From drugstore to drugstore...

"I had to traipse through the whole neighborhood to get the medicine I need — like a junkie looking for a fix." Charo Martínez, 65, had a kidney transplant 18 months ago. To prevent her body from rejecting the organ, she needs to take immunosuppressive drugs, but she is having more and more problems obtaining them. Recently, the urgency of the situation forced her to go to her doctor at Barcelona's Vall d'Hebron hospital to ask him for the medication, even though pharmacies are supposed to dispense it. For weeks she had been getting by with the pills given to her by a transplant recipient friend who had more than she needed. A number of patients like her in Catalonia are running into difficulties when trying to obtain medication that is vital to their health.

People with transplants need to take these pharmaceuticals on a continual basis to stop their bodies rejecting their new organs. They are expensive: the most widely used cost about 200 euros. The economic crisis, and the precarious situation of many drugstores — which have had to deal with repeated non-payments from the regional government — have brought about a dearth of the drugs in their stockrooms, meaning patients have to ask for them piecemeal, as they need them. In turn, the pharmacies put in orders to the wholesalers, which buy them from the producers.

But the imbalances in the system are forcing many patients to wander from pharmacy to pharmacy. Some end up asking their doctor to dispense them. Patients' associations complained to the head of the Catalan health department, Boi Ruiz, in a meeting several weeks ago. "It is growing more and more common for the pharmacies to not have certain medicines in stock," explains Antoni Tombas, president of the Kidney Patients Association (ADER).

The health department recognizes the situation, but maintains that the detected cases are "occasional." "There are thousands of people who take these treatments regularly," says Antoni Gilabert, director of pharmacies for the CatSalut regional health service. In one week alone, complaints from three patients came to the attention of CatSalut, which solved the cases on an individual basis. One of the patients was sent to a hospital to get the pharmaceuticals, while the others were told which pharmacy they could find them in. Gilabert admits that hospitals must be for "exceptional cases."

It is more and more common for the pharmacies not to have certain drugs"

The pharmacy service at the Hospital de Bellvitge, in the municipality of Hospitalet near Barcelona, has sent a circular letter to doctors telling them that if patients come to them in search of immunosuppressive pills, "do not send them to the hospital pharmacy," explains Teresa Casanovas, director of the hospital's Chronic Hepatitis Assistance Program. "The last patient who came here was a woman who had gone three days without medication," she adds.

Doctors providing aftercare to these patients confirm how complicated the situation is. "For some months, a number of people have had problems getting these drugs," says Francesc Moreso, clinical chief of the Kidney Transplant section in the Nephrology Service at Vall d'Hebron Hospital.

This happened to María Ramírez, who received her last kidney transplant in November. "I had been going to my pharmacy for 10 days," she says. "They told me that they would have it the next day. But I went and it was never there."

The situation has both Ramírez and Martínez living in a state of anxiety. "It makes me feel undeserving, guilty for being ill."

The last patient who came had gone three days without medication

The pharmacies warned in late October that if the regional government continued failing to pay them - by then it owed pharmacies 390 million euros — some might not be able to ensure a supply of the more expensive products. Boi Ruiz told the patients' associations that the problem should not continue as pharmacists had been paid the three months' backlog owed to them. "He also said that, if this still happened to people, they should call the CatSalut response number," says Rosa Pamies, of the Corsnous association, which represents heart-transplant recipients. The telephone service is handled by the Medical Emergencies System, though it is not the number for emergencies. The health department has set it up as a mechanism for solving these problems - a solution viewed suspiciously by doctors and patients' associations.

The Catalan government has promised to get the payments to pharmacies back to normal in 2014, which has not prevented the process from continuing. The pharmacist who serves Ramírez explains the problems she faces, under condition of anonymity. "We used to handle the more expensive medicines for the whole neighborhood, but the non-payments have caused us to send bills back to the suppliers," she says. The slowness caused the main supplier to cut off the pharmacy's supply.

"What do you do if that happens? You change wholesaler, and the snowball keeps getting bigger." But the new wholesaler did not have the pharmaceuticals in stock, and took time to obtain them from the producer, according to the pharmacist. Added to these problems is the fact that these particular drugs have never been very profitable for the drugstores, since the margins they obtain are narrow compared with the disbursement they require.

The situation for Ramírez became so serious that she herself called the company that produces her medicines, Novartis, which for some time has provided pharmacies with a phone number in case of supply problems. "We didn't use to get more than 10 calls a month from Catalonia; now it's between 100 and 200," the company explains. "Between last summer and now we have detected more cases," says Antoni Puig, Logistics director for Novartis, which produces some of the most widely used immunosuppressive drugs. Novartis maintains that it is still supplying these drugs to wholesalers on a normal basis, and that the problems in the circuit are not due to any decisions of its own.

Frances Pla, vice-president of Barcelona's Official College of Pharmacists (COFB), explains that these pharmaceuticals "are not as available as they used to be" because "the supply circuit has grown complicated." According to Pla, the supply problems are centered on "the shelves of the distributors."

Fedefarma, one of the principal suppliers in Catalonia, has so far declined to offer its version to this newspaper.