Women being treated for breast cancer say they have faced shortages of the essential drug tamoxifen for a fourth consecutive month, with some travelling to Latvia or Poland to obtain it.
Ineta Jokubauskienė, from Šiauliai, has been battling breast cancer for two years. She says that to ensure her treatment is successful and to prevent the disease from returning, she must take tamoxifen every day. However, not all patients have been able to access the medication.
“When I started looking, it turned out there was none available anywhere in Šiauliai, and I searched across Lithuania. In every pharmacy. Online it might show stock in the warehouse, but unfortunately it is usually already reserved,” she said.
Other women with breast cancer report similar experiences. Although Jokubauskienė eventually obtained the drug in Lithuania, she says some patients have travelled to Latvia or Poland to buy tamoxifen, which can be purchased there with a paper prescription.
“When you can’t get it, it’s an enormous shock and causes even more stress, which really affects our bodies – and that’s the last thing we need right now. It’s upsetting that in Poland and Latvia it’s available nearby, yet in Lithuania the supply system is faltering,” she added.
Non-governmental organisations have also received complaints. Neringa Čiakienė, director of the Association for Support of Oncology Patients, said the situation is unprecedented.
“About 5,000 packs are required each month, meaning roughly 5,000 women rely on the medicine on average. Although a contract has been signed with a supplier to import that quantity, the prolonged disruption following earlier shortages has led to increased demand,” she said.
As a result, some women’s treatment has been temporarily interrupted.
“We see patients who have had a break since November. They say: ‘I haven’t taken the medication for four months,’” Čiakienė said.
Prices rise amid supply problems
Čiakienė also noted that women who do manage to obtain tamoxifen are now paying more for it.
“They ask, ‘Why is this happening?’ We understand this is the price of scarcity. Those who agree to import and compensate for the shortage are likely adding a higher mark-up to make it worthwhile,” she said.
Although a pack costs up to €20, she said this is still a significant burden for some women.
“They say: ‘Perhaps the state has decided to get rid of us, because in Poland we can buy the same medicine three times cheaper.’ Many women feel deeply disappointed with the system,” she added.
Medicines authority: supplies are sufficient
According to the State Medicines Control Agency, the situation began to change in November when the company supplying reimbursed tamoxifen reported disruptions. However, the agency insists there is currently enough of the drug on the market.
“We acted swiftly, informed the National Health Insurance Fund and enabled the inclusion of an alternative tamoxifen product from another company so that reimbursed treatment would remain available,” said the agency’s head, Dovilė Marcinkė.
She questioned why some pharmacies appear to be running short.
“Is it unavailable because there is none, because pharmacies are not ordering it, or because patients are purchasing six months’ supply at once? There may be various reasons. At present, there is enough on the market for a one-month course – it is not the case that the medicine is entirely unavailable,” she said.
Pharmacies reject suggestions that they are failing to order stock deliberately.
“To suggest that pharmacies are not ordering it on purpose is more than laughable. Every pharmacy has a clear interest in ensuring that people who come in receive the medicine they need,” said Kristina Nemaniūtė-Gagė, head of the Pharmacies Association.
She said difficulties arise particularly when medicines cannot be substituted.
“If the database shows stock, that does not mean it is automatically in pharmacies. Wholesalers distribute medicines to certain pharmacies. Some are able to purchase them, others are not. Pharmacies often receive smaller quantities than they ordered, and naturally shortages occur,” she explained.
Ministry recommends limiting sales
In response to repeated supply disruptions, the Health Ministry has advised pharmacies to temporarily limit sales of tamoxifen, dispensing only a one-month supply per patient.
“This can be managed by responsible use – taking only what is needed for one month so that all women can continue treatment without interruption,” Marcinkė said.
However, patient advocacy groups stress that women have the right to request the number of packs prescribed by their doctor.
“Women living in remote or rural areas have every right to ask for three, four or even six packs, as prescribed,” Čiakienė said.
Plans to address recurring shortages
As tamoxifen isn't the only medicine affected by supply disruptions, amendments to the Pharmacy Law are expected to be proposed during the Lithuanian parliament's autumn session, according to Deputy-Minister of Health Danielius Naumovas.
“We want to simplify and speed up procedures to manage shortages as far as possible. But not everything can be controlled. Unfortunately, some manufacturers do not supply Lithuania. When shortages occur, larger markets take priority. Lithuania is not a priority,” he said.
More than half of such cases are linked to production or supply chain problems, which neither Lithuania nor the European Union can currently fully regulate, he added.
Naumovas said that during Lithuania’s forthcoming EU presidency, efforts would be made to bring more pharmaceutical manufacturing back to the bloc – ideally including dedicated production facilities in Lithuania.
Meanwhile, the Parallel Import Association argues that Lithuania should make greater use of parallel imports – purchasing medicines from suppliers who source them in other EU countries.
“There should be as few barriers as possible to medicines registered in other member states entering our market. There are cases where a drug used by patients in the Netherlands does not reach Lithuanian patients simply because of regulatory obstacles,” said the association’s head, Donatas Parulis.
He said parallel imports would increase choice, but current strict requirements – including documentation that suppliers cannot obtain – create additional hurdles.
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