64.2% of people who consume tobacco daily have considered quitting, and 41.9% have not only considered it, but have even tried, according to the latest Survey on alcohol and other drugs in Spain from the Ministry of Health. It is not at all surprising, therefore, that when Todacitan was added to the catalog of drugs financed by the National Health System at the beginning of February, it disappeared from pharmacies in a matter of hours. Since then, the only drug to stop smoking that is funded is on the list of products "with supply problems" of the Spanish Agency for Medicines and Health Products. Until when?
Todacitan, which has cytisine as its active ingredient, has been marketed in Europe since 2013, but was not authorized in Spain until November 2018. While it was supplied as an unfunded medicine (at the price of almost 200 euros for treatment) there were no supply problems, explains Antoni Torres, president of the employers' association Federació d'Associacions de Farmàcies de Catalunya. So it was financed, the price dropped to 116 euros, of which you only need to contribute the percentage of co-payment that the law establishes according to income and socio-economic situation (the average will be around 41%).
They sold out immediately the moment the funding was announced, and wholesalers made an initial request, which was answered and arrived in pharmacies in February: 19,951 packs, boxes of 100 tablets equivalent to a full treatment . The shelves were quickly emptied again and they have not restocked the product. Pharmacists suspect that the laboratory has not had enough production capacity at its plant in Poland to cope with the sudden and considerable increase in demand. "If you're producing 1,000 containers a day, you can't suddenly increase production to 50,000", explains a professional.
However, sources from the Polish pharmaceutical company Aflofarm, manufacturer of the medicine, assure La Vanguardia that there is no problem with production capacity, stock, or lack of active principle or other ingredients. In fact, they say that there is a batch of 29,000 units ready to be sold in Spain, but it is blocked by a simple "labeling problem", according to the company. "We are making every effort to restore the supply and as soon as this lot can be released, the demand from the pharmacies will be met." Aflofarm believes that very soon, in the middle of this month, the product will be able to leave the Ministry of Health's list of "medicines with supply problems" in a situation of "temporary shortage" in which it has appeared since February 21, without date expected resolution of the incident.
Although it may seem implausible, the labeling problem argument is plausible. Not long ago there was a shortage of a certain presentation of an antibiotic because the producer did not have paper of the appropriate grammage to print the prospectus and that would fit in the packaging. Packaging and leaflets are regulated in detail, and despite the fact that laboratories can request changes, the procedure can take several months, Torres assures.
A woman smoker from Madrid explains that the general practitioner prescribed Todacitan for her on February 13 but has not been able to find it. "My prescription expires in ten days and the pharmacy has already told me that I will have to go to the family doctor to have it refilled," he points out. In order to prescribe this pharmacological treatment for smoking cessation, Health requires that the patient be included in an individual or group support program and have "a clear motivation to quit smoking", that is to say, that he has tried at least once in the last year.
The great advantage of this therapy, which mimics the mechanisms that nicotine awakens in the brain, is that it lasts 25 days and presents a higher percentage of success than other similar pharmacological therapies. Up to 40% quit smoking during the treatment period, although the percentage of users who continue to quit smoking after one year is much lower.
