In a move to address medicine shortages Mexico’s outgoing president Andrés Manuel López Obrador last year launched a Super Pharmacy, or “Megafarmacia del Bienestar,” dubbed the largest medicine stockpile n the world. But with the country’s presidential elections looming and evidence that few prescriptions have actually been filled, detractors say the scheme was merely a strategy to increase his MORENA party’s popularity.
I think there is another way to solve the supply of medicines, such as planning, consolidated purchasing, a distribution network and a clear understanding of demand
Juan de Villafranca, executive president, Mexican Association of Pharmaceutical Companies (AMELAF)
A Government-Run Super Warehouse
“No one should be without medicine,” said López Obrador said when he inaugurated Mexico’s so-called “Super Pharmacy,” a huge 40,000 square meter warehouse near Mexico City, last December.
The new building, for which the government paid MXN 1.4 billion, has two 95,000 square-metre industrial buildings, 97 shipping platforms and 102,000 storage spaces and is supposed to work as a distribution hub run by Birmex, the state-owned biologics manufacturer, and hold 286 million units.
According to the government, if patients cannot find a medicine in their local hospitals, they can call the central warehouse to report the shortage and operators will contact the three Mexican public health systems (ISSSTE, IMSS and the Ministry of Health) to find out if any of these institutions have the medicine. If the medicine is available, operators will call patients and tell them where they can pick it up, and if it is only stocked at the Super Pharmacy, a distribution plan will be set up to send it anywhere in the country within 24 to 48 hours.
“We have achieved this goal of having a large pharmacy, so that all medicines can be distributed and can reach the most remote villages in our territory,” said López Obrador in his inaugural speech for the Super Pharmacy.
Widespread Medicine Shortages
The Super Pharmacy was intended to address Mexico’s struggle with rampant medicine shortages, a problem that saw a 950-percent increase in the number of appeals for shortages of medicines, from 220 in 2018 to 2,307 in 2021, according to the Zero Shortages access to medicines collective.
The lack of medicines has also been responsible for the deaths of otherwise healthy people, reports Associated Press, with examples such as anaesthesiologists drawing multiple doses of morphine from a single vial, leading to the contamination of vials and dozens of deaths.
Scandals surrounding medicines going out-of-date in warehouses while hospitals have trouble getting hold of them date back long before López Obrador became president in 2018 while Cofepris, Mexico’s regulatory agency, has long been plagued by accusations of corruption.
Fake medicines are yet another issue. Since medications are often unavailable at government hospitals, patients look to private drug stores where falsified medicines abound.
López Obrador has been looking to resolve drug shortages since he came into office and in 2019 launched a crusade against pharma companies, accusing them of charging exhorbitant prices and corruption. He then set about implementing his own logistics scheme for the acquisition and distribution of drugs, at first using the United Nations Office for Project Services (UNOPS) and Birmex. Yet shortages persisted and by the end of 2022 the government transferred the responsibility for delivering drugs to the Institute of Health for Welfare (Insabi).
Months later, legislators from the president’s MORENA party endorsed the extinction of Insabi and the responsibility for guaranteeing the supply of drugs went to the Mexican Social Security Institute (IMSS).
Criticism and Few Tangible Results
While López Obrador claims the Super Pharmacy will put a stop pharmaceutical companies’ corrupt monopoly, his detractors are asking why the government is opening a central pharmacy instead of implementing state policies to ensure that all hospitals have a complete inventory of necessary medicines.
“We have to consider the issue of drug expiry dates, the financial cost, the conditions of the warehouse or pharmacy because it has to be in a controlled environment, and then the distribution,” said Juan de Villafranca, executive president of the Mexican Association of Pharmaceutical Companies (AMELAF). “I think there is another way to solve the supply of medicines, such as planning, consolidated purchasing, a distribution network and a clear understanding of demand.”
According to recent data from Birmex, since its inauguration in December 2023, the facility has filled only 341 prescriptions through the end of April 2024 and few have benefited from the Super Pharmacy. In fact, the warehouse has delivered medicines to just two beneficiaries of the Mexican Social Security Institute (IMSS), 210 to patients of the Institute of Security and Social Services for State Workers (ISSSTE) and 129 to people without social security who receive care through IMSS-Bienestar.
The director of Birmex, General Jens Pedro Lohmann Iturburu, admitted that when the Super Pharmacy began operating, of the 12,541 calls received in search of medicines, only 67 prescriptions had been filled. The facility’s capacity to handle calls is another issue and of a total of 95,297 calls received, only 341 cases have been resolved.
For Mexico’s opposition, the move was nothing more than a political stratagem ahead of the approaching election. “It cost us MXN 2 billion. It is 90,000 square metres in size, and it fills an average of only five prescriptions a day!” opposition candidate Xochitl Galvez complained. “This government’s super pharmacy is yet another example of its ineptitude and corruption.”
For CANIFARMA, the organization that represents the interests of the pharmaceutical industry in Mexico, the Super Pharmacy faces the same problems as the rest of the country’s health institutions. “The underperformance of the Super Pharmacy is a reflection of the systemic challenges faced by Mexico’s health system in ensuring an adequate supply of medicines, a problem that persists despite efforts to centralise and improve distribution logistics in the country,” read a statement on the website.
Upcoming Elections
With the country’s concurrent state and federal elections rapidly approaching in June, bringing López Obrador’s MORENA party candidate Claudia Sheinbaum up against opposition candidate Xochitl Galvez, it remains to be seen what will become of the project. While Galvez has spoken out against the Super Pharmacy, in terms of healthcare policy, she has focused her campaing proposals on the reinstatement of the Seguro Popular, a programme cancelled by López Obrador’s government that guaranteed access to health services for people not covered by other state programmes.
If she wins the presidency, Claudia Sheinbaum says she plans to use Birmex to purchase medicines and make agreements with local pharmacies through her “Healthy Republic” scheme. In the plan there was no mention of the Super Pharmacy.
