Italian pharmaceutical intermediate distribution has a structural feature that differentiates it from almost all other logistics: it must guarantee a quasi-public constant service (12 hours from pharmacy request per Italian decree 219/2006) on a demand that oscillates by 30-50% between seasonal peak and valley. An express courier can respond to a peak by raising prices or introducing longer lead times. A DIF wholesaler cannot: the service promise is the same in March and December, and the margin—regulated at 3.65%, or 3% on generics after the TAR Lazio ruling of 9 February 2026—doesn’t “recolour” on difficult months.
A note for non-Italian readers: the seasonal volatility described in this article is observable across all mature European pharmaceutical markets. The 12-hour service constraint and the regulated margin are Italian specifics; the operational dynamics of peak management and shortage handling are largely transferable.
The 2025-2026 season’s data makes it particularly concrete. The Italian National Health Institute estimated for winter 2025-2026 up to 15 million Italians affected by seasonal flu, with case peak expected between Christmas and New Year holidays and extended until January 2026. The AIFA (Italian Medicines Agency) determination of 2 September 2025 updated the list of products authorised for the 2025-2026 vaccine campaign, modifying the mix of available vaccines and creating a new supply dynamic for pharmacies. To this overlap the drug shortages: the AIFA “Non si trova” (Not Found) list, managed in collaboration with the Italian State Mint and Polygraphic Institute, includes over 3,000 drugs with availability issues, of which approximately 300 require import from abroad because there are no valid therapeutic alternatives on the Italian market.
For the intermediate distributor these two dynamics converge into a single operational challenge: absorbing demand peaks while maintaining declared service, and managing inter-site redistribution of shortage drugs without leaving the pharmacy uncovered for the patient. All this, it must be said, in a media narrative that often identifies the distributor as “guilty” of drug shortages, when the role of DIF is actually the last visible link of a structurally tense global supply chain.
This article addresses how capacity is planned for seasonal peaks in DIF, what is the concrete role of the intermediate distributor on drug shortages, and what operational and simulation tools allow managing variability without degrading service.
The three peak seasons of Italian DIF
There is not one peak. There are three distinct seasons, with different dynamics, product mixes and geography.
Autumn-winter (October-March): respiratory peak. Seasonal flu, RSV, residual COVID, pneumonia, bronchitis, paediatric otitis. The delivery mix shifts toward antibiotics (amoxicillin, clarithromycin, azithromycin often in shortage during the most intense peaks), anti-inflammatories, antipyretics, antitussives, mucolytics, flu vaccines. The autumn vaccine campaign (typically starting in October and continuing until December-January) is a peak within the peak: vaccines are thermolabile products, have a tight delivery window, require specific planning.
Spring (March-May): allergic peak. Antihistamines, corticosteroids for topical and inhalation use, products for seasonal asthma. The mix is less critical in temperature terms but quantities per pharmacy can double during weeks of pollen peak.
Summer (June-August): geographic peak. Demand shifts from cities to coastal and mountain areas based on tourism. For wholesalers with national coverage (e.g. Univex) it means temporarily redesigning routes by shifting capacity toward areas with normally low activity. For regional wholesalers serving tourist areas it’s a net peak on their own territory (e.g. distributors in Liguria, Romagna, Sardinia, Sicily, Trentino, Aosta Valley).
On sector benchmarks, each of these peaks can bring DIF activity to 130-150% of baseline over 4-8 week periods. The difference between a distributor absorbing this variability without degrading and one suffering it is the discipline of seasonal capacity planning, not single dispatcher heroism in the hot months.
The operational effect on routes: what changes in a peak
To fix ideas, let’s see what changes operationally in a DIF route during an autumn-winter respiratory peak compared to spring baseline.
| Parameter | Baseline (spring) | Peak (Jan-Feb) | Change |
|---|---|---|---|
| Median parcels per pharmacy/week | 38 | 56 | +47% |
| Number of weekly orders per pharmacy | 4.2 | 5.8 | +38% |
| % deliveries with at least one “urgency” | 8% | 22% | +175% |
| Average stop time per delivery | 6 min | 7.5 min | +25% |
| Average vehicle load (cube utilization) | 62% | 79% | +27% |
| Disruptive events/day per 100 pharmacies | 6 | 14 | +133% |
The numbers are indicative (vary by area, customer profile, intensity of the specific season) but the pattern is invariant: volumes grow, mix shifts to time-critical products, urgencies explode, operating margin to absorb the unexpected compresses. A plan working perfectly at 60% cube utilization in spring can saturate at 80% in January, and any saturation above 85% makes the fleet unable to respond to new urgencies without degrading already-planned drops.
Dynamic intraday replanning (already an important operational asset in normal conditions) becomes absolutely necessary during peaks. Without it, the day systematically breaks: delays accumulate on end-of-route drops, urgencies compete with planned drops, the dispatcher spends the day on the phone. With a dynamic replanning system, the same events are absorbed with much more contained service loss.
Drug shortages: the (real) role of DIF
AIFA keeps the shortage drugs list updated on its portal, classifying them by therapeutic alternatives available on the Italian market. Of the ~3,000 drugs on the list, approximately 300 require import from abroad because there are no validly substitutable ones in Italy. For the others, the pharmacy can typically propose to the patient one of the alternatives provided by the AIFA card.
The role of the intermediate distributor in shortages is threefold and (importantly) it’s not to “create” the shortage: the shortage originates upstream (production problems, withdrawals, global active-ingredient redistribution, import regulatory issues). The concrete role of DIF is:
First, inter-site redistribution. If a drug is available in some DIF warehouses (regional or national) and not in others, the distributor’s logistics network can move stock where needed. Comifar and QFarma, with their branches across the territory, have this territorial levelling capability; an independent regional one is less capable but can still rely on inter-wholesaler exchange networks.
Second, alternatives management. When a drug is in shortage but available equivalents exist, the distributor must be able to deliver the alternative quickly. It’s an administrative activity (authorisation check, possible communication to the physician, substitute prescription) with a non-negligible cost.
Third, urgent imports. For drugs on the “Not Found” list requiring foreign import (the ~300), the distributor (with case-by-case AIFA authorisation) can manage the import procedure, with times, costs and administrative complexity that can absorb significant back-office resources. On a pharmacy requesting an unavailable life-saving drug, managing the single case can cost €200-500 between administrative time, communication with AIFA and international logistics.
The media narrative often doesn’t distinguish these three roles. When a citizen doesn’t find a drug at the pharmacy, current opinion attributes responsibility to the distributor. Reality is that DIF is the last visible link of a global supply chain: the problem is almost always upstream (manufacturer or regulatory authority), but the point of contact with the public is the pharmacy counter, and the pharmacy’s operational interlocutor is the distributor.
Capacity planning for peaks: the systemic approach
The most common mistake in peak management is “service-level relaxation”: tolerating that during 2-3 weeks of intense peak the service drops from 3-hour averages to 6 hours, accepting that some urgencies aren’t handled in time, postponing non-critical drops. It’s a mistake because it degrades the service promise visibly to pharmacies, and because recovery times (winning back dissatisfied pharmacies) are long and expensive.
The systemic approach works instead in three phases.
Phase 1: Forecasting (3-6 months before the peak)
The peak is visible coming. On historical basis (last 3 years), the distributor knows the seasonal pattern of their territory. January grows 35-45% versus baseline; the first half of October grows 20-25% for the vaccine campaign; Easter weeks 14-16 typically have an anticipated peak on allergic. On this basis, capacity dimensioning for peaks must be decided 3-6 months before, not at the last minute.
The concrete decisions: seasonal contracts with drivers, agreements with temporary support fleets, cluster reconfiguration for those months, advance communication to pharmacies on service windows. It’s a strategic planning activity, not operational management.
Phase 2: Scenario simulation
The “what-if” simulation model (loading current state, applying a predicted peak factor, calculating capacity requirement) returns the concrete number: how many additional deliveries per day in cluster X, how many extra km, how many additional person-hours, how many pharmacies would be in service saturation under the standard scenario.
On benchmarks, a simulation system allows estimating the requirement with 5-10% accuracy versus actuals, sufficient to dimension resources without excessive oversizing (expensive) or undersizing (risky). It’s exactly the same logic of the “what-if” model applied to inserting new pharmacies in the route, described in the pillar on pharmaceutical logistics.
Phase 3: Execution and intensive replanning
During the peak, dynamic intraday replanning becomes continuous activity, not exceptional. Cluster reconfigurations (moving pharmacies between routes to balance load) happen weekly, not quarterly. Capacity reservation (leaving a route slot free for predictable urgencies) is a codified operational rule, not left to dispatcher discretion.
On Optivo’s DIF clients applying this discipline, the effect is measurable: service level during peaks (% deliveries within 12 hours, % urgencies handled within target) stays above 99%, against the 92-95% typical of distributors managing peaks “heroically” without systemic support. The difference shows in pharmacy customer satisfaction and, most importantly, in winning back pharmacies that historically had moved from other wholesalers due to peak service issues.
The operational case: the seasonal flu vaccine campaign
Let’s see how it works in practice on a concrete event: the autumn flu vaccine campaign. Typically starts mid-October with first available manufacturer lots, peaks in November, decreases in December-January.
Specific characteristics:
- Tight thermolability: vaccines at 2-8°C in unbroken cold chain, with penalties for chain breaks
- Season-specific lots: the AIFA determination updates yearly the list of authorised vaccines (e.g. the 2 September 2025 one for the 2025-2026 season)
- Concentrated order peaks: pharmacies tend to order large quantities at campaign start, then incremental weekly replenishment
- Inter-DIF competition: wholesalers compete to be “first to deliver” the new vaccine to the pharmacist. It’s a very important perceived service-quality metric
Campaign planning starts in July-August with quantity estimation from manufacturers, continues in September with planning lot arrivals at distributor warehouses, and culminates in October with first dedicated routes. For a regional intermediate distributor with 250 pharmacies and 12 active vehicles, a well-planned vaccine campaign means:
- 3-5 weeks of volumes at 130% of baseline
- 80% of first vaccine deliveries within first available day (vs 50-60% for non-planners)
- Zero cold chain breaks (vs 1-2% for those managing vaccines without systematic temperature tracking)
- Commercial reconquest of pharmacies historically fluctuating between competitors
Planning investment is marginal compared to commercial return: 30-50 person-hours of planning manager between August and October, against a potential upside of 15-30 consolidated pharmacies after a well-managed campaign.
Seasonal peak KPIs
| KPI | Frequency | Typical DIF target |
|---|---|---|
| Capacity utilization (cube) during peaks | Daily | < 85% average |
| % deliveries within 12 hours (during peak) | Daily | > 99% |
| % urgencies handled within target | Daily | > 95% |
| Disruptive events absorbed without degradation | Weekly | > 80% |
| Cold chain breaks | Daily | 0 |
| % pharmacies with first vaccine by D+1 | Seasonal (campaign) | > 80% |
Frequently asked questions
How much do DIF volumes grow during the flu peak?
On benchmarks, volumes delivered by DIF during respiratory peak weeks (typically January-February) grow 30-50% versus annual baseline. The factor includes both increased average quantities per delivery and increased number of weekly deliveries per pharmacy. Growth is larger in high-density urban areas and in seasons with particularly aggressive viruses (variant K flu, COVID with respiratory variants).
How do pharmacies signal drug shortages to the distributor?
Through their pharmacy management system, which sends an electronic order to the distributor. The distributor’s system returns in real time the outcome (available / unavailable / available in X days). If the drug is in shortage, the system can automatically propose the alternatives provided by the AIFA card. The most advanced distributors have bidirectional integration with the main pharmacy management systems (CGM WINGESFAR, Pharmagest, Sinfo One and others) allowing structured communication on shortages.
Can intermediate distributors import drugs from abroad for shortages?
Yes, but with case-by-case AIFA authorisation. The procedure requires a documented request (specific patient, therapeutic indication, unavailability of national alternatives) and approval times that can vary from a few days to weeks depending on complexity. Import procedures are typically managed by a dedicated distributor back-office with regulatory expertise; cost per case can vary from €200 to over €1,000.
Is dynamic replanning essential during peaks?
Yes, even more than in normal conditions. During peaks, daily disruptive events double (+133% on our benchmarks), the planned route’s absorption margin compresses, urgencies explode in number. Without a dynamic intraday replanning system, service quality during peaks inevitably drops, even with good advance planning.
How is a peak simulated with the Optivo calculator?
The Pharmacy Margin Calculator works at variable frequency: to simulate the peak, just increase the weekly frequency (e.g. from 2 to 3 deliveries/week for typical pharmacy during a respiratory peak) and observe how cost-to-serve changes. For more complex simulations (geographic clusters, fleet capacity) a more articulated model is needed: it’s exactly what we build with DIF clients in the first onboarding phase on the platform.
In summary
Italian pharmaceutical intermediate distribution operates in a sector where demand oscillates 30-50% between seasons while the declared service stays unchanged (12 mandatory hours, 3-hour ADF averages). Three distinct seasons (autumn-winter respiratory, spring allergic, summer geographic) produce predictable-pattern but execution-intense peaks.
On the most severe peaks (autumn flu campaign, intense spring allergies), DIF volumes grow 30-50%, urgencies double, mix shifts to time-critical and thermolabile products. Dynamic replanning, important in normal conditions, becomes indispensable not to degrade service.
On drug shortages (a structural phenomenon affecting ~3,000 drugs on the AIFA “Not Found” list), DIF is the last visible link of the global chain, not the cause. The concrete role articulates in inter-site redistribution, therapeutic alternatives management, authorised urgent imports. On this last point, each case can require €200-1,000 of regulatory back-office.
The systemic approach (forecasting 3-6 months before, scenario simulation, execution with intensive replanning) brings service level during peaks stably above 99%, against the 92-95% of distributors managing peaks “heroically”. It’s a capability that builds in months and produces long-term commercial returns: service consistency is what keeps historical pharmacies and wins back those that moved due to issues in previous peaks.
If you want to understand how to plan capacity for the next critical season—resource sizing, cluster simulation, shortage management on exposed pharmacies—talk to our team. From 12 months of operational data we can build the seasonal capacity projection for your specific profile.