Pharmacy Liberalisation in Europe: Prospects and Implications

Very little in the pricing environment in Europe is predictable to pharmaceutical companies and only rarely is much notice given of change. But before the end of 2009, if the European Court of Justice accepts the arguments put to it forcefully by the European Commission and by DocMorris, then revolutionary reform among industry’s main customer group, the community pharmacist, in several of the main countries, including 4 of the EU-5, will get the green light. The main issue to be resolved is whether national regulations on pharmacy ownership and establishment of new premises infringe EU law, and if this is of wider importance than for the pharmacy profession alone. It amounts to a battle over control of a healthcare provision between Brussels and the member states, with the outcome also of great significance to patients, wholesalers, manufacturers and payers.

‘Pharmacy Liberalisation in Europe: Prospects and Implications’ provides fully-researched, up-to-date information and interpretation on what deregulation could mean to all participants in the medicines’ market. Whether your interest is in marketing prescription brands, generics or OTCs, in their distribution, or in paying the bill for them, this report is for you. To be forewarned of what might happen will allow adequate preparation for it.

The report addresses:

- Background and current status of infringement actions brought by the European Commission against seven EU member states, plus the key ECJ case involving the controversial DocMorris pharmacy in the German city of Saarbrücken.
- The arguments for and against reform.
- What might happen, who would be the winners and the losers.
- Details of the current ownership structure, and ownership and establishment rules for pharmacies in countries all across Europe from Iceland to Cyprus.
- Interdependency of pharmacy and wholesaling, and how this could evolve.
- What lessons can be found from markets that have already deregulated.
- How vertical integration impacts reimbursement of multisource products and the response by payers to this.
- The latest on plans to break up Apoteket’s pharmacy monopoly in Sweden.

Executive Summary

1. Background
1.1 Community Pharmacy
1.2 Pharmacy Regulations
1.3 Intervention by the European Commission
1.4 Limitations on Commission Action

2. The Arguments
2.1 National Developments
- 2.1.1 Italy
- 2.1.2 Germany
- 2.1.3 Spain
- 2.1.4 Austria
- 2.1.5 France
- 2.1.6 Portugal
2.2 Other Contributions to the Debate
- 2.2.1 ÖBIG Report for PGEU
- 2.2.2 ECORYS Report for European Commission
2.3 ECJ Oral Hearing in Italian and DocMorris Cases
2.4 Other Commission Interventions Concerning Pharmacy

3. Deregulation to Date
3.1 National Situation
- 3.1.1 Bulgaria
- 3.1.2 Germany
- 3.1.3 Hungary
- 3.1.4 Iceland
- 3.1.5 Ireland
- 3.1.6 Lithuania
- 3.1.7 Malta
- 3.1.8 Netherlands
- 3.1.9 Norway
- 3.1.10 Poland
- 3.1.11 Portugal
- 3.1.12 Sweden
- 3.1.13 Switzerland
- 3.1.14 UK
3.2 Liberalisation of OTC Sales Channels

4. What Could Happen
4.1 More Pharmacies?
4.2 Are More Pharmacies Needed?
4.3 Greater Price Competition?
4.4 Pharmacy Acquisition by Wholesalers?
- 4.4.1 Profiles of Leading Wholesalers with Pharmacy Chains
-- 4.4.1.1 Alliance Boots
-- 4.4.1.2 Celesio
-- 4.4.1.3 Phoenix
-- 4.4.1.4 OPG
- 4.4.2 Wholesalers’ Future Vision
- 4.4.3 Other Wholesalers with Pharmacy Chains
- 4.4.4 Other Forms of Wholesaler Involvement in Pharmacies
- 4.4.5 Pharmacist Ownership of Wholesalers
4.5 Pharmacy Acquisition by Other Types of Companies?
4.6 Distribution Changes in Sweden?

5. Implications
5.1 For Patients
5.2 For Pharmacy
5.3 For Other Professions
5.4 For Wholesalers
5.5 For Manufacturers
- 5.5.1 Impact on Rebate Agreements in Germany
- 5.5.2 Higher Distribution Costs in Sweden
- 5.5.3 Expansion of Homecare
5.6 For Governments/Third Party Payers
- 5.6.1 Reimbursement Problems with Multisource Products
- 5.6.2 Clawback Ineffective
-- 5.6.2.1 UK
-- 5.6.2.2 Netherlands
-- 5.6.2.3 Sweden

List of tables
1.1 Pharmacy and pharmacist demography in Europe
1.2 Share of medicine sales from wholesalers by customer group
1.3 Is it possible for a non-pharmacist to own a pharmacy?
1.4 Pharmacy regulation indices
1.5 Timetable of EU proceedings against pharmacy regulations
3.1 Pharmacies in Iceland
3.2 Leading pharmacy chains in Ireland
3.3 Leading pharmacy chains in Lithuania
3.4 Leading pharmacy chains in the Netherlands
3.5 Ownership structure of community pharmacies in Norway
3.6 Evolution of pharmacy numbers and share of chains in England
3.7 Evolution of supermarket pharmacies in UK
3.8 Evolution of large pharmacy chains in UK
4.1 Evolution of pharmacy numbers across Europe, 1995-2006
4.2 Other access points for medicines in Europe
4.3 Ranking of Europe’s ‘big 3’ wholesalers by country
4.4 Pharmacy ownership by leading wholesalers
4.5 Other wholesaler-owned pharmacy chains
4.6 Share of community pharmacies in virtual chains

Appendices
1. Pharmacy Ownership and Establishment Criteria, 2008
2. European and National Pharmacy Associations

About the Author:

Donald Macarthur is an independent analyst, consultant and writer on international pharmaceutical business issues. Issues covered include drug cost containment policy worldwide, pricing and reimbursement, hospital access, European integration and enlargement, wholesale and retail distribution, mail order, homecare, orphan drugs, generics, parallel trade, Rx-to-OTC switching, and several aspects of the Japanese market and industry.

He has written over 50 major reports and also founded, edited and published for four years the world’s first periodical on drug pricing and reimbursement, Pharma Pricing Review..

Formerly with PriceSpective and also the first Secretary General of the European Association of Euro-Pharmaceutical Companies, consultancy clients include the European Federation of Pharmaceutical Industries and Associations - he was the very first consultant ever used by EFPIA - Pharmaceutical Research and Manufacturers of America (PhRMA), the European grouping of national full-line pharmaceutical wholesaling associations (GIRP), the UK’s Office of Fair Trading, other government agencies, and many major multinational biopharmaceutical manufacturers, legal and financial firms. Numerous presentations have been given at international conferences, and he has testified both at a US Senate Committee hearing and at the HHS Secretary’s task force hearing on prescription drug importation. His articles have appeared in many English language pharmaceutical business journals, with some translated into Japanese, German and Turkish.

Qualifying as a pharmacist from the University of London, Mr Macarthur's early career involved community and hospital pharmacy practice, 16 years in development, regulatory affairs and medical department functions in the pharmaceutical industry in the UK (Fisons, 1969-72; Parke-Davis, 1972-75; Roche, 1976-78; Serono, 1978-82; Lundbeck 1982-84), one year in Japan, and four years with PJB Publications (publishers of Scrip).

Order Online - visit http://www.researchandmarkets.com/reports/1582661

Order by Fax - using the order form below

Order By Post - print the order form below and send to

Research and Markets,
Guinness Centre,
Taylors Lane,
Dublin 8,
Ireland.