The Spanish Association of Generic Medicines (AESEG) has disseminated a report this Tuesday in which it warns that four essential medicines used in the treatment of hypertension and type 2 diabetes already show objective signs of fragility in their supply. According to the entity, this situation is due to the persistent drop in prices, the reduction of effective supply, and a greater concentration of suppliers.
The association does not claim that these four drugs will necessarily enter into shortages, but it does identify clear signs of vulnerability, which is why it urges taking preventive measures. "We are not saying that tomorrow any of these medicines will be lacking, but there are indeed objective signs of vulnerability. Shortages do not start when the patient cannot find the medicine at the pharmacy; it happens much earlier," said the general secretary of AESEG, Elena Casaus.
The document is based on an internal analysis by AESEG prepared from public and verifiable information, coming from CIMA, the Spanish Agency of Medicines and Health Products (AEMPS), the Nomenclátor, and the official lists of voluntary price reductions from the Ministry of Health, as well as various market sources.
One of the cases studied is furosemide 40 mg/30 tablets, indicated, among other uses, for heart failure and certain forms of arterial hypertension. AESEG details that its laboratory sale price (PVL) has been reduced from 1.44 euros in 2021 to 0.36 euros in 2026, which implies a decrease of nearly 75 percent over five years. At the same time, the number of marketed presentations has decreased from 19 in 2021 to 11 in 2026.
"The problem is not the 36 cents, but the reduction in the number of suppliers and the concentration of supply, which makes the system much more vulnerable to any incident that affects any of them," pointed out the technical director of AESEG, María Álvarez.
Another of the analyzed medicines is metformin 850 mg, used for type 2 diabetes, whose presentation of 60 tablets has suffered a reduction of 0.99 euros in PVL. Of the 36 registrations reviewed, only 10 are actually on the market. Between 2024 and 2026, the marketed presentations have decreased from 15 to 10 (-33.3%) while the canceled authorizations have increased from 8 to 15 (+87.5%).
In the case of hydroxychloroquine 200 mg/30 tablets, used in autoimmune diseases such as lupus and rheumatoid arthritis, the PVL has decreased from 7.79 euros to 2.97 euros in 2026, which represents a reduction of 6.1 percent. Of the nine authorizations examined, only five are currently marketed.
Finally, AESEG focuses on deflazacort, a drug with anti-inflammatory and immunosuppressive properties, which has accumulated a price erosion close to 72 percent and has seen its effective supply contract by 57 percent.
AESEG calls for action before shortages
The generics association reminds that these medications have provided significant savings to the National Health System for decades and emphasizes that it does not question price competition. What it proposes is that, when a voluntary price drop is extraordinarily intense or affects an essential or critical medication, or a market with few effective suppliers, the Administration evaluates in advance the possible impact on supply security.
"We are not at all against competition or price reductions. Generic medications exist precisely thanks to competition and have generated significant savings for the healthcare system. The problem arises when that competition ceases to be sustainable. In Spain, there are mature medications that, despite being subjected to successive price reductions for years, continue to experience new drops," Casaus has stated.
Among the measures suggested by AESEG are to proactively review elements such as available stock, additional manufacturing capacity, procurement of the active ingredient, replenishment timelines, and the existence of contingency plans. It also reminds that the legal obligation to supply does not necessarily imply having industrial capacity to multiply production immediately.
Reform of the pricing system and protection of vulnerable markets
For AESEG, the solution does not only involve modifying the minimum price threshold. It considers it essential to review the mechanisms that allow for chaining new reductions in mature medications whose cost is already just a few cents, with special attention to the current system of voluntary reductions in homogeneous groups.
The association proposes to rethink this scheme of voluntary price reductions and replace it with a more orderly, predictable, and supply security-compatible competition model. Alongside this, it suggests raising the minimum threshold of the Reference Price System from 1.60 to 2 euros per presentation, updating it periodically, and turning it into a true safety net, in addition to introducing safeguards and extraordinary review mechanisms for essential, critical medicines or markets particularly exposed.
Call to the new Government to prioritize supply
In this scenario, AESEG has asked political parties and the next Government to place the security of medicine supply among the priorities of health and industrial policy. "We make a call for them to incorporate the security of supply of essential medicines as a priority of health policies," Casaus has emphasized.
In this line, the association demands that in the next legislature the reform of the Reference Price System and voluntary price reductions in homogeneous groups be addressed, the specific protection of vulnerable markets, the preventive evaluation of extraordinarily intense price reductions, and greater coherence between pharmaceutical policy, industrial policy, and public procurement.