The Portuguese Pharmacy and Supply Chain
The Portuguese university degrees are among the best in the world and the pharmaceutical sciences one is probably the best; upon graduating we are ready to work in the industry, pharmacy, hospital, labs, and so on, and that is why recruiters come from all places to recruit Portuguese pharmacists.
First, it is important to point the major differences between English speaking countries’ pharmacies and non English speaking countries.
The owner of the pharmacy must have a pharmaceutical sciences degree or have a chief science officer with one – this is the person in charge, not the owner, because they are the liable ones.
This pharmacy model is alike many other models of non English speaking countries’ pharmacies.
In a pharmacy everything is done with special software, common to all pharmacies, and everything is recorded for ever – the records can be analyzed by the IRS and the National Agency for Medicines – INFARMED – whenever they want.
We don’t handle drugs inside the pharmacy, we have packages, sealed, and with the bar code, batch number and expiration date in the label and in the blisters or any other pharmaceutical form labels inside the outer package.
Over the counter medicines are behind the counter and if someone wants to buy an OTC, the person asks the pharmacist or technicians for advice and cannot buy whatever quantities they want, just the necessary.
It is absolutely forbidden to take out one blister from one package, for example, sell it to one person and the other to another person – if there are adverse effects, public health is in danger and it would be impossible to track the batch that caused it.
We must notify the National Agency for Medicines if there are any adverse effects reported to us, that are no described in the drug leaflet, and with this notification that drug is immediately suspended from the market for further testing’s.
Special prescriptions, for example, for controlled substances are different and they need all the information about the doctor and the patient before selling, and it is impossible to sell such drugs without that information, the software “frizzes” and the selling cannot de done.
We have an average of four daily faxes coming from the INFARMED (National agency for medicines) with mandatory recalls; we must check immediately if we have those medicines to send them back to the wholesaler that, in turn, will send them to the pharmaceutical company.
We must send a computer generated record of all controlled substances sold each month and another for semi controlled substances such as antidepressants, sleeping pills, etc.
Pharmacists are trained to work as first line doctors, people go to the pharmacy first and, if necessary, they will go to the doctor afterwards.
Pharmacists do the follow up of diabetic people and tell the doctor if the prescribed drugs are being effective or not, if they need dose adjustments, if they notice interactions with other medications and so on. They also offer this and other services to the community, without any compensation, follow up of drug addicts, and people suffering from a variety of common diseases.
There are three big wholesalers, and other smaller ones; pharmacies place their orders with the wholesalers and sometimes, for greater quantities, with the producer.
Each pharmacy has a “profile” with the wholesaler, a number and a bar code; the order is computer generated, matching the sales with the minimum inventory the pharmacy decided to have of each product, and it goes via internet directly to the wholesaler.
We can order any time of the day, although normally there are two orders each day (morning and afternoon) and in a period of maximum two hours we have it delivered.
Drugs come in containers with the barcodes that correspond to the pharmacy’s identification, are filled in the wholesaler by robots, and there is human intervention with last minute phone orders, psychotropic substances and cold chain.
This is a typical Portuguese container; the pharmacy bar code is inside and outside. We call them “banheiras” which literally means bathtub. Each wholesaler has different colours for their containers to avoid confusion when they arrive to the pharmacy.
The supply chain has integrated cold chain; the containers are different and go though different treadmills where people insert the medicines inside the special containers and seal them.
We can see the progress of the order in the computer, by logging in the wholesaler’s website and monitoring the treadmills and the transport vehicle with the order, the conditions inside it and the estimated time of arrival, including traffic jams and the likes.
The transport vehicles have a special section for cold storage where the special cold containers stay all the way down to the pharmacy.
When they get to the pharmacy they are introduced into the informatics system by reading the packages bar codes, batch numbers and expiration dates.
The software comprises a “specialties dictionary” where you find any drug in all pharmaceutical forms and doses that are patented and in the market.
If we have a new drug we read the information mentioned above and it opens a data sheet of that drug (because it is in the dictionary) with three rows – the upper one already pre-filled with the drug’s name, bar code, batch, if it is for cold storage, indication of whether it is a psychotropic substance, etc.
As we record the “entry” of that order, we read all the information on each drug package to see if it matches the pre-filled information and cold storage drugs are handled the first.
We then have three cold storages – the pharmaceutical refrigerator where temperatures are between 3º C to 8º C; the very cool warehouse for medicines needing cool storage but not cold storage, and the room temperature warehouse.
We need to have special devices monitoring temperature and humidity in all places of the pharmacy, including the counter area, inside some devices such as the refrigerator, and we print weekly charts for temperature and humidity that are keep in special archives, as demanded by the National Agency of Medicines.
Each year every device must be calibrated and all the documents kept for the same reason.
This is a large Portuguese type refrigerator with alarm and temperature/humidity control; there is a device inside for that purpose.
If, by any chance, we have doubts about the cold maintenance during the supply chain, we do not accept that order, keep the bar codes and related information, and reorder – when the new order arrives we compare the information to be sure it is a new order.
There is little chance of having counterfeited medicines in the supply chain because is so much information to check and compare. Furthermore, doctor prescriptions are computer generated with the drug barcodes in it and we need to check if it coincides with the package we are selling.
In all my years as a pharmaceutical chief science officer and pharmacy owner I never witnessed one single mistake in the supply chain management.
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