Medicine shortages in Spanish pharmacies have been rising steadily in recent years. The latest data from the Spanish Agency for Medicines and Health Products (AEMPS) show that 740 medicines are currently experiencing supply problems in Spain, with more than 881 affected in the last three months. This figure has nearly tripled compared with four years ago. Industry inefficiency is a concern within the pharmaceutical sector, yet a clear, widely accepted solution remains elusive. The shortage is multifactorial, stemming from fluctuating demand, packaging supply difficulties, and challenges in obtaining raw materials from major suppliers in China and India, alongside a rise in parallel exports that drain local stocks.
Anthony Torres, head of the Federation of Pharmacists Associations of Catalonia (FEFAC), warned that the situation is deteriorating: “Drug shortages in Spain will increase, affecting more and more molecules of interest.” Labs and distributors point to disagreements over product diversions to European markets with higher prices. Torres notes that price differentials between Spain and parts of the rest of Europe are substantial, averaging around 50% with Germany. For certain specialty drugs, the regulated price in Spain can be seven times higher than elsewhere. He adds that the current healthcare framework, with low investment, wages, and drug prices, is not sustainable, and prices are reported to fall two to three times a year. However, there are no robust comparative studies of European pricing, and laboratories often resist sharing pricing information.
Within the European context, several formulas are being explored to ease the problem. Proposals include a system of aid or solidarity between countries in times of shortage, setting price ranges for drugs on the European market, establishing a strategic list of essential medicines, and restricting the movement of pharmaceutical products within the EU.
The struggle to curb health spending during the last financial crisis in 2008 led to tighter public budgets for medicines, from which the industry took time to recover. The environment of low prices supported the production of basic medicines in China and their distribution through India, where recent GDP growth and increased domestic consumption intersected with renewed sourcing challenges abroad. As a result, a perfect storm has emerged, intensifying Europe’s dependence on foreign supplies, a situation brought into sharper focus by the recent pandemic.
Industry representatives argue that low drug prices in Spain incentivize wholesalers to export products to higher-priced markets. While such exports can be legal, they clearly affect domestic availability. Companies report production levels to the health authority, but there is no guarantee that shipments will remain within Spanish borders.
Distributors, represented by Fedifar, contend that they inherit limited responsibility due to their position in the supply chain, while the primary accountability lies with pharmaceutical laboratories. They emphasize that demand peaks have been the main driver of shortages to date.
Torres notes that Spain’s shortages have both global and structural origins. One example is the case of a popular anti-diabetic medication used weekly to control blood sugar and reduce cardiovascular risk. While the drug is essential for many adults with type 2 diabetes, it is also used off-label for weight management, driving demand beyond projections and contributing to shortages. Limited information for prescribers can exacerbate the problem, though the medical community has not publicly criticized supply issues as heavily as the labs. Strong doctor-lab relationships may have softened critical voices.
Structural factors include shortages of children’s syrup formulations. Pharmacists have proposed broader possibilities for pharmacological alternatives, such as sachets, capsules, or tablets, and advised not forcing pharmacists to dispense the cheapest option when price differences among similar drugs are slight. A more flexible approach could help stabilize supply while maintaining patient outcomes.
Farmaindustria, the employers’ association, calls for price reform and streamlined public financing. Juan Yermo, its managing director, advocates for an agile, predictable, and efficient model. He says that reform should address pricing and funding systems, evaluation methodologies, the structure and timing of therapeutic positioning reports for new drugs, and early access mechanisms for drugs with the greatest clinical benefit.
According to FEFE, about half of units are priced under six euros. Portugal recently approved price adjustments for drugs under 10 euros, with a 5% increase for prices between 10 and 15 euros, and the creation of a list of essential medicines to monitor availability. Spain is watching developments closely, with an election year potentially slowing any price-action momentum.
Hospital and pharmacy spending on medicines and health products in Spain ranged from 36.4% to 38.3% of total public health expenditure between 2005 and 2021, according to the Public Health Expenditure Statistics released by the ministry. This data is compiled in the ESGP figures and reported by Health and Diario Farma.