These medications make my life liveable
In England, a quiet catastrophe is unfolding at the pharmacy counter, where the gap between what the NHS pays for medicines and what they actually cost has grown wide enough to swallow lives. Pharmacies — already hollowed out by years of underfunding — are dispensing essential drugs at a loss, stocking less, and in some cases closing altogether, leaving patients with epilepsy, Parkinson's, and heart conditions to search desperately for medications that keep them upright and alive. This is not merely a supply chain problem; it is the accumulated consequence of a system that priced medicine as though the world would stay still, and now finds itself unable to move fast enough as it shifts beneath it.
- A record 210 medications landed on the government's emergency price concessions list in April alone, signalling that the gap between NHS reimbursement rates and real-world drug costs has reached a breaking point.
- Patients are experiencing seizures, falls, and deteriorating conditions in real time — the Epilepsy Society has linked three deaths in two years to medication gaps, and the human toll is still climbing.
- Pharmacies are absorbing losses of tens of thousands of pounds annually, with some owners remortgaging homes or draining pensions just to keep their doors open, while 1,500 have already closed since 2017.
- To limit financial damage, pharmacists order smaller quantities of at-risk drugs, which paradoxically deepens the shortage for the patients who need them most.
- Industry bodies have formally asked the government to add medicine supply to the National Risk Register, but no response has come, leaving pharmacists, patients, and experts waiting at the edge of a worsening crisis.
Chloe is 29 and has epilepsy. The medication that controls her seizures has become nearly impossible to find. When she couldn't get it, the seizures came back — she fell, hit her head, and now carries a scar. She is not alone in this search.
Across England, people dependent on everyday medicines for heart conditions, Parkinson's, bipolar disorder, and ADHD are struggling to fill prescriptions. The Epilepsy Society has documented three deaths in two years where lack of medication was a contributing factor. The shortages are not random — they are structural.
The NHS sets a fixed price for each drug and expects pharmacies to source it at or below that rate. When global manufacturing and transport costs surge, the real price climbs while the reimbursement lags. A government concessions list is meant to bridge the gap, but it moves slowly. In April, it hit a record 210 medications. In the meantime, pharmacies dispense at a loss. One pharmacy in Shepperton, Surrey lost £140,000 on NHS medicines last year alone. Its owner, Akash Patel, cannot complete some epilepsy prescriptions this month — and the pills he can provide will cost his pharmacy nearly £9 out of pocket. To limit losses, he stocks less, which means more patients go without.
The economics are unambiguous. One common antidepressant is reimbursed at £3.89 per prescription; Patel cannot buy it for less than £5.25. Olivier Picard, who chairs the National Pharmacy Association, says he loses money on over 300 medications. "The government wants to pay very low prices for medicines," he says, "but it is backfiring now."
The UK spends a lower share of its health budget on medicine per patient than France or Germany. When global supply tightens, manufacturers sell where they earn more — and England increasingly is not that place. Since 2017, 1,500 High Street pharmacies have closed. The number nationwide is at its lowest in 20 years.
For patients like Chris Henry, 49, who takes medication for Parkinson's and works full time while raising four children, the stakes are immediate. Without the correct dose, his body control deteriorates. He placed his order early and is waiting. "These medications make my life liveable," he says. Experts and industry groups are warning that without faster reimbursement reform and higher baseline prices, the shortages will only deepen — and the communities left without a pharmacy will have nowhere left to turn.
Chloe is 29 and has epilepsy. The medication that keeps her seizures at bay—a drug based on Lamotrigine—has become nearly impossible to find. In recent weeks, when she couldn't get it, her seizures returned. She fell, hit her head, and now carries a scar across her back. She describes the situation as terrifying. She is not alone.
Across England, people dependent on everyday medications are facing a crisis. Those with heart conditions, stroke risk, eye infections, bipolar disorder, and ADHD are struggling to fill prescriptions. The pharmacies that dispense these drugs are running short, and the shortages are deepening. The Epilepsy Society has already documented three deaths in the past two years where lack of medication played a role.
The root of the problem lies in how the NHS pays for medicine. The system works like this: the health service sets a fixed price for each drug and expects pharmacies to source it at that price or lower. When global manufacturing costs spike—driven by energy prices, transport, and ingredients tied to oil—the actual cost to buy the medicine climbs. If a pharmacy can no longer obtain a drug at the NHS price, it gets added to the government's price concessions list, and the pharmacy is supposed to be reimbursed at the new market rate. In April, this list hit a record: 210 medications. But the system moves slowly. When prices surge suddenly and dramatically, pharmacies end up dispensing medicine at a loss, sometimes substantial ones. Last year, one pharmacy in Shepperton, Surrey, lost £140,000 on NHS medicines alone.
Akash Patel runs that pharmacy. This month, he cannot complete a prescription for a patient with epilepsy because some items are unavailable. The pills he can provide will cost his pharmacy nearly £9 out of pocket. To minimize losses, pharmacists stock these medications in smaller quantities, which means more patients miss out. Patel's father, Gaurang, who founded the business, worries the pharmacy cannot sustain these losses much longer. Some pharmacists have remortgaged their homes or emptied pensions to keep operating. Since 2017, 1,500 High Street pharmacies in England have closed. The number of pharmacies nationwide is at its lowest in 20 years. Shepperton once had three; it now has one.
For patients, the shortage means rounds of anxious phone calls and what Chloe calls "going on patrol"—sometimes sitting on a bus for hours hunting for a single medication. Chris Henry, 49, takes Co Careldopa for Parkinson's Disease. His medication is also on the concessions list. He works full time and has four children. Without his correct dose, his body control deteriorates and involuntary movements become unpredictable. He placed an order early, hoping it arrives before he runs out. "These medications make my life liveable," he says. "Trying to manage Parkinson's is a nightmare at the best of times."
The economics are stark. One commonly prescribed antidepressant, Venlafaxine, is reimbursed by the government at £3.89 per prescription. Patel can buy it for no less than £5.25. He orders small amounts and hopes the price drops on the next order. Often it does not arrive at all. Olivier Picard, who runs a pharmacy and chairs the National Pharmacy Association, says he loses money on over 300 medications—blood thinners, blood pressure drugs, painkillers, the everyday items people need to live. "The government wants to pay very low prices for medicines but it is backfiring now," he says. "No one is winning here—and it's the patients who suffer most."
The UK spends a lower proportion of its health budget on medicine per patient than France or Germany. When supplies tighten globally, manufacturers choose to sell where they earn more. Gaurang Patel points to the long supply chain: the war has not yet fully impacted availability, but the costs to manufacture and transport have already climbed. "I'd stockpile if I could, but I don't have the cash flow," he says. Experts warn that without reform—faster reimbursement adjustments, higher baseline prices to make the UK a viable market—the shortages will persist and worsen. The Independent Pharmacies Association has asked the government to add medicine supply to the National Risk Register. So far, there has been no response.
Notable Quotes
In the last few weeks I haven't been able to get the right medications and my seizures came back. I fell and hit my head and have a big scar across my back now from it.— Chloe, 29, with epilepsy
The government wants to pay very low prices for medicines but it is backfiring now. No one is winning here—and it's the patients who suffer most.— Olivier Picard, National Pharmacy Association chair
The Hearth Conversation Another angle on the story
Why does the NHS pay a fixed price if the actual cost keeps changing?
It's a cost-control mechanism that made sense when prices were stable. But global supply chains have become volatile. Oil prices, energy costs, manufacturing—they all feed into the final price. The system can't keep up.
So pharmacies just absorb the loss?
For a while, yes. But you can't lose £140,000 a year indefinitely. Some have remortgaged homes. Others have closed. When a pharmacy shuts, the whole community loses access.
Why don't manufacturers just keep supplying the UK at a loss?
Because they won't. If they can sell the same drug in France or Germany for more money, they will. The UK has priced itself out of the market by keeping reimbursement rates artificially low.
What happens to patients in the meantime?
They search. They call pharmacy after pharmacy. They skip doses or run out. For someone with epilepsy or Parkinson's, that's not an inconvenience—it's dangerous. Chloe had a seizure and fell. The Epilepsy Society has documented deaths.
Is there a quick fix?
Not really. The government would need to pay more for medicines across the board, which costs money. Or reform the reimbursement system to respond faster to price spikes. Neither is simple or cheap. Right now, nothing is happening.
So it gets worse?
Unless something changes, yes. More pharmacies will close. More people will struggle to find medication. The crisis deepens.