PGEU GPUE. Pharmaceutical Group of European Union Groupement Pharmaceutique de l Union Européenne

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The Models of Pharmacy in Europe John Chave, Secretary General Members: Professional Bodies & Pharmacists Associations 2013: 32 Countries Austria Belgium Bulgaria Bosnia Herzegovina Cyprus Czech Rep Denmark

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The Models of Pharmacy in Europe John Chave, Secretary General Members: Professional Bodies & Pharmacists Associations 2013: 32 Countries Austria Belgium Bulgaria Bosnia Herzegovina Cyprus Czech Rep Denmark Estonia Finland France Germany Greece Hungary Ireland Italy Luxembourg Malta Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Croatia FYR Macedonia Norway Serbia Switzerland Turkey European Pharmacy 2013 Three Currents of Change Liberalisation Economic Change Professional Change Ownership Establishment OTC monopoly Criteria Criteria for pharmacies Ownership limited to pharmacists only Free ownership but limitation of chains Completely liberalised Establishment criteria OTC pharmacy exclusivity Ownership AND Establishment Ownership Establishment NPMs Internet Norway Netherlands Ireland [Greece] Malta UK Germany Slovakia Denmark Latvia CZ Sweden Netherlands Denmark Poland Norway Portugal Ireland Poland Italy Lithuania Romania Lithuania Hungary Bulgaria Hungary Portugal The Decisions of the European Court of Justice In 2007, The European Commission started legal action against ownership restrictions in Italy and Germany. The Commission argued that such restrictions were not compatible with the EU internal market. At the same time, the Court considered a legal challenge to pharmacy establishment restrictions in Spain. The Decisions of the European Court of Justice The Court affirmed the right of EU Member states to restrict ownership of pharmacies to pharmacists; The Court argued that ownership restriction was necessary to protect the independence of the pharmacist; In a different case, the Court ruled that geographical retsictions on the establishment of new pharmacies were justified in order to ensure an adequate distribution of pharmacies across the territory. Norway Alliance apotek / Boots apotek, wholly owned Vitusapotek, wholly owned Independent pharmacies (no chain connections) Apokjeden / Apotek 1, wholly owned Public Hospital pharmacies Other independent pharmacies with a chain connection Number of pharmacies according to ownership June Source: Norwegian Pharmacy Association Independents and small chains Ireland Corporate Chain Ownership 8% 92% Source: Irish Pharmacy Union UK Independents Multiples 39% 61% 2 % in 4 years Source: UK National Pharmacy Association Netherlands Independent Multiples 32% 68% Source: KNMP - Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie Netherlands Independent Multiples 32% 68% Source: KNMP - Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie Number of Pharmacies owned by multiples 120 Lloyds in Belgium Source: APB - Association Pharmaceutique Belge Some thoughts on liberalisation European Pharmacy is still an overwhelmingly independent profession, and will remain so for the forseeable future; The debate now in Europe is not about legality of restrictions; it is about whether liberalised systems reduce costs; The challenge for European pharmacists is to demonstrate that regulated models generate added value. Economic Change The Dutch Generic Tendering System The effects of tendering on prices in the Netherlands, Top 10 packs by sales, May-June 2008 Pharmaceutical Product Preferred supplier Pharmacy purchase price ( ) Change May 2008 June Omeprazole tablets/capsules, 20 mg Ratiopharm % 2. Alendroninezuur tablets, 70 mg Centrafarm % 3. Omeprazole tablets/capsules, 40 mg Centrafarm % 4. Paroxetine tablets, 20 mg Ratiopharm % 5. Simvastatin tablets, 40 mg Actavis % 6. Pravastatin tablets, 40 mg Focus Farma % 7. Simvastatin tablets, 20 mg Ratiopharm % 8. Tamsulozine tablets/capsules, 0.4 mg Centrafarm % 9. Amlodipine tablets, 5 mg Ratiopharm % 10. Citalopram tablets, 20 mg Ratiopharm % Source: Stichting Farmaceutische Kengetallen (SFK), quoted in Kanavos, Seeley and Vandoros, 2009 Since the first wave of tenders the Dutch generics market decreased 66% Groupement - Off Pharmaceutique Patent de l Union prices Européenne fall on average 85% Pharmacist remuneration systems in EU Pure Margin Predominantly Margin Pure fee Predominantly fee Fee/Margin Recent changes Meanwhile workload increases... Economic Change In many EU countries margins and fees for pharmacists are being reduced; It is estimated that within the next two years 80% of medicines dispensed in the EU will be generics; Margin based remuneration systems were not designed for very low price generics. Independent pharmacies need to consider ways of generating economies of scale in order to confront economic challenges. Professional Change Models of Professional Practice in Europe Pharmacy in Europe is still dominated by the traditional dispensing model. A wider range of services such as medicine use reviews and other pharmaceutical care services are available in the UK, Netherlands and to a limited extent in France. Professional practice is very similar across Europe. What we know about the future of European Health Systems The rational and appropriate use of medication will become a central cocern of health systems as the populations ages, both for economic and health reasons 65% of people over 60 have two or more chronic conditions, Patients over 65 take on average 2 to 6 prescribed medications and non prescribed medications, with 13 prescribed medications at higher end of the range. A higher prevalence of certain diseases, such as Alzheimer, Parkinson, glaucoma, osteoarthritis, and congestive heart. Adherence rates in this age group are 60% or less. Up to 50% of cardiovascular disease admissions may be due to poor adherence. What we know about the future of European Health Systems Effective early detection and management of chronic disease will be essential if costs are to be contained What we know about the future of European Health Systems Primary Care Services/the Health Care team will have to undertake new roles What we know about the future of European Health Systems There will need to be a significant shift from secondary to primary care settings, and an increased reliance on self care. Where does this lead? Looking Forward The European Pharmacy Blueprint A vision for pharmacy supported by all PGEU members A Prescription for the Future It is essential that pharmacy maintains its key strengths: independence, trust value, network/accessability and reliability; Remuneration systems may need to move away from margins towards fees; The opportunities offered by ehealth must be taken, particularly with regard to patient medication records; New services should not be seen as replacing the traditional pharmacy model, but supporting it. The future of pharmacy lies in the hands of today s practitioners. PGEU ANNUAL REPORT 2012 THANK YOU
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