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If you’ve been to a pharmacy recently and been told your usual prescription isn’t available, you are not alone and you are not imagining it. The same thing is happening across the country, and its been getting steadily worse for years.
Ireland reimburses generic medicines at rates that are, compared to most of our European neighbours, on the low side. When pharmaceutical companies have limited stock to distribute across multiple countries, and limited stock is pretty much now the norm rather than the exception, they send it to the markets that pay more. We get what’s left. It’s the same logic that applies to any other product in any other market, except in the case of medication that people need to stay alive we tend to forget that supply and demand is still real.
The HSE and the HPRA deal with the shortfalls by importing unlicensed alternatives from other countries, which keeps some supply flowing. But, unfortunately, those imported alternatives frequently cost the patient more, because reimbursement often doesn’t fully cover the substitute product or takes time to come through. So if you’re a pensioner on a fixed income filling the same prescription every month, you’re the one absorbing the cost – you wouldn’t want to expect anyone in Brussels or in the Department of Health is picking up that tab.
The Community Pharmacy Agreement signed in September 2025 brought some changes. Pharmacists got more scope to substitute equivalent products and the system for tracking reimbursed emergency imports was improved. That sounds lovely, but pharmacists are still spending large chunks of their day explaining to patients why their medication has changed, what the replacement is, and whether it will work the same way. Not likely, one would have thought, to be the optimal use of a pharmacist’s time. Nor probably the patient’s.
As with many things Ireland’s situation is just the sharpest version of a problem that exists right across the EU. Surveys show shortages affecting hundreds of products per country at any given moment. Nearly every member state now reports ongoing supply problems. Almost like there is some common cause to what is happening, but more on that later.
These shortages used to be temporary and traceable, a factory recall, a quality issue, a pandemic-related spike in demand, etc. What we’re living with now is something more permanent; shortages have become structural.
Since the 1990s, the production of the raw chemical ingredients that go into most medicines, what the industry calls active pharmaceutical ingredients, or APIs, has been steadily moving from Europe to Asia, mostly China and India. This happened for the obvious reason that it was cheaper. European governments were happy enough with the arrangement when it delivered lower prices. Nobody was asking the awkward, and kind of dickish, questions about what might happen if those Asian suppliers couldn’t deliver, or maybe just didn’t want to.
Then came COVID, which disrupted everything. Then the war in Ukraine, which disrupted it again. And so on, ever so shall it be.
Antibiotics, heart medications, cancer drugs all ran short. And the discovery was made, belatedly, that Europe had allowed its own capacity to atrophy to the point where there was no realistic productive capability to fall back on.
Generic pharmaceuticals, which is what most of these shortage-affected products are, operate on thin margins. Companies facing production problems or cost increases make a pretty simple calculation: serve the markets where you earn the most and withdraw from the ones where you earn the least.
On top of all of this, the physical manufacturing base for many of these compounds is concentrated at a tiny number of sites. If something goes wrong at one factory the ripple effect hits pharmacy shelves across the continent within weeks. There is no reserve capacity.
The EMA got expanded monitoring powers in 2022. Stockpiling guidance was issued in 2023. A Critical Medicines Alliance was set up in 2024 and it published a set of recommendations. And so on, endlessly.
The bigger legislative push came in early 2025 with the Critical Medicines Act, which is the Commission’s attempt to tackle the problem on multiple fronts at once. The idea is to incentivise new manufacturing within Europe through financial support, faster permitting, reformed procurement rules so that governments factor in reliability of supply alongside price, enabling smaller countries to pool their purchasing power instead of each competing alone, and establishing sourcing agreements with countries outside Europe’s current supplier base.
The Parliament’s health committee adopted its position in late 2025 and the broader legislative process is expected to run through 2026. Amazingly for the EP the political dynamics are actually favourable. Medicine shortages are not a left-right issue. Patient groups want action. Industry groups want action. Member states have endorsed the principle of reduced dependence on external suppliers at Council level. If anything is going to attract cross-party support in a fractured European Parliament, it’s this.
The concern, though, is speed. Something EU legislative processes have not traditionally been designed for.
While the EU has been legislating, Washington has been acting. The second Trump administration, since taking office in 2025, has used executive orders to loosen up, much like a dose of salts, domestic manufacturing regulations, established a national reserve of critical pharmaceutical ingredients, and threatened 100% tariffs on imported branded medicines unless major pharmaceutical companies committed to building production capacity in the United States.
The results were swift. Several of the world’s largest pharma firms took to their knees to collectively pledge north of a hundred billion dollars in US investment. In return, they got tariff exemptions and pricing concessions.
Now, from an American perspective, this is a success story. The US is getting new factories, new jobs, and a more secure domestic supply. From a European perspective, it’s a problem. That money is now committed to American facilities. It is not going to be spent building capacity in Europe. If the global pharmaceutical industry spends the next decade expanding primarily in the US, European supply gets more fragile, not less, regardless of what legislation Brussels manages to pass.
And the diplomatic environment between Washington and Brussels is not, to put it mildly, conducive to the kind of cooperative international partnerships the Critical Medicines Act was counting on.
Now, perhaps we find that the pharmaceutical firms have been less than honestly in their American declarations, and perhaps they plan to do the bare minimum, but the bare minimum here may be more than Europe gets.
The Critical Medicines Act is the right kind of response. The question is whether it will arrive in time and whether member states will actually implement it with any urgency, or whether it will go the way of so many EU initiatives and be another piece of well-intentioned legislation that takes years to translate into anything a patient would notice.
Ireland has a particular stake in this. Our market position, small, below-average reimbursement rates, dependent on larger countries getting served first, means we benefit more than most from collective European purchasing power and a properly functioning single market. But we are also more exposed than most when those systems fail to deliver.
The IPU is counting over 200 shortages today, and that number has been climbing. Nothing currently in the legislative pipeline is going to change it this year. The question is whether it changes it at all or whether we’re simply going to be told, again, that the EU is working on it.