Small Changes, Big Impacts

How changing generic choices provides huge opportunity for climate savings.

While ago, we talked about how a box of drugs is packaged and can optimise the use of space within logistics and freight. Sometimes, some of the changes made within compliance aids can really help radically reduced the carbon footprint of transportation because of the fact that having a product also cuts the number of lorries required to transit that equipment in half. The vast majority of the lowest carbon footprint is actually pushing the lorry around, so reducing the size of medicines and devices also reduces the number of lorries which in turn reduces the carbon footprint in steps, not through a simple linear scaling.

In our latest support of Alphabet Pharmacy we tackled the problem of medicine boxes by looking at generic prescriptions and helping them optimise the choice of money and product size.

Unlike compliance aids, sometimes it's better for pharmacies to choose a slightly bigger box, given internal packaging materials. This means that larger packaged products may be offset with other products in smaller boxes at pharmacy level for climate and even cost differences in the wholesale market. This works because the health-economics of generic drugs are the same to the NHS, but is different to prices community pharmacies see on the ground.

The NHS tariff provides only the reimbursement price, not the price a drug actually bought at by the pharmacy. Community pharmacies must optimise margins within the NHS reimbursement price, to cover their own costs, overheads, staff wages and benefits. While this creates a constraint, this does allow community pharmacy appliances free reign to select generic manufacturers that optimise medicinal supplies for cost and climate impacts, safe in the knowledge a licensed, generic drug’s health performance is constant.

This above image probably shows the key difference in space, with a constant health impact. In health-economic terms these two sets of drugs are identical. However, from a climate change perspective they are not.

Volumetrically these two sets of boxes differ by a factor of 2.8. The boxes on the left occupy 2.8 times the volume of those on the right and is 3 times the density. Choosing the boxes on the left increases the carbon footprint of the same medicines by 3 times and utilises more packaging and van boxes.

Extrapolating this to the effect it has on freight, reduces the number of lorries by two for every 3 sets of medicines, but recognising that this means each packaging box will be denser, the net effect of this is to reduce the carbon footprint of transit from a total of 570 grams of CO2 per kilometre, to 368 for the same stock. A 35.4% reduction in medicine carbon footprint, which in turn, reduces the component of recurrent demand by an equivalent amount. Aka the proportion of NHS health demand caused by the NHS itself, through the delivery of prescription medicines. But this also yields a benefit through a reduced inhaler prescribing regime too. Given each inhaler has a 10 kilogramme carbon footprint, every reduction magnifies through that onward, nonlinear demand on itself.

It is important to realise this surfaces limitations in health economics that health-climate-economics plug. Without it, health-economic modelling becomes an enabler of incorrect choices, while it is blindsided by the effects of climate change on the health service.

To conventional health-economics both sets of drugs are the same and possess no negative impacts in each case. Yet, this is a departure from the reality of operating a medicine regime, which recognised these two cases as fundamentally different. This is the reason why a new approach to procurement becomes necessary in a world that's finally recognised that climate is a public health concern.

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