The struggle to get hold of medication in England is set to get worse

"It's just terrifying," Chloe states. "I experience panic attacks." The 29-year-old, who has epilepsy, is facing challenges in obtaining the necessary medications to prevent life-threatening seizures.

Her Lamotrigine-based drug is just one of the many everyday medications that are increasingly difficult to access in England.

Although she has alternative medications available, the one crucial for maintaining her quality of life and ability to work is the one that eludes her.

"In recent weeks, I have been unable to acquire my required medications, leading to the return of my seizures. I fell and sustained a significant head injury, resulting in a prominent scar across my back," Chloe explains.

The state of access to medications in England has reached a precarious level. Individuals with heart issues, stroke risks, eye infections, bipolar disorder, and ADHD, among others, are struggling to receive the medications they rely on.

These supply issues mean that individuals like Chloe often find themselves leaving pharmacies throughout the country without the medications they desperately need.

The root of these shortages can be attributed in part to soaring global prices. However, they are further complicated by the intricate funding process associated with medications in the UK.

The NHS compensates pharmacies with a fixed price for each medicine dispensed, requiring them to source the drug at that price or lower.

When drug prices increase beyond the NHS's reimbursement rate, the medication is added to the government's price concessions list. As of April, this list has reached a record 210 medications.

Pharmacy owners are subsequently reimbursed at the newly established price for medications on this list.

However, abrupt spikes in market prices—often exceeding the original tariff and even surpassing the concession price—mean that pharmacies frequently dispense medications at a loss.

This situation hampers their ability to maintain adequate stock levels for all patients, leading to delays and unanticipated shortages.

'Going on patrol' for medication

For patients, this translates into anxiety-fuelled rounds of phone calls. Chloe shares that she sometimes spends several hours on the bus "going on patrol" in search of her necessary medication.

The Epilepsy Society has already identified three fatalities within the past two years where lack of medication was a contributing factor.

Additionally, pharmacy owners are experiencing increased pressure.

In Shepperton High Street, Surrey, pharmacist Akash Patel is attempting to fulfill a monthly prescription for another patient with epilepsy.

This month, certain items are unavailable, leaving the pharmacy nearly £9 in the red for the pills he can provide.

To mitigate losses, pharmacists tend to stock these medications at lower quantities, resulting in more patients likely missing out.

Since 2017, 1,500 High Street pharmacies in England have closed, with 27 closures occurring this year alone. The total number of pharmacies in England has reached its lowest point in two decades.

"It's been worsening over the past few years, and now it’s at its most critical," Patel remarks.

The rising cost of medicines is linked to the growing expenses and complexities associated with bringing products into the UK. Global tensions have led to increased energy and transport costs, and many medications rely on oil-based ingredients, which are also experiencing price hikes.

Simultaneously, some manufacturers argue that UK prices have remained so low that distributing certain drugs in the UK is no longer feasible, resulting in shortages that drive up wholesale costs for pharmacies.

For those managing long-term conditions, this uncertainty is deeply unsettling. Chris Henry, 49, relies on Co Careldopa for his Parkinson's Disease. Similar to Lamotrigine, his medication has been placed on the government's concessions list.

Upon learning about the shortages, Chris promptly placed an order and hopes that the new supply arrives before he exhausts his current stock.

"This is genuinely concerning," he states. With four children and a full-time job, Chris understands that without his correct medications, his motor control and dyskinesia would become increasingly unpredictable and harder to manage.

"Managing medication for Parkinson's Disease is already a challenge, so the thought of shortages adds an extra layer of anxiety," he expresses. "These medications are essential for my quality of life."

One commonly prescribed antidepressant, Venlafaxine, is also listed among the concessions. Although the government has set the reimbursement price at £3.89, Patel's lowest purchasing price is £5.25.

"It's a significant loss-making drug, prompting us to order only in small quantities hoping for a price decrease on our next order," Patel adds. "Even then, there’s no assurance it will be available."

'I'd stockpile if I could, but I don't have the cash flow'

The UK government allocates a smaller percentage of its health budget per patient for medicines compared to many adjacent Western European nations, including France and Germany.

Consequently, when supplies dwindle, manufacturers are likely to redirect their products to markets where profit potential is greater.

Last year, Patel's pharmacy incurred a loss of £140,000 on the NHS medications dispensed. His father, Gaurang, who established the pharmacy, expresses concern over how much longer the business can withstand these financial losses.

"Perhaps it's time for us to close as well; our pension has already been depleted by these losses," he reveals.

In Shepperton, only one pharmacy remains, down from three previously. The other two closed after years of financial deficits.

Some pharmacists have reported to the BBC that they have had to remortgage their homes or tap into private pensions to keep their businesses viable while awaiting reimbursement payments that align with soaring costs.

Gaurang highlights that rising global costs, especially for oil, are likely to impact medicine prices soon. "This supply chain is extensive, and while the war has not yet affected supplies, the costs to produce medications have risen, along with transport expenses," he says. "I would stockpile if I could, but I lack the cash flow."

Experts caution that without necessary reforms, these shortages are likely to persist.