The Aboriginal Medical Services Alliance Northern Territory says it is "deeply concerned" about the escalating shortage of Bicillin L-A and its alternatives; essential medicines used to treat and prevent rheumatic heart disease (RHD) and other serious conditions.

There has been a national drug shortage of Benzathine Benzylpenicillin, commonly known as Bicillin L-A, for some time.

In July, with no warning, the sponsor of the temporary alternative for Bicillin L-A (Extencilline) announced that Australian supplies had been exhausted and further imports from France would not be possible. This has left health services struggling for solutions.

"This is a looming public health crisis," AMSANT chief executive Dr John Paterson said on Thursday.

"The NT has some of the highest rates of rheumatic heart disease in the world. Thousands of people, particularly in rural and remote communities, rely on uninterrupted access to Bicillin for monthly injections to prevent recurrent acute rheumatic fever and other life-threatening complications. Without it, lives are at risk."

A limited supply of one alternative - Brancaster - is currently available, but it is not listed on the Pharmaceutical Benefits Scheme, meaning health services must purchase it privately at significant cost; around $66 per vial. Another potential substitute - Benzatacil - is still awaiting emergency (Section 19A) approval for use in Australia.

"These privately billed medicines not only place a financial burden on already stretched services — but there is real concern about whether supply will be sufficient to meet demand across the Northern Territory," Dr Paterson said.

"We simply cannot afford to be left without the medicines we need to prevent heart disease and premature death in our communities."

Aboriginal people are significantly over-represented among people with rheumatic heart disease.

AMSANT urged urgent national coordination and government support to secure supply, fast-track approvals, and ensure affordable access to all appropriate alternatives.

The Alliance also called for Aboriginal Community Controlled Health Services (ACCHSs) to be reimbursed for the emergency use of these alternative medications.