Supply shortages: the gap on the shelf is the counterfeiters’ door

In the autumn of 2023 a person lay in hospital in Austria with hypoglycaemia and a seizure. The trigger was a prefilled pen that looked like a semaglutide preparation but contained insulin glargine. The laboratory of a German testing authority later identified the substance unambiguously; the authorities assumed relabelled insulin pens. The person concerned had not obtained the preparation from a pharmacy. According to the state of the investigation at the time, the batch came from another source.

That sentence is the most important one in the whole case, and it also describes the situation in Switzerland. Counterfeits almost never reach patients via the wholesaler and the community pharmacy. They reach them alongside, past, around the outside. Via an online shop, via a beauty salon, via a recommendation on a social network, via an acquaintance who has some left over.

That is precisely what Swiss law is built on. With the ratification of the Medicrime Convention in October 2018, parliament inserted Article 17a into the Therapeutic Products Act, regulating unique identifiers and safety features on medicine packaging, modelled on the European Falsified Medicines Directive. Unlike in the EU, however, application and verification are fundamentally optional. The Confederation’s reasoning is remarkably clear: no falsified medicines intended for the Swiss market have so far been found in the legal supply chains.

That is a statement about the past, not a guarantee for the future. And above all it is a compliment that is rarely read as one. Switzerland dispenses with a comprehensive mandatory system because the chain works. The chain works because wholesalers, hospital pharmacies and community pharmacies make it work. Anyone working in a pharmacy is not administering boxes. They are upholding an assumption on which the legislator relies.

The pressure comes from outside, and it is increasing

Swissmedic supplies the figures every February. In 2025, together with the Federal Office for Customs and Border Security, 6,647 illegal medicine consignments were identified, 17 per cent more than in the previous year. Over several years this is at a similar level to earlier years, but the composition has shifted. Erectile dysfunction products, for years the dominant item at almost 80 per cent, still accounted for 41 per cent. Around 19 per cent, by contrast, were preparations against hair loss and twelve per cent hormones including melatonin. Eight per cent concerned psychotropic drugs as well as sleeping aids and sedatives, five per cent nasal sprays and laxatives.

The politically most interesting figure is somewhat buried. In 2022, nine per cent of the consignments processed were posted in Western Europe. In 2025 it was 40 per cent. The illegal market has changed its address. What used to come from Asia and struck the recipient as suspicious through packaging, language and shipping route today comes from an EU country, with a European postmark and a website that looks like a pharmacy. A considerable share of the goods still originates in third countries and is smuggled in via EU transit states. For the person at the counter this means: the most important warning sign your customers used to recognise intuitively has disappeared.

That 94 per cent of the cases processed by Swissmedic end in the simplified procedure, with a warning and destruction of the goods, says something additional about the people behind them. These are not criminals. These are patients who ordered something they could not obtain legally, or not quickly enough.

GLP-1 as an object lesson

How quickly a wave of demand fills the illegal channels was described by Swissmedic in a warning of its own in August 2025. Capsules, drops and food supplements are being offered that advertise with the abbreviation GLP-1 and in part carry the logos of regulatory authorities, including that of Swissmedic itself, plus invented certifications. None of these products has been tested or approved. In a slimming preparation advertised as purely natural, the Swissmedic laboratory detected the prescription-only substance semaglutide in an effective dose.

To this come two further patterns. First, counterfeits by label swapping, in which commercially available pens are relabelled; the outward similarity conceals the fact that a completely different substance is in the container. Second, illegally produced active substances, usually as powder or solution, frequently from Asia, without any pharmaceutical control, distributed via online channels and promoted by influencers. Swissmedic explicitly points out that offers of injectable preparations from beauty studios and salons are to be questioned with particular scepticism.

One can read this warning as a curiosity. One can also read it as a forecast. With the oral availability of GLP-1 substances, the last practical hurdle of illegal trade falls away. A tablet needs no cold chain, no pen, no injection training. It can be sent in an envelope and imitated in a blister that nobody can distinguish from a real one. Anyone who believes the problem will be over once the supply shortages of injections end considerably underestimates the adaptability of this market.

For context, without blurring the proportions: in 2017 the WHO estimated, on the basis of over 100 studies with around 48,000 samples from 88 countries, that about one in ten medicines in low- and middle-income countries is substandard or falsified. This figure does not describe Switzerland and must not be transferred to it. It describes where a health system ends up when the legal chain loses its reliability.

The real connection

This brings us to the point at which the two themes of this text become one. Counterfeits and supply shortages are as a rule discussed separately, the one as a crime topic, the other as an industry and pricing topic. That is a fallacy.

A person does not leave the legal supply chain out of a sense of adventure. They leave it the moment they hear that their medicine is currently unavailable. Every refusal at the counter is an opportunity for the grey market, and that market is reachable around the clock, phrased in friendly terms and never sold out.

The scale of that opportunity is known. The pharmacists’ association puts the situation, on the basis of the privately run platform drugshortage.ch, at an average of around 700 unavailable medicines. The number of supply shortages has risen over years and remains at a high level; affected are above all inexpensive, off-patent preparations, that is precisely those needed daily in primary care. The range of substances subject to reporting at the reporting office for vital human medicines was expanded in January 2026 and now comprises around 330 substances. Compulsory stockpiles cover, depending on the medicine, two to four months of demand.

The effort this generates is not background noise. In European comparison, all EU member states recorded supply shortages in 2025; according to a survey by the European pharmacists’ association, pharmacies there spend on average twelve hours a week absorbing the consequences. That is more than a day a week, and it is work that nobody sees, nobody bills and nobody misses – until it stops happening.

It is precisely here that it is decided whether a shortage becomes a counterfeiting risk. Someone who receives a refusal plus a call-back in the afternoon, a discussion with the practice, an alternative with the dose conversion explained and a specific date when the goods will be there does not go searching online. Someone who receives a refusal and nothing else searches that same evening. Switzerland’s counterfeiting prevention consists primarily not of customs and criminal law. It consists of what happens in the ten minutes after the sentence “we don’t have that at the moment”.

What the legislator is currently doing

Following decisions of August 2024 and 20 March 2026, on 19 June 2026 the Federal Council opened the consultation on a partial revision of the Therapeutic Products Act, running until 16 October 2026. Its content deserves more attention in the community pharmacy than it has so far received.

It is envisaged that wholesalers and importers, in the event of an imminent or existing shortage in Switzerland, may temporarily import and place on the market medicines that are not approved. It is further envisaged that community pharmacies, hospital pharmacies and the army pharmacy may themselves produce non-approved medicines. Medicines from countries with comparable medicines control are to be eligible for simplified approval. In addition, the rules on mail-order trade are to be relaxed and single-dose dispensing more clearly regulated.

The first of these points is logistics. The second is something else. It writes the pharmacy back into the law as a manufacturer, not as a dispensing point but as a producing part of security of supply. That is, soberly viewed, the return of a competence gradually denied to the profession over decades, and it comes not from nostalgia but because the state realises it needs it.

This return is, however, no gift. Producing yourself means taking on responsibility, for quality, documentation, staff and liability, in a business that already spends twelve hours a week managing shortages. Anyone who wants this has to help shape the conditions, and the consultation is still running. It ends in mid-October. After that, decisions will be made about the profession, no longer with it.

On mail-order trade the arguments genuinely diverge. Those in favour of relaxation point out that willing demand flows better into a controlled legal channel than into an uncontrolled foreign one. Those against point out that every lengthening of the distance between professional and patient lowers the density of counselling and further complicates the distinction between legal and illegal online offerings for lay people – precisely because the illegal providers now look European. Both are plausible; which effect predominates depends on the concrete design, and that is exactly why taking part in the consultation is worthwhile.

Serialisation helps, but not where the fire is

The dossier on safety features is running in parallel. The Swiss Medicines Verification System exists and is live. The draft ordinance on Article 17a went into consultation on 6 May 2025, which closed at the end of August 2025; the Federal Office of Public Health is working on the report, and the next steps will be determined in the course of 2026. Several cantons and associations have called for longer transitional periods and better alignment with the EU system, in order to avoid duplication.

Expectations should be sorted cleanly here. A verification system checks whether a pack in the legal chain is genuine. It is effective against counterfeits penetrating that very chain, and this risk grows with parallel trade, reimports and emergency imports during shortages – that is, with precisely the instruments now being expanded against shortages. In that sense, serialisation and supply policy belong together.

Against the problem that Swiss statistics actually depict, a scanner does not help. A preparation that was never in the legal chain throws no error message. It lies in an envelope in the letterbox, and the only place where it can be noticed is a conversation.

What this means for daily work

The most effective detector therefore remains the professional – and not in their role as inspector but in their role as someone people tell things to.

That presupposes a particular way of conducting the conversation. Someone who has ordered online usually knows it was not a good idea. Someone who is lectured about it will not say so next time, and next time it may be a relabelled insulin pen. The question that works is open and non-judgemental: where the preparation came from, what it says on the pack, whether it looks like last time. The question that does not work begins with “you surely haven’t…”.

What should raise attention includes packaging without labelling or with foreign-language labelling, a missing or broken tamper-evident seal, a dose scale or pen mechanism that does not match the known product, a strikingly low price, purchase without a medical prescription, and effects that do not match the declared substance. The last point is the clinically most delicate, because it only shows after use. A sudden severe hypoglycaemia in a person not on insulin therapy is not a pharmacological riddle but a pointer to the source of supply.

Here, however, lies an uncomfortable interaction that is rarely spoken aloud. Managing shortages means in practice that goods reach the pharmacy from compulsory stockpiles, with foreign presentation or in rationed quantities, that preparations are switched more frequently and that packs look different from the last purchase. For the professional this is routine. For the patient it means she gets used to her medicine suddenly having a different name, looking different and being labelled in a foreign language. She thereby loses precisely the simple rule of thumb that could protect her from a counterfeit. The shortage therefore does not only make the grey market more attractive, it also makes it less conspicuous.

The consequence of this is not reassurance but a shift. If appearance becomes useless as a check for lay people, only the source of supply remains. That is the message that belongs permanently anchored in counselling, and it is simple enough for any counter: it is not the pack that decides whether a medicine is safe, but the route by which it arrived. An unfamiliar-looking preparation from the pharmacy is safe. A familiar-looking one from the internet is not.

Where there is a suspicion, the product does not belong in the bin but should be retained and reported. Swissmedic operates its own channel for reports on suspected illegal or falsified products, examines the information, initiates corrective measures and forwards to national or international bodies. Every report improves the data basis on which the authorities base their warnings and politics its decisions. Without reports from practice, the statistics remain what customs happens to pick up.

And finally, part of prevention is something that stands in no ordinance: the active management of the refusal. A documented alternative proposal, a discussion with the prescriber, a partial dispensing where permissible, a call-back with a delivery date. Not because it is remunerated, but because it is the only measure that keeps the patient in the system.

The real question

There is currently a great deal of talk about security of supply. A popular initiative has been on the table since October 2024, the Federal Council countered it with a direct counter-proposal in March 2026, an expert report of October 2025 named the fields for action, and the legal revision is in consultation. The debate revolves almost exclusively around quantities, prices, stockholding and production locations. That is necessary and it falls short.

Because what is actually lost in a shortage is not just a pack. It is the matter-of-factness with which a person assumes that they will get what they need where it is safe. That matter-of-factness is the quietest and most valuable infrastructure of the health system, and it is the only effective protection against a market that delivers at any time and never guarantees what it delivers.

The Confederation justifies its restrained anti-counterfeiting regime by pointing out that nothing has so far been found in the legal chain. That is true. But it is not a condition, it is a result – and one that is earned afresh every day, at around 1,800 locations, mostly without anyone noticing. In this system the pharmacy is not the last mile of logistics. It is the place where a product becomes a reliable statement.

That is not a romantic self-image. It is the business basis.