Patient Perspective: Reporting on Medicines Shortages—Hemophilia a Case in Latvia

Following austerity measures in Latvia, the reimbursement system faced major changes. Coagulation factor concentrates (CFC) used for hemophilia A treatment were moved to a reference list. This meant that government would only pay for the cheapest treatment included in the reimbursement system. Prescription rules did not change, but hematologists could no longer choose the treatment for their patients. Patients continued to attended their hemophilia center every three months, where they received special prescriptions for treatment according to their condition in line with Baltic Hemophilia treatment guidelines. During 2011–2016, 13 shortages were registered for CFCs for hemophilia A (2 products). Patients were not aware that the system must provide them with necessary treatment within 2 days from request in the drugstore. It was pharmacies’ responsibility to report shortages. Patients were instructed to report shortages to the Latvian Hemophilia Society, who, after verifying the fact with the respective pharmacy and wholesaler, reported the shortage to Health Inspection. Even when facts were confirmed by authorities, the reimbursement system did not react to shortages, and 11 times continued agreement with the distributor. In one case, the shortage was due to fact that the product was no longer produced, but no information was provided to the National Health Service of the Republic of Latvia (NHS). It took two months to exclude the product from the reimbursement system. In second case, the product was withdrawn from the system by the distributor, but immediately another product was provided for a similar price. The reimbursement system continued to function without patients’ involvement, with processes only between the paying authority, industry, wholesalers, pharmacies and doctors.