Photo/Illutration Masao Takahashi looks at almost empty bins for cough suppressants and expectorants at his dispensing pharmacy in Tokyo’s Koto Ward on Jan. 17. (Kazuhiro Fujitani)

On a recent day, storage bins for cough suppressants and expectorants, which are used to help clear phlegm, were almost empty at a dispensing pharmacy in Tokyo’s Koto Ward.

One or two of about 10 types of cough suppressants and only one of about four types of expectorants were in stock.

Drugs to reduce throat inflammation and antibiotics were also in short supply.

Masao Takahashi, who operates the pharmacy, said he is “walking a tightrope every day.”

“I am always worried about inventories,” Takahashi, 64, said in mid-January. “When I ask wholesalers, they say, ‘We cannot make it in the morning, but we will do something in the afternoon.’”

Pharmacies continue to suffer from prolonged drug shortages even after the government asked manufacturers to ramp up production in autumn.

Inventories of cough suppressants and expectorants became unstable about three years ago after many manufacturers of generic drugs were ordered to suspend operations over flawed testing and quality problems.

Demand for these drugs also rose last year as infectious diseases, such as seasonal influenza and respiratory syncytial virus infections, spread after the novel coronavirus was downgraded to a Category 5 disease under the infectious diseases control law in May.

The health ministry requested pharmaceutical companies to expand production in October and November and also decided to subsidize labor costs if they comply.

By the end of December, supply volumes increased by more than 10 percent from levels in September, ministry officials said.

But Takahashi said he has not seen a difference in the supply.

“As someone working on the front lines, I feel that nothing has changed,” he said. 

If a prescribed drug is not available, Takahashi contacts the doctor and asks for changing to another type.

If there is not enough in stock, he personally delivers additional drugs to the patient after they arrive.

Drugs delivered from wholesalers are from different manufacturers almost on a weekly basis.

Some patients who are worried about changing drugs say they will wait until the same type arrives or they will go to another pharmacy.

Takahashi, chairman of the Tokyo Pharmaceutical Association, said member pharmacists have reported the same problems.

“Drugs will not be available in sufficient volumes unless overall supplies increase further,” he said. “It will probably take two to three years to return to normal levels.”

The health ministry acknowledged that demand has not been fully met.

It plans to speed up disbursement of subsidies to drugmakers and consider revising drug prices in fiscal 2024 to encourage production.

As of the end of December, 4,522 drugs, or about 26 percent of those on the national health insurance drug price list, were either in “limited shipments” or “out of supply,” according to the Federation of Pharmaceutical Manufacturers’ Associations of Japan.

Generic products accounted for 3,263 of those drugs.

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