causing "diabetes distress" with poor quality sleep, insomnia, nightmares, messed-up body clock and zero appetite, all entirely outside of my control getting prescription medicine I need, cancelled social walking group this weekend as they were planning two hour long walk up very steep hills followed by posh cafe visit, and realised I'm not in control of managing my diabetes enough to take part without being the "slow walking pedestrian" going at snail's pace, with total antisocial "can't eat anything at cafe so brought packed lunch" snub and this really sucks, and my life is very limited due to lack of healthcare or treatment to manage my T2 diabetes, ugh...:(
 
Oh. good. grief. So sorry.

And sorry you have felt you needed to cancel your social too :(
 
Thanks, I have limited mobility but refused physiotherapy on NHS with assessment leading to light exercise classes for one hour where towards the end I have to grab chair to continue as I'm so unfit unhealthy breathless and overweight, so I have to use taxis and trains and coaches to get around with lots of preparation and being met at the end of the journey, so still experiencing same difficulties like year ago living with untreated undiagnosed diabetes, so no wonder I feel vulnerable to getting hold of high dose Mounjaro Kwikpens on private prescription for 20% weight loss, side effects and extortionate cost be damned!
I also note the GP Surgery Pharmacist today made so many snarky putdown comments about Semaglutide drugs like "Ha you do realise that Semaglutide prescription medications are not licensed in the UK on the NHS for weight loss, in case you were misinformed, nobody will give you NHS prescription for any injectable semaglutides for you to lose weight, that's not going to happen!", so inevitably there's this huge cultural or medical baggage attached to all Semaglutide drugs, like stigma you can't avoid, thrown at me as diabetes patient by NHS staff, when I'm clearly not in the category of selfish mindless influencers wannabe celebrities constantly pushing and promoting "skinny jabs" solely as "weight loss wonder drugs" from private clinics causing the global shortages of diabetes prescription medications, and worrying about what will happen when I don't have all the time/energy/effort/fight left to take on the NHS staff to get the NHS prescriptions for Semaglutides they definitely don't want to prescribe! :(
 
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