Many return to their workshop pharmacistsadding to pharmacy they have one more service, familiar to their science, but dormant for many: preparation of herbal preparations. Ointments, syrups, emulsions, suspensions, as well as pills, prepared in a pharmaceutical laboratory on prescription, for treatment tailored to the specific needs of the patient, especially when the drug is not available in the form or dosage that he needs, or even when it is in short supply or withdrawn from sale. There is no need for expensive equipment, “1-2 precision scales, capsule container, solution and raw materials, active substances and excipients, but above all, the knowledge that a pharmacist has”, notes on “K” 1st Vice President of the Panhellenic Pharmaceutical Association and President of the Institute for Continuing Education and Professional Development of Pharmacists (IDEEAF), Seraphim Zikas.

Last weekend in School of Pharmacy EKPA the first two training workshops on the preparation of herbal preparations for Attica were held, organized by Panhellenic Pharmaceutical Association And IDEAF. Two will follow to Attica tomorrow and the day after tomorrow. “There is huge interest. Within three days after we announced the workshops, all 160 vacancies were filled,” said Mr. Zikas. The seminars are based on ensuring the quality of herbal preparations in the pharmacy laboratory and the optimal technologies for their preparation. As PFS President Apostolos Valtas said, “Pharmacy is a living organism. For this reason, pharmacists need to be trained and specialized.”

Similar seminars have been held for four years outside of Attica and Thessaloniki. As Mr. Zikas points out, “we thought that because of the crisis and the lack of drugs, we should use the quality of pharmacists that has been dormant for so many years.” And he continues: “In the past, say, during the period of great “prosperity,” the transactional role of the pharmacist intensified and the role of the laboratory degraded. However, the role of the pharmacist is related to the preparation of drugs. And there are patients for whom ready-made drugs do not apply. For example, people with skin conditions who may require a combination of active substances, in which case the ointment or emulsion can be prepared according to a doctor’s prescription to suit individual needs. Also pediatric patients who require a change in dosage or form of the drug. For example, propranolol for children (for cardiovascular diseases) in the form of a syrup instead of tablets. Aspirin for children in the appropriate dosage. Even eye drops, for the preparation of which aseptic conditions are required. There are pharmacies in Athens who prepare in their laboratory the well-known collyrium, which is currently in short supply.”

OUR Ilias Katzoyannis, district pharmacist, master and candidate of medical sciences at the University of Democritus of Thrace – Faculty of Medicine, is one of the pharmacists with an operating laboratory for the preparation of herbal preparations. Such as refers to “K”“I come from a pharmaceutical family, my father grew up in a lab era and he passed that love on to me. I just had a commitment and a mission to take it to the next level. To bring it to my time.” Mr. Katsoyannis notes that “pharmacists have never lost interest in herbal medicines. However, the pharmaceutical market has shifted several times over the past 30-40 years from a patient-centric model to a pharmaceutical-centric model, and vice versa. As the model of treatment and disease management becomes more human-centric, i.e. we deal individually with each patient, there is a willingness of both the medical and pharmaceutical communities to be more actively engaged in galenic preparations.”

“In the past, during a period of great “prosperity”, the transactional role of the pharmacist increased,” Mr. Zikas, vice president of PFS, tells K.

Her pharmacists pandemic period they had to be “closed” again in their laboratory several times. “During the pandemic,” emphasizes Mr. Katsoyannis, “pharmacists around the world had to prepare antiseptic preparations in their laboratories based on a prescription issued by World Health Organization to deal with an emergency. So that in itself showed very convincingly how important it is for pharmacists to have a good relationship with their laboratory and be able to practice this part of their science and art every day. In addition, during the pandemic, there was a shortage of medicines, which in some countries, including Greece, was covered to a certain extent by their pharmacies and laboratories. In Greece, the most typical example concerns a specific hormonal drug whose active ingredient is estradiol valerianate, which was in short supply. Community pharmacies immediately responded to the call of the medical community for this need, they purchased raw materials, went into their laboratories and prepared a drug that was used by people undergoing assisted reproduction and those suffering from hormonal problems.

According to Mr. Katsoyannis, at the moment the number of pharmacies that systematically produce herbal preparations is small, however, as he clarifies, even if a citizen ends up in an area where pharmacies do not prepare herbal preparations, pharmacists will direct him to where he must go. In addition, a galenic Facebook group has been created with over 6,500 members.

Compensation method

“There is interest from pharmacists. However, the galenic reimbursement method does not justify the investment for a large number of pharmacies,” notes Mr. Katsoyannis, specifying that the investment concerns equipment, maintenance and certification of this equipment – “precision balances must be“ calibrated ”. “at regular intervals,” he notes, “but also the maintenance and replenishment of a modern library with developments in the field of pharmaceuticals. Herbal medicines are covered by EOPYY, while for about ten months they have been written electronically, unlike in the past when prescriptions were written by hand. However, the current costing model has not adapted to new data for at least three decades. “The Panhellenic Pharmaceutical Association has made proposals for a new model for calculating the cost of herbal medicines because the current model is largely outdated. Please note that this includes forms of drugs that are no longer on the market,” says Mr. Katsoyannis.

Low prices in Greece lead to drug recalls

A problem with no apparent solution, it seems drug shortage in our country. Classical antibiotics, antidiabetic drugs, as well as drugs for the central nervous system and other vital drugs are not available or are in small (relative to demand) quantities on pharmacy shelves. “The problem of the pharmacist now lies in the management of elliptical drugs”, notes on “K” President of the Panhellenic Pharmaceutical Association Apostolos Valtas. And he explains that “in order to be able to serve patients, he will need to talk to a pharmacy or contact a pharmaceutical company and ask them to supply drugs directly. And in this situation, a company with a large number of medicines in limited quantities announced that it will stop direct supplies to pharmacies from June 1, which is expected to complicate the situation,” notes Mr. Valtas.

The reasons for the shortage relate, among other things, to production problems due to the lack of raw materials (active substances, packaging), which are combined with very low drug prices on the Greek market. As Mr. Valtas explains to K, if a pharmaceutical company cannot cover all the demand for a product, it will prefer to focus on markets where the price of the product is higher. In addition, low drug prices favor parallel exports, a phenomenon that creates problems for the state and EOF with their temporary ban. There is currently a parallel export ban list that was released last November, and yesterday the EOF published a new vaccine parallel export temporary ban notice (26 with new decision) asking pharmacies to report stocks to EOF. them for the vaccines in question.

“A well-known branded painkiller with codeine cost 5.10 euros, it was withdrawn and is now imported through IFET at a price of 18.01 euros.”

Low prices for medicines in Greece also lead to phenomena of their withdrawal from the Greek market. As recently pointed out by the Panhellenic Pharmaceutical Association, “the phenomenon of withdrawal from the drug market of low-cost pharmaceuticals is increasingly observed, as, for example, the drug Presolon tab 5mg (cortisone drug), which has a retail price of euros, has recently been discontinued at the request of the company producing because it is no longer of significant commercial and economic interest.” According to the PFS, “it is inevitable that these drugs will be replaced in the prescription with more expensive ones, or the ISFT will be forced to import drugs of the same active substance from abroad at a multiple price, burdening the budget of insurance funds and the pockets of patients, since the size of their participation in costs will also increase.

“A well-known branded painkiller with codeine cost 5.10 euros, it was withdrawn and is now imported through IFET at a price of 18.01 euros. And this is one of hundreds of examples,” Mr. Valtas explains to “K”, noting that “people should understand that sometimes it is better to raise the price than recall a medicine. And this part should not be a field of political confrontation.”

Imports, necessarily at higher prices, are carried out through IFET and in scarce medicines. The case of the antidiabetic drug Ozempic is indicative. IFET has received 15,000 packs of the drug (12,000 have already been imported), and they will be available in pharmacies from next week. “I find out that its price will be more than three times higher,” the president of PFS “K” notes.