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 ?”