Drug shortages: 39% of French people at risk in 2024

39% of French peo­ple say they expe­ri­enced med­i­cines short­ages in 2024¹ – up from 44% in 2023 – and 35% of them say they were unable to obtain alter­na­tive treat­ments. To quan­ti­fy the extent of the short­age in France, the DREES (Direc­tion de la recherche, des études, de l’évaluation et des sta­tis­tique) con­duct­ed an orig­i­nal study at the request of the ANSM (Agence nationale de sécu­rité du médica­ment et des pro­duits de san­té) using data from lab­o­ra­to­ries and wholesalers/distributors. Clé­ment Dher­bé­court, an expert in pub­lic pol­i­cy eval­u­a­tion at the DREES and co-author of the study, details the main findings.

Clé­ment Dher­bé­court. We had two main objec­tives: the first was to improve the accu­ra­cy of the ten­sion sig­nal on drug pro­duc­tion by pro­duc­ing dai­ly analy­ses of the num­ber of stock­outs and stock­out risks with­in lab­o­ra­to­ries, as well as the sales vol­umes to phar­ma­cies affect­ed by these ten­sions. The sec­ond objec­tive was to esti­mate the change in the num­ber of “miss­ing box­es”, i.e. box­es that could not be sold to phar­ma­cies by their sup­pli­ers, which is cur­rent­ly the most rel­e­vant indi­ca­tor of the short­age situation.

To do this, we relied on two main data sets. DREES had fig­ures for sales of med­i­cines to phar­ma­cies, either by whole­salers-dis­trib­u­tors (who account for 80% of the vol­ume of box­es sold) or direct­ly by lab­o­ra­to­ries. ANSM gave us access to the reports of short­ages and risks of short­ages sub­mit­ted by laboratories.

Not at present. To get a bet­ter idea of this fig­ure, we would need to rely on an elec­tron­ic pre­scrip­tion sys­tem, which is only just begin­ning to be devel­oped. Alter­na­tive­ly, we could con­sid­er more indi­rect data, such as fig­ures on orders placed by phar­ma­cies for indi­vid­ual med­i­cines. This data exists but is not cur­rent­ly pub­licly avail­able. The 2025 Social Secu­ri­ty Financ­ing Act², which has been passed but has not yet come into force, cre­ates a pub­lic sys­tem for access­ing phar­ma­cy order data to enable more detailed analy­sis by the authorities.

We looked at med­i­cines of major ther­a­peu­tic inter­est (MMTI) for which the ANSM drew up the first offi­cial list at the end of 2024, cov­er­ing around 10,000 prod­ucts (editor’s note: the same mol­e­cule can give rise to sev­er­al prod­ucts if there are sev­er­al dosages or man­u­fac­tur­ers) out of the 17,000 marketed.

From mid-2016 to 2017, the dai­ly num­ber of MMTIs in short sup­ply remained rel­a­tive­ly sta­ble, at around 100 drugs. It began to rise at the end of 2017, peak­ing at around 250 dur­ing the first lock­down in 2020. From 2021 onwards, the upward trend accel­er­at­ed, with a very clear peak emerg­ing in the win­ter of 2022–2023, reach­ing 800 MMTI short­ages per day. Since then, there has been a slow decline to 400 by the end of 2024. How­ev­er, this lev­el remains very high com­pared to pre-Covid lev­els. The aver­age num­ber of ther­a­peu­tic alter­na­tives avail­able, with­out dis­rup­tion or risk of dis­rup­tion, was 5 in sum­mer 2021, 4 in Jan­u­ary 2022, 1.6 through­out 2023, falling to 2 at the end of 2024.

A stock short­age declared by a lab­o­ra­to­ry, across all drugs, leads to an aver­age 11% drop in deliv­er­ies to phar­ma­cies through­out the dura­tion of the dis­rup­tion. This is sig­nif­i­cant, of course, but we can­not talk about a wide­spread collapse.

How­ev­er, this aver­age masks a wide range of sit­u­a­tions. As might be expect­ed, long stock short­ages (more than four months) can lead to very sig­nif­i­cant declines in sales, of more than 75%, over sev­er­al months. Con­verse­ly, short­er short­ages of three months have no impact on sales. We can assume that these sit­u­a­tions reflect cas­es where whole­salers still had stocks or where man­u­fac­tur­ers pro­duced the med­i­cines in ques­tion on a just-in-time basis.

In March 2023, at the height of the 2022–2023 win­ter cri­sis, short­ages led to 8 mil­lion few­er box­es being sold in phar­ma­cies. The over­all mar­ket for the med­i­cines con­cerned was esti­mat­ed at 80 mil­lion or 120 mil­lion box­es per month, depend­ing on whether MMTIs are defined accord­ing to the ANSM or accord­ing to the def­i­n­i­tion that has been used by lab­o­ra­to­ries for sev­er­al years, which adds sev­er­al dozen parac­eta­mol-based med­i­cines to the ANSM list. Depend­ing on the def­i­n­i­tion used, this rep­re­sents a 10% or 6.5% drop in the num­ber of box­es sold. How­ev­er, these fig­ures do not con­sid­er any increas­es in the pro­duc­tion and sale of alter­na­tive treat­ments, which were not affect­ed by the shortage.

Between the end of 2022 and the end of 2024, lab­o­ra­to­ries built up an aver­age of three weeks’ worth of stock for prod­ucts report­ed as at risk of short­age. But despite this pos­i­tive trend, there are signs that these risks are becom­ing more com­plex. The num­ber of drugs sub­ject to ANSM mea­sures (import autho­ri­sa­tions, quo­tas on the num­ber of box­es or patient pri­ori­ti­sa­tion, for exam­ple) rose by ten points in 2024.

Dis­rup­tion reports alone are not very infor­ma­tive: when report­ing a dis­rup­tion, lab­o­ra­to­ries must select a rea­son for the man­u­fac­tur­ing issue they are expe­ri­enc­ing from a pre­de­fined list, but in most cas­es, the expla­na­tions pro­vid­ed are too gen­er­al to iden­ti­fy a spe­cif­ic cause: “insuf­fi­cient pro­duc­tion capac­i­ty”, “increase in sales vol­ume”, or even “oth­er…

How­ev­er, when tak­en togeth­er, two fac­tors point to sys­temic caus­es: the almost per­fect cor­re­la­tion between the change in the num­ber of med­i­cines over time in rela­tion to the infla­tion curve, and the fact that all cat­e­gories of med­i­cines have been affect­ed by the increase in the num­ber of short­ages, even if they peaked at dif­fer­ent times.

One pos­si­bil­i­ty is the well-doc­u­ment­ed increase in glob­al demand for drugs, with a par­tic­u­lar rise in pur­chas­es out­side the Unit­ed States and Europe. The con­se­quences of the Covid cri­sis and the war in Ukraine have also caused infla­tion to rise and dis­rupt­ed pro­duc­tion chains world­wide, which may have affect­ed the drug mar­ket. Sup­ply chain issues for raw mate­ri­als, which are some­times sus­pect­ed of play­ing a sig­nif­i­cant role, do not appear to be among the main caus­es. In fact, lab­o­ra­to­ries only report­ed this type of prob­lem in one in ten cas­es of shortages.

The study does not allow us to set­tle this debate. It would be nec­es­sary to observe the actu­al price from one coun­try to anoth­er, which is not pos­si­ble at present because the dis­counts nego­ti­at­ed by indi­vid­ual gov­ern­ments are not known. At this stage, the pre­cise caus­es of the short­ages remain dif­fi­cult to pin­point, as they are nec­es­sar­i­ly mul­ti­fac­to­r­i­al and vary great­ly from one med­i­cine to anoth­er. In gen­er­al, it can be not­ed that the improve­ment in the sit­u­a­tion since win­ter 2022–2023 has occurred with­out any sig­nif­i­cant change in med­i­cine prices in France. This sug­gests that stock short­ages are not entire­ly deter­mined by the issue of prices.

Interview by Anne Orliac

Study: “Ten­sions et rup­tures de stock de médica­ments déclarées par les indus­triels : quelle ampleur, quelles con­séquences sur les ventes aux officines ?”