Infectopharm in Heppenheim currently receives daily calls from concerned pharmacists and doctors. According to its own figures, the South Hessian company recently supplied 97 percent of the penicillin juices sold in Germany. They are prescribed to children against scarlet fever and tonsillitis – but have not been available in many pharmacies for months. Parents with a prescription for infectocillin or infectobicillin therefore often have to go to the doctor a second time, who then prescribes another antibiotic. And that's only the second-best solution.

Infectopharm has delivered 750,000 packs of penicillin juices in the past six months, "far more than usual in a whole year," as the company announced on request. It is expected to soon be able to add a larger amount of infectocillin – but this is not possible all the time: "The lead times in production are several months."

Stada: "Exceptionally high demand"

Stada in Bad Vilbel also reports an exceptionally high demand. For some products, such as the nasal spray AL, the volumes have increased in the short term, said a spokeswoman. Occasionally, there were also supply bottlenecks at STADA, but the failure rates were "in the single-digit percentage range".

Stada has twenty production facilities and 13,000 employees worldwide. Infectopharm, on the other hand, is a family business with around 250 employees. It develops its own pharmaceuticals, but has them produced by other companies – in Europe, as Managing Director Philipp Zöller emphasizes.

But production capacities are limited: According to the Pro Generika association, there is only one production facility in Europe that can handle the entire manufacturing process for penicillins under one roof. It is located in Kundl, Austria, and is operated by Sandoz, the generics division of the Swiss pharmaceutical company Novartis. However, other companies are also supplied.

According to a spokeswoman, Sandoz has doubled production capacities in Kundl compared to the previous year due to the high demand in the current flu season "by creating new jobs and introducing additional work shifts". In addition to penicillin, amoxicillin is also produced there — an active ingredient that is used, for example, to treat lung or middle ear infections. Here, too, demand has skyrocketed.

"Other manufacturers cannot step in because they have long since stopped production," says Pro Generika. A problem that also exists with many drugs for adults – such as thyroid hormones.

Association criticizes austerity policy of health insurance companies

The association sees the reason for the market concentration in the austerity policy of the health insurance companies. For generics, the statutory health insurance companies only cover the costs up to a certain amount. This is different with patent-protected drugs, because the incentive for pharmaceutical companies to invest money in research into new active ingredients is to be preserved. In the case of generics, on the other hand, there are – in theory – so many alternatives that the health insurance companies only pay for the cheapest.

As a result, however, many manufacturers have withdrawn from the market, reported the European head of Stada, Stephan Eder, on Wednesday during a discussion at the University of Frankfurt. On average, the statutory health insurance companies reimbursed the generics manufacturers per daily dose only six cents, ten years ago it was eleven cents.

Fixed amounts for paediatric medicines suspended

In order to make supplying the German market more attractive for international providers, the statutory health insurance funds suspended the so-called fixed amounts for 180 paediatric medicines for three months in February. For the future, the Federal Institute for Drugs is to draw up a list of drugs for which there may be neither discount agreements nor fixed amounts in the future. Remaining fixed amounts are to be increased by 50 percent.

The National Association of Statutory Health Insurance Funds (GKV) criticized the plans. A permanently higher price level will not solve the problems, the association wrote in a statement. There is no connection between "global supply bottlenecks and the price instruments of the GKV". Important medicines are in short supply worldwide, "even in countries without comparable instruments".

Stada manager Eder counters that "cost-reducing instruments" exist almost everywhere, and in large markets such as the USA, Great Britain, France or Germany they are "particularly aggressive". Such large markets, however, are decisive for whether the production of a drug pays off in the long term.

Eder admits that even with higher remuneration, very few corporations would bring active ingredient production back to Europe. From his point of view, however, it would make sense if health insurance companies not only looked at the price, but also at the diversification of the supply chain when concluding contracts with generic manufacturers.

Infectopharm puts it this way: "From a purely economic perspective, it would be the only right decision for us to stop the sale of penicillin dry juices. Only ethical responsibility speaks against it." According to Managing Director Zöller, the company earns money above all "with products that are ultimately less relevant – with dietary supplements, for example, and non-prescription drugs".

They are not price-regulated.