Prescription Panic: Where to Get your Meds after Brexit

At the same time that the Health Secretary is telling people not to hoard medicines in the lead-up to Brexit, there is talk of giving emergency powers to pharmacists to block or substitute alternative medicines to prescriptions to prevent drug shortages after Brexit.

So should you worry? Matt Hancock spoke recently of a willingness to go after suppliers that engage in hoarding.

Matt Hancock wrote in a letter to directed to NHS organizations, general practitioners and pharmacies:

“Hospitals and community pharmacies throughout the UK do not need to take any steps to stockpile additional medicines beyond their business-as-usual stock levels. There is no need for clinicians to write longer NHS prescriptions. Local stockpiling is not necessary and any incidences involving the over-ordering of medicines will be investigated and followed up with the relevant chief or responsible pharmacist directly.

“Clinicians should advise patients that the government has plans in place to ensure a continuous supply of medicines to patients from the moment we leave the EU. Patients will not need and should not seek to store additional medicines at home.”

But should you believe him? What’s so bad about preparing for the worse? While it is true that it is panic buying that will most likely lead to the shortage and hike in prices that you may be afraid is coming, can you actually still trust this administration not to bollix that up like everything else?


Shortages, Blockage and Border Delays

It’s not just the medicines are in a physical shortage, but access to them will be limited by the descent of border controls that until now the UK never had to contend with before. Everything will become slower and more expensive. Lorries stuck in queues on ports would cause all sorts of shortages and humanitarian problems. Negotiations for new frictionless custom deals have been called ‘unrealistic’ while the UK and the EU could not even agree on the deal for how the UK exists the EU.

Millions must be spent to prepare ports for such an eventuality. Director General of Borders at Revenue and Customs Karen Wheeler said that she did not “anticipated immediate upheaval in the event of a “no deal” scenario.” However, she suggested that new facilities may need to be built to accommodate new customs controls, preferably inland, to reduce the strain at the port areas.

Despite words of reassurance, many people are stockpiling anyway. There is a certain American survivalist prepper mood to things, but medicines available only from the EU are among the limited supplies that may run out even sooner in the leadup to Brexit.

The British government had already advised drug companies back in July to stockpile six months worth of medicine to prevent shortfall. While the UK imports 40 million packets of medicine from the EU, even more is exported.

The UK upon leaving the EU will no longer use the London-based European Medicines Agency (EMA) to authorize drugs for use across the EU and including the UK. This may mean slower access to new drugs and treatment procedures as the UK would need to have its own approval agency and discuss how their own pharmaceuticals would be approved for use outside the country.

Perhaps more alarming would be the shortage of healthcare professionals.


The Shortage Protocol

The Department of Health and Social Care’s “serious shortage protocol” is meant to amend Human Medicines Regulation 2012 to dispense alternative medicine according to the protocol, rather than the provided prescription, without having to contact a doctor.

Matt Hancock explained that it was not just about Brexit. “Last month had a shortage of Epipens, because of a problem with the supplier in the United States. It is important that as well as making sure we have a supply of medicines or medical devices, if trained pharmacists and clinicians need to make judgements like this, then they have the ability to do so.”

Pharmacists would be allowed to dispense alternative medicine in according to limited circumstances in the protocols, to be managed at the pharmacy level. The pharmacist would have to use their professional judgment to decide on what medicine to dispense.

The pharmacist in the end may possibly

  • dispense a reduced quantity
  • dispense an alternative dosage form
  • dispense a therapeutic equivalent
  • dispense a generic equivalent

Perhaps the only hope that people may get is that it could be cheaper for being less than what they would normally expect.


The EHIC after Brexit

For those with some means, flying to Europe to acquire medicines there while on vacation is an attractive prospect due to the European Health Insurance (EHIC) card. With 27 million issued EHIC cards, those who travel to the EU as well as Iceland, Liechtenstein, Norway and Switzerland would receive free health care on the same terms as residents of those countries.

UK expats and millions of travelers each year rely on the EHIC to reduce the cost of insurance and make travel more viable for older people and those with higher medical risks. It provided a boost to the economy by supporting the travel industry.

Brexit is expected to hit on 29 March 2019, but there is an agreement in principle that there should be a transition period between 29 March 2019 up to 31 December 2020 to work out further details of the new relationship between the UK and the EU.

But in a No Deal Brexit all these rights might suddenly cease right after Brexit.

The Healthcare (International Arrangements) Bill introduced in the House of Commons 26 October 2018 is largely another scrabbling attempt to retain all the benefits of the status quo while withdrawing from the EU. To be fair, reciprocal health agreements do help the host country too in encouraging tourism.

In the case that the worst happens and the EHIC closes with a bang, the only other places that the UK has reciprocal health arrangements that would offer free or reduced treatment and prescription medicine costs for proof of UK citizenship would be:

  • Anguilla
  • Australia
  • Bosnia and Herzegovina
  • British Virgin Islands
  • Falkland Islands
  • Gibraltar
  • Isle of Man
  • Jersey
  • Kosovo
  • Macedonia (Former Yugloslav Republic of Macedonia)
  • Montenegro
  • Montserrat
  • New Zealand
  • St Helena
  • Serbia
  • Turks and Caicois Islands

Which other than small dependencies and countries in the southern hemisphere leave a few small states and Eastern Europe. One might as well predict inevitable medical tourism over to Ireland.


Should you stockpile meds?

If you’re at all using your EHIC card the answer is yes. If the reciprocal healthcare system stops on Brexit date it could take weeks to months more to get an alternative system. There could be short-term chaos and a run for the supplies. If you are permitted by your physician or healthcare provider to have three months of long-term medication, then you might avoid being made to pay in full for your meds until the situation is resolved.