Drug shortage fears trigger HRT export ban and scrip-switching powers for pharmacists

The government has banned exports of HRT products and activated emergency prescription-switching powers for pharmacists amid rising concern over drug shortages.

Drug shortage fears (Photo: simonkr/Getty Images)

The DHSC has announced 'restrictions on the exportation of all variations of HRT products' amid supply shortages for a number of products, and put in place further restrictions for 'all adrenaline auto-injectors and hepatitis B vaccines'.

The government has also made use for the first time of legislation that took effect earlier this year to give pharmacists powers to modify prescriptions.

A 'serious shortage protocol' (SSP) has been introduced for the antidepressant fluoxetine - allowing pharmacists to 'supply an alternative strength or pharmaceutical form' of the drug without first consulting with the original prescriber.

The protocol applies to patients with a prescription of fluoxetine 10mg, 30mg and 40mg capsules, all of which are currently in short supply.


GPonline reported in August that GPs may have to switch patients to alternative HRT medication amid warnings from suppliers that some widely-prescribed drugs would soon be out of stock. A total of 15 HRT products are currently out of stock according to the MIMS drug shortage tracker.

Overall, more than 100 medicines prescribed in primary care are currently out of stock in the UK - and GP leaders have warned that shortages are having a serious impact on both GPs and patients.

The DHSC said restrictions on HRT exports had been imposed because 'some HRT drugs are being parallel exported' - a practice that sees medicines meant for the UK market sold abroad at a higher price. The government has written to wholesalers warning that it will 'exercise its powers to stop parallel exporting'.

BMA GP committee executive team member Dr Farah Jameel said HRT shortages had been going on for 'far too long' and said it was 'encouraging that the government is finally taking steps to resolve it by limiting HRT exports from the UK'.

Drug supplies

Dr Jameel added: 'Thousands of women rely on HRT in the UK, and we know that many patients have been needlessly suffering as a result of recent manufacturing and supply issues.

'Drug supply issues are common, and while clinicians can prescribe alternative medication, amending a patient’s prescription takes time and this can significantly add to our already heavy workload – particularly if the issue is ongoing.'

She warned, however, that 'prescribing alternative interim medication might not always help to fully relieve a patient’s symptoms, further delaying their treatment and causing avoidable, unnecessary distress'.

Health and social care secretary Matt Hancock said: 'I know how distressing medicine shortages can be for those who rely on drugs like HRT and it’s absolutely crucial patients can always access safe and effective treatments through the NHS.

Care quality

'The new measures we’re introducing today will help us ensure patients get the medicines they need and the high quality care they deserve.

'Helping the NHS is a priority for this government, and people should be fully reassured that we will always act to ensure that there is an adequate supply of the medicine you need.'

The government said that the SSP for fluoxetine would 'remain in place while manufacturing issues mean the drug is temporarily in short supply, to alleviate pressure on the supply chain'.

Dr Jameel added: 'While this protocol is a sensible measure in theory, patients must have the reassurance that changing the strength or form of their much-needed medication – in this case commonly used for mental health-related conditions – won’t have any adverse effects. Furthermore, we have to be sure that it won’t add to GP workload or cause unnecessary confusion among practice teams.'

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