Agents who import medicine to Malta struggle to deal with Malta’s bureaucratic system of procuring medicine and in return, they are “slapped in the face” with “extremely harsh” penalties by the government when they struggle to find a supplier.

Health Minister Chris Fearne, over a week ago, accused agents who import medicines to Malta for not “tendering the contract with the government” and selling medicines to the private sector for a “larger profit margin” even though the medicine may be scarce in Malta.

“It is not true at all,” sources told The Malta Independent on Sunday. “As if any agent has any interest in not supplying the medicine.”

Agents, across the board, are “offended” by Minister Fearne’s “false” claim that they opt to sell to the private sector for more money.

Sources said that the agents cannot control whether or not a medicine is scarce; they are dependent on the manufacturer outside the country.

“When it comes to the private sector, the agents are always doing their best to supply medicine… Agents are essential friendly middlemen who are taking on the responsibility of supply.”

“Agents have been hit very hard by Brexit because a lot of medicines from the UK have stopped. Now they are trying to find new routes to get medicines in.”

An added challenge is that considering Malta has quite a small market, it has a lot of competition with larger countries that offer a larger market for suppliers, sources said.

As things stand, on Tuesday, Fearne said that there were 24 medicines out of stock; seven of the medicines were lacking due to delayed delivery and six of the medicines were not available because the delivery was still to arrive.

Sources suggested that instead of accusing the agents of something allegedly false, there should be a lot more unity between agents and the government, especially in a situation where there is a widespread scarcity of medicines throughout Europe, and countries are holding stock for themselves not to give to other countries.

“Instead of attacking the agent, the minister should be working closely with the agent to help prevent the shortage of medicines and not see the agent as an enemy.”

Seeing that agents are in contact with suppliers, sources said that the government should be in contact with agents to predict which medicines might be going out of stock and work towards always making sure that patients receive new medicines at the beginning of their lifecycle.

“The agents would know what is going to be out of stock in a couple of weeks’ and/or months’ time,” the sources said.

 

‘It’s almost like a war’ – Hostility from the government

Whenever agents struggle to find a supplier, instead of being supported, the sources said that the government responds in a very hostile way with “bullying” tactics and the relationship between the agents and the government was compared to a “war”.

Instead, the government will seek the medicine on the open market and buy it for “an exuberant amount of money”, on the agent’s account. “They do not cap the agents’ liability, it's just an open cheque.” Money is just deducted from the money that the government owes, therefore, the agents have no right to protest it, the sources said.

“Instead of working with the agents they just lump them with a huge bill (when a supplier cannot be found) that is much more than what the tender was worth…. Purchase on accounts and penalties for not supplying are extremely harsh.”

“Agents are doing their best constantly to make sure that there are no out-of-stock medicines, not for us, but for the hospital,” the sources said.

 

A bureaucratic system full of time wasting

“This department is full of bureaucracy where no one makes decisions about anything,” they added.

The Office of the Ombudsman had also criticised the “bureaucratic” system of procuring medicine, following an investigation into a patient who took around a year to receive the medicine prescribed to them. The report was included in the 2022 Ombudsman’s report.

“From this and previous investigations, it is clear that the procurement process is very laborious,” the report said.

Sources explained that when agents struggle to find a manufacturer who is willing to sell certain medicine, they try to find alternatives. However, whenever an alternative is proposed to the government this must be approved by the Central Procurement and Supplies Unit (CPSU), which is usually a very bureaucratic and long process.

There are huge delays for decisions to be taken, taking weeks, the sources said. They added that in situations where the medicine needs to be registered, then there is usually a feud between the CPSU and the Medicines Authority, which takes even more time.

These delays create an additional problem for agents when dealing with suppliers, who could easily just find another agent instead of waiting for the government to come to a decision, the sources said.

 

PN reply

Nationalist Party spokesperson for primary health care Ian Vassallo also spoke to The Malta Independent on Sunday on this matter.

Vassallo said that a number of importers have reached out to the PN “claiming that even when tenders have been awarded, the government take ages to make the order, sometimes months and then, of course, it will take time till the medicine is available as they will order after the government approves its intention to actually get the medicine”.

“Importers who spoke to us are ready to have the medicines available if the government is fully committed to stocking their products,” the PN MP said.

Vassallo added that this issue was initially brought up in the parliamentary health committee last December, and he expressed his concern over the number of medicines that have not been available “for different conditions for days including treatment for oncology patients, skin disorders such as scabies and respiratory conditions including the much-needed inhalers. Also one would add the lack of available supplies in stock of daily use items in theatres and clinics”.

Vassallo also brought up a report, published by the European Federation of Pharmaceutical Industries and Associations (EFPIA) and healthcare consultants (IQVIA), which showed that Malta had access to the lowest number of new innovative medicines approved in the EU between 2018 and the end of 2021.

“This shows that the government is opting to limit itself to the present medications and not invest money in better medicines as approved, even though budget after budget the Health Minister keeps committing itself to do so (for example for multiple sclerosis, mental health and osteoporosis).”