Aripiprazole shortage - key facts for patients including aripiprazole alternative options

Aripiprazole shortage – Facts you must know

Aripiprazole has been in and out of stock for the last few weeks. Fluctuations in the supply created an aripiprazole shortage in the UK. However, the true story of aripiprazole shortage is linked to the current price that pharmacies must pay to the wholesalers, which makes a supply of aripiprazole to patients difficult. More information is included in the later part of this post.

What is aripiprazole?

Aripiprazole is classified as atypical antipsychotic. In the UK aripiprazole is used to treat:

  • Schizophrenia
  • treatment of moderate to severe manic episodes in Bipolar I Disorder
  • prevention of new manic episodes

In the UK, the most common form of aripiprazole prescribed to patients is aripiprazole 5mg and 10mg tablets.

Aripiprazole shortage – how NHS fails patients

As I wrote in the introductory part, aripiprazole has been in and out of stock for a couple of months. Some wholesalers are more affected by aripiprazole shortage than others, however, there are a couple of suppliers who almost had a continuous supply of aripiprazole. Pheonix and Sigma Pharmaceuticals are two suppliers who have had aripiprazole in stock almost all the time during aripiprazole shortage. At the current time, aripiprazole is in stock in both suppliers.

Pheonix and Sigma supply drugs to many independent pharmacies, with Pheonix being an owner of Rowlands Pharmacy chain.

What went wrong with aripiprazole supply?

Despite the availability of aripiprazole, many pharmacies do not supply it to patients and advise them simply that the drug is ‘out of stock’. Both suppliers mentioned in the previous paragraph set a high price for aripiprazole tablets. The reimbursement price for both aripiprazole 5mg and 10mg tablets are significantly lower than what pharmacies pay to the wholesalers for obtaining aripiprazole. The reimbursement price is the money pharmacies receive from NHS to cover the cost of the drug supplied.

To put into perspective, at its peak a box of 28 aripiprazole 5mg tablets cost around £50. Pharmacies are paid from NHS £0.89 per box supplied. A box of aripiprazole 10mg tablets costs around £80, with pharmacies being paid £1 for each box supplied. A pharmacy which makes supply aripiprazole 5mg tablets loses around £49 per box and around £79 for a supply of aripiprazole 10mg tablets. It is understandable why many pharmacies decided not to supply aripiprazole to patients.

What does NHS do about aripiprazole shortage?

The Department of Health and Social Care (DHSC) has a rather outdated mechanism in place for dealing with changes in the price of drugs. At the end of the month, a price concession is published, which shows changes in price reimbursement (how much NHS pays to pharmacies for the supply of drugs) of a number of drugs.

Both aripiprazole 5mg and 10mg tablets were listed in the price concession list, however, NHS set the reimbursement price at £5 and £31.99 respectively for both drugs NHS (DHSC).

At the beginning of September prices of aripiprazole 5mg and 10mg tablets dropped by about half, however, it is still much above the NHS price. Price concession only applies to the month which is granted, leaving pharmacies in a difficult position to supply aripiprazole to patients.

How to get aripiprazole?

Choosing an independent pharmacy or one of Rowland Pharmacies may bring some luck to patients who seek aripiprazole, however, due to the cost of the aripiprazole, pharmacies may choose not to supply it.

Alliance (which supplies drugs to Boots and other pharmacies) has an intermediate supply of aripiprazole tablets. Availability changes on daily basis. Use Prescription stock checker page to locate stock of aripiprazole in your local Boots pharmacy.

Aripiprazole alternatives – can you get them?

When a drug is out of stock, GP may prescribe the same drug in a different formulation or strength. Regardless of pricing issues, aripiprazole shortage affects all strengths of this drug.

Aripiprazole belongs to the second generation of antipsychotic drugs. Changing aripiprazole to another antipsychotic drug may not be as straightforward as with other drugs. Patients who fail to find a stock of aripiprazole need to contact their GP or prescriber who is in charge of their treatment to consider other treatment options. British National Formulary (BNF) classifies the following drugs as second-generation antipsychotics, which may be considered as aripiprazole alternatives:

  • amisulpride,
  • asenapine,
  • cariprazine,
  • clozapine,
  • lurasidone hydrochloride,
  • olanzapine,
  • paliperidone,
  • quetiapine, and
  • risperidone.

 

I am a qualified pharmacist working in an independent pharmacy in the UK.
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