European Community Pharmacy Facts & Figures PGEU DATABASE 2010/11

Transcription

1 European Community Pharmacy Facts & Figures PGEU DATABASE 2010/11 p.1/46

2 Sources This document presents the most recent data received from PGEU members for years 2010 /2011. Data on European population, countries area and GDP are taken from Eurostat. Data on Pharmacy Education was kindly provided by European Pharmacy Students Association. May 2012, PGEU p.2/46

3 Table of Contents Sources... 2 I. KEY PHARMACY FIGURES... 4 I.I. Community Pharmacy Workforce... 4 I.II. Community Pharmacies I.III. Computerisation of Community Pharmacies I.IV Pharmacy Education and Training I.V Education and Training of the Pharmacy Technician/Pharmacy Assistant with the Right to Dispense. 22 II. LEGAL ASPECTS II.I. Dispensing Rights II.II Prescribing Rules II.III Electronic Prescriptions II.III Prescribing Rights II.IV Non-Prescription Medicines II.V Internet Sales of Medicines III. PHARMACY ECONOMY III.I. Prescriptions III.II. VAT III.III. Patient co-payment IV. PHARMACY SERVICES AND QUALITY ASSURANCE IV.I. Pharmacy Services IV.II. Quality Assurance Glossary p.3/46

4 I. KEY PHARMACY FIGURES I.I. Community Pharmacy Workforce I.I.I. PHARMACISTS Country Registered pharmacists Pharmacists working in community pharmacy % of females Pharm holding specialization in community phar. Italy % N/A France % / Spain % N/A Germany % N/A UK % N/A Poland % 4800 Turkey % / Portugal % / Romania % / Belgium % N/A Czech Rep % N/A Hungary / / Austria ,5% / Bulgaria % / Norway % N/A Sweden % N/A Ireland / N/A Serbia / / Switzerland % 1638 Denmark % / Slovakia % 2542 Croatia % 37 Finland % 263 Lithuania 2875 / / / FYR Macedonia % / Netherlands % / Estonia % N/A Slovenia / 56 Latvia / / Malta / / Cyprus / / Luxembourg / / Greece / / p.4/46

5 I.I.I.a FEMALE/MALE PHARMACISTS RATIO Female pharmacists Male pharmacists Estonia Croatia Slovakia Poland Czech Rep. Bulgaria Romania Norway FYR Macedonia Portugal Austria Finland Denmark Sweden Spain Switzerland Belgium Germany Italy France Netherlands UK Turkey 98.00% 92.00% 86.00% 85.00% 82.00% 82.00% 80.00% 80.00% 80.00% 79.00% 78.50% 76.00% 75.00% 72.00% 71.00% 70.00% 70.00% 67.00% 66.00% 66.00% 60.00% 57.00% 51.00% 2.00% 8.00% 14.00% 15.00% 18.00% 18.00% 20.00% 20.00% 20.00% 21.00% 21.50% 24.00% 25.00% 28.00% 29.00% 30.00% 30.00% 33.00% 34.00% 34.00% 40.00% 43.00% 49.00% p.5/46

6 I.I.I.b COMMUNITY PHARMACISTS/REGISTERED PHARMACISTS RATIO Greece Luxembourg Cyprus Malta Latvia Slovenia Estonia Netherlands FYR Macedonia Lithuania Finland Croatia Slovakia Denmark Switzerland Serbia Ireland Sweden Norway Bulgaria Austria Hungary Czech Rep. Belgium Romania Portugal Turkey Poland UK Germany Spain France Italy Pharmacists working in community pharmacy Registered pharmacists p.6/46

7 I.I.I.c FOREIGN PHARMACISTS Country Diploma from another EU country Diploma from non/eu country Diploma from any other country (total) Poland Slovakia FYR Macedonia Portugal Austria UK Spain / / 705 France I.I.I.d SUPERVISION BY PHARMACIST Countries that require pharmacists present on the premises during all the time Austria, Belgium, Bulgaria, Croatia, Denmark, Finland, France, Germany, Ireland, Italy, Latvia, Lithuania, FYR Macedonia, Norway, Poland, Portugal, Serbia, Slovakia, Slovenia, Spain, Switzerland, Turkey. Countries that DO NOT require physical presence of pharmacist at all time Estonia, the Netherlands, Sweden, UK. p.7/46

8 I.I.II. PHARMACY TEAM Country Pharmacists per pharmacy Pharmacy assistants per pharmacy Pharmacy technitians per pharmacy Number of prescriptionist per pharmacy Pharmacy helpers/other empl. per pharmacy Employees per pharmacy per pharmacy Austria 4,00 5,00 N/A N/A 3,00 12 Belgium 1,8 / / N/A / / Bulgaria 1,17 / / N/A / / Cyprus 1,05 / / N/A / / Croatia 2,24 / / N/A / / Czech Rep. 2,24 / / N/A / / Denmark 2,4 8 N/A N/A 2,7 15 Estonia 1,6 N/A 1,2 N/A 0,8 3,7 Finland 1,73 3,73 N/A 4,73 N/A 10,2 France 2,24 2,7 N/A N/A N/A 1,5 Germany 2,26 0,4 2,6 N/A 1,6 6,9 Hungary 2,36 / / N/A / / Ireland 1,75 0,3 N/A N/A 5,5 6,1 Italy 2,82 1,73 N/A N/A 1,17 3,99 Latvia 1,62 / / N/A / / Lithuania 1,79 / / N/A / / Luxembourg 4,05 / / N/A / / FYR 1,4 N/A 1,45 N/A N/A 2,86 Macedonia Malta 1,43 / / N/A / / Netherlands 1,73 / / N/A / / Norway 2,05 5,85 N/A 1,8 0,24 10 Poland 2,14 N/A 3,53 N/A 1,31 6 Portugal 2,72 / / N/A / / Romania 1,72 / / N/A / / Serbia 1,7 / / N/A / / Slovakia 1,96 N/A 1,37 N/A 0,45 3,74 Slovenia 3,24 1,6 0,02 N/A 1,5 6,2 Spain 2,06 / / N/A / / Sweden 4,3 1,1 1,1 / 0,9 7,44 Switzerland 2,87 4,77 N/A N/A 1,49 10,83 Turkey 1,14 N/A N/A N/A 3,4 3 UK 2,41 / / N/A / / p.8/46

9 I.I.II.a PHARMACY TEAM Denmark Austria Switzerland Finland Norway Sweden Germany Slovenia Ireland Poland Italy Employees per pharmacy Pharmacy helpers/other empl. Number of prescriptionist Pharmacy technitians Pharmacy assistants Pharmacist per pharmacy Slovakia Estonia Turkey FYR Macedonia France p.9/46

10 I.II. Community Pharmacies I.II.I PHARMACIES Country Number of Pharmacie s Pharmacies owned by pharmacist Partnerships owend by partnerships of pharm Pharmacies owned by company owned chains Pharmacies owned by state/publicly owned chains Pharmacies owned by other entities Austria N/A N/A / Belgium 5072 / / 109 / 612 Bulgaria 4201 / / / / / Cyprus 440 / / / / / Croatia 1071 / / / 233 / Czech Rep / / / / / Denmark N/A N/A N/A N/A Estonia N/A 294 N/A N/A Finland N/A N/A 18 N/A France N/A 124 N/A Germany N/A N/A N/A Greece / / / / / Hungary 2480 / / / / / Ireland N/A Italy Latvia 825 / / / / / Lithuania 1482 / / / / / Luxembourg N/A 53 N/A N/A FYR Macedonia Malta 210 / / / / / Netherlands 1980 / / 400 N/A N/A Norway / 551 N/A / Poland N/A 101 Portugal N/A N/A N/A Romania 6900 / / 1828 / / Serbia N/A N/A 550 N/A Slovakia N/A 14 Slovenia N/A N/A 212 N/A Spain N/A N/A N/A Sweden 1122 / / Switzerland N/A N/A Turkey N/A N/A N/A N/A UK N/A N/A p.10/46

11 I.II.I.a PHARMACIES UK Turkey Switzerland Sweden Spain Slovenia Slovakia Serbia Romania Portugal Poland Norway Netherlands Luxembourg Italy Ireland Germany FYR Macedonia France Finland Estonia Denmark Croatia Belgium Austria Pharmacies owned by other entities Pharmacies owned by state/publicly owned chains Pharmacies owned by company owned chains Partnerships owend by partnerships of pharm Pharmacies owned by pharmacist Number of Pharmacies p.11/46

12 I.II.I.b NUMBER OF PHARMACIES Turkey France Germany Spain Italy Poland Greece UK Romania Belgium Bulgaria Portugal Czech Rep. Hungary Serbia Netherlands Slovakia Switzerland Ireland Lithuania Austria Sweden Croatia FYR Macedonia Latvia Finland Norway Estonia Cyprus Denmark Slovenia Malta Luxembourg Number of Pharmacies p.12/46

13 I.II.I.c PHARMACIES PER INHABITANTS Greece Bulgaria Cyprus Malta Belgium Spain Lithuania FYR Macedonia Ireland Latvia Estonia Slovakia France Romania Turkey Poland Serbia Italy Portugal Germany Czech Rep. Hungary Croatia Switzerland Luxembourg UK Slovenia Austria Finland Norway Sweden Netherlands Denmark Pharmacies/ inhabitants p.13/46

14 I.II.I.d PHARMACIES PER 100 KM 2 Malta Belgium Greece Germany Italy Netherlands Cyprus UK Spain Switzerland Slovakia Bulgaria France Luxembourg Poland Czech Rep. FYR Macedonia Portugal Turkey Romania Hungary Ireland Serbia Lithuania Croatia Slovenia Austria Latvia Estonia Denmark Sweden Finland Norway Pharmacies/100 km2 p.14/46

15 I.II.I.e PHARMACISTS PER PHARMACY Sweden Austria Luxembourg Slovenia Italy UK Portugal Denmark Hungary Germany Czech Rep. Croatia France Poland Spain Lithuania Belgium Finland Romania Serbia Ireland Latvia Estonia Slovakia Norway Malta FYR Macedonia Netherlands Greece Bulgaria Cyprus Turkey Pharmacists/pharmacies p.15/46

16 I.II.I.f INHABITANTS PER PHARMACY Denmark Netherlands Sweden Norway Finland Austria Slovenia UK Luxembourg Switzerland Croatia Hungary Czech Rep Germany Portugal Italy Serbia Poland Turkey Romania France Slovakia Estonia Latvia Ireland FYR Macedonia Lithuania Spain Belgium Malta Cyprus Bulgaria Greece Inhabitants per pharmacy p.16/46

17 I.III. Computerisation of Community Pharmacies I.III.I COMPUTERISATION OF PHARMACIES Country Regular Internet connection in pharmacies Broadband connection in pharmacies Does pharmacies use dispensing software Number of pharmacy software providers in the country Austria 80% Yes 7 Belgium Yes 9 Bulgaria / / / Croatia Yes 4 Denmark Yes 3 Estonia / Yes 2 Finland Yes 2 France 95% Yes 3 Germany / Yes N/A Ireland Yes 3 Italy 70% Yes 7 Lithuania / Yes 10 FYR Macedonia 80% Yes 33 Netherlands Yes 5 Norway Yes 1 Poland 70% Yes 5 Portugal 55% Yes 8 Serbia 70% / / Slovakia 60% Yes 3 Slovenia Yes 3 Spain 90% Yes 40 Sweden Yes 3 Switzerland 90% Yes 10 Turkey Yes 6 UK / Yes / p.17/46

18 I.III.I.a INTERNET IN PHARMACIES 0% 90% 90% UK* Turkey Switzerland Sweden Spain Slovenia 60% 70% 55% 70% Slovakia Serbia Portugal Poland 80% 0% 70% 0% 95% 0% 0% 80% Norway Netherlands FYR Macedonia Lithuania* Italy Ireland Germany* France Finland Estonia* Denmark Croatia Bulgaria* Belgium Austria Regular Internet connection in pharmacies Broadband connection in pharmacies p.18/46

19 I.III.I.b CONSUTATION ROOMS IN PHARMACIES 90% 80% 70% 60% 50% 98% 99% 40% 83% 30% 20% 10% 0% 27% 5% 10% Turkey Poland Finland Portugal Netherlands Switzerland Belgium Ireland Norway Slovakia Slovenia How many pharmacies have consultation room p.19/46

20 I.IV Pharmacy Education and Training I.IV.I PHARMACY EDUCATION AND TRAINING Country Faculties Student s/year Number fo annual newly licensed pharm. Continu ing educati on compul sory? Continuing Profession al Developme nt compuls.? is the licence compulso ry for comm. Pharm? How long is licence valid? (in years) Austria No Yes Yes Unlimited Belgium No No Yes Unlimited Croatia Yes No Yes 6 Czech Rep. 2 / / / / / / Denmark / No No No / Estonia No No Yes Unlimited Finland Yes No Yes Unlimited France 24 N/A 3090 Yes Yes Yes / Germany No No Yes Unlimited Ireland No No Yes 1 Italy Yes No Yes Unlimited Latvia 2 / / / / / / Lithuania No Yes Yes 5 FYR Yes Yes Yes 7 Macedonia Malta 1 / / / / / / Netherlands Yes Yes Yes 5 Norway / No No No N/A Poland Yes No Yes N/A Portugal No Yes Yes 1 Romania / / / / / Serbia / Yes No Yes N/A Slovakia Yes No Yes Unlimited Slovenia Yes No No N/A Spain No No Yes 1 Sweden No Yes Yes N/A Switzerland Yes No Yes 10 Turkey No No No N/A UK 26 / / No Yes Yes 1 p.20/46

21 I.IV.I.a PHARMACY STUDENTS France Spain Italy Germany Turkey Poland Austria Portugal Serbia Belgium Netherlands Switzerland Slovakia Denmark Romania Sweden FYR Macedonia Ireland Croatia Slovenia Norway Lithuania Finland Estonia Number of newly licensed pharmacist/year Students/year p.21/46

22 I.V Education and Training of the Pharmacy Technician/Pharmacy Assistant with the Right to Dispense I.V.I EDUCATION AND TRAINING OF PHARMACY TECHNICIANS AND ASSISTANTS Country Seconda ry educatio n (high school) Post/sec ondary educatio n Length of educati on (years) If part time please indicat e Number of students reg. every year Number of students qualifying every year Is there a compulsory license for technicians /as/pre? Austria / Yes 3 / No Belgium Yes / 2 / / / Yes Croatia Yes 4 / / No Denmark Yes / 3 / No Estonia / Yes Yes Finland / Yes 3 N/A Yes France Yes Yes 2 / / / No Germany Yes / 2,5 / Yes Lithuania Yes Yes 3 / / / Yes FYR Yes / 4 / / / Yes Macedonia Netherlands / Yes 3 / / / Yes Norway / / 1 / / / / Poland / Yes 2 / No Portugal Yes Yes 4 / / / Yes Serbia Yes No 4 / / / / Slovakia Yes Yes 5 / No Slovenia Yes No 4 / N/A 200 No Sweden Yes Yes 1,5 No No Switzerland Yes / 3 / Yes Turkey Yes / 2 / / / / UK Yes Yes / / / / / p.22/46

23 II. LEGAL ASPECTS II.I. Dispensing Rights II.I.I PHARMACIST DISPENSING RIGHT Country Pharmacists have an exlusive right to dispense Other professions are dispensing? Belgium Yes No Croatia Yes No Estonia Yes No Finland Yes No France Yes No Germany Yes No Italy Yes No Lithuania Yes No FYR Macedonia Yes No Serbia Yes No Slovakia Yes No Spain Yes No Turkey Yes No Austria No Yes Denmark No Yes Ireland No Yes Netherlands No Yes Norway No Yes Poland No Yes Portugal No Yes Slovenia No Yes Sweden No Yes Switzerland No Yes UK No Yes II.I.I.a DISPENSING DOCTORS Norway France Ireland Netherlands Austria UK Switzerland Number of dispensing doctors p.23/46

24 II.I.II DISPENSING OF VETERINARY MEDICINES Country Do pharm hold exclusive right to dispense veterinary medicines? Which other professions can supply veterinary med? Sweden Yes / Turkey Yes / Austria No Vets Belgium No Vets Croatia No Yes Denmark No Vets and other Estonia No Vets Finland No Vets France No Vets Germany No Vets Ireland No Vets and Licensed Merchants Italy No Vets and Wholesalers Lithuania No Vets FYR Macedonia No Vets Netherlands No Vets Norway No Vets Poland No Vets Portugal No Vets Slovakia No Vets Slovenia No Ph. Assist. Switzerland No Vets UK No Vets, Others p.24/46

25 II.II Prescribing Rules II.II.I PRESCRIBING RULES Country How are medicines prescribed (INN, Brand) Can a prescriber lock a prescription? Is generic substitution by pharmacists allowed? Is pharm. obliged to dispense cheapest drug? Belgium Both Yes No Yes Denmark Both Yes Yes Yes Estonia Both Yes Yes No Finland Both Yes Yes No France Both Yes Yes No Germany Both Yes Yes Yes Ireland Both Yes No No Italy Both Yes Yes Yes FYR Macedonia Both No Yes Yes Netherlands Both Yes Yes No Norway Both Yes Yes No Poland Both Yes Yes No Serbia Both / / No Slovakia Both Yes Yes Yes Slovenia Both Yes Yes Yes Spain Both Yes Yes Yes Sweden Both Yes Yes Yes Switzerland Both Yes Yes No UK Both Yes No No Austria Brand No No No Croatia Brand Yes Yes No Turkey Brand No Yes No Portugal INN No Yes Yes Lithuania INN No Yes Yes Romania INN / / No Greece INN No Yes Yes p.25/46

26 II.II.I.a IDENTIFICATION OF MEDICINE II.II.I.b SUBSTITUTION BY PHARMACIST p.26/46

27 II.III Electronic Prescriptions II.II.I IMPLEMENTATION OF ELECTRONIC PRECRIPTIONS Country Yes, at national level Yes, at regional level Yes, there are local pilot projects No, but there are plans to implement it Austria Belgium Croatia Denmark Estonia Finland France Germany Ireland Italy Lithuania FYR Macedonia Netherlands Norway Poland Portugal Slovakia Slovenia Spain Sweden Switzerland Turkey UK No, and there is no information II.II.I.a IMPLEMENTATION OF ELECTRONIC PRESCRIPTIONS Yes, at national level Yes, at regional level 4 No, but there are plans to implement it Electronic prescriptions 1 No, and there is no information p.27/46

28 II.III Prescribing Rights II.III.I PHARMACISTS PRESCRIBING Country Pharm. To prescribe reimbursed products? If yes for initial prescription? If yes, for repeating/adjusting GP's prescription? Austria No / / Belgium No / / Croatia No / / Denmark No / / Estonia No / / Finland No / / France Yes Yes Yes Germany No / / Ireland Yes / / Italy No / / Lithuania No / / FYR Macedonia No / / Netherlands No / / Norway No / / Poland No / / Portugal No / / Slovakia No / / Slovenia No / / Spain No / / Sweden No / / Switzerland Yes No Yes Turkey No / / UK Yes Yes Yes p.28/46

29 II.IV Non-Prescription Medicines II.IV.I. NPMs CLASSIFICATION Country NPMs can only be sold in the pharmacy Pharmacist only Pharmacy only General sales list Austria Yes / / / Belgium Yes / / / Finland Yes / / / France Yes / / / Germany Yes / / / Lithuania Yes / / / FYR Macedonia Yes / / / Slovakia Yes / / / Turkey Yes / / / Spain Yes / / / Slovenia No / Yes No Croatia No / Yes Yes Denmark No / Yes Yes Estonia No / Yes Yes Ireland No / Yes Yes Italy No Yes No No Netherlands No / Yes Yes Norway No / Yes Yes Poland No / Yes Yes Portugal No / No Yes Sweden No / Yes Yes Switzerland No / Yes Yes UK No / Yes Yes II.IV.I.a MARKET VALUE OF NPMs SALES IN NON/PHARMACY OUTLETS Market value of NPMs sales outside the pharmacy Netherlands Denmark 28.00% Sweden 20.00% Norway 17.00% Poland 15.00% Portugal 14.00% Switzerland 12.30% Italy 8.00% Finland0.50% 80.00% p.29/46

30 II.IV.I.b NPMs DISTRIBUTION II.IV.I.c NPMs DISTRIBUTION p.30/46

31 II.IV.I. OTC PRODUCST AVAILABLE OUTSIDE THE PHARMACY Country NPMs Herbals Food suplemen ts and vitamins Comment Croatia Yes Yes Yes Non prescription medicines as well as medical devices can be sold in specialised stores. Denmark No Yes Yes GSL is introduced since It includes analgetics, nicotine replacement products, antihistamines etc. They can be sold in supermarkets, gas stations, etc. Other products that are available outside of pharmacies are Homeopatics and natural medicines. Finland No Yes Yes Nicotine replacement is sold outside pharmacies since France No No Yes Ireland No Yes Yes GSL medicines may be sold in pharmacies (at the front of the shop) and through non/pharmacy outlets such as supermarkets, petrol stations, newsagents, etc. The Irish Medicines Board produces a list of GSL medicines that may be sold in non/pharmacy outlets. Italy Yes Yes Yes Lithuania No No No FYR Macedonia No No Yes Netherlands No Yes Yes GSL medicines may be sold in pharmacies (at the front of the shop) and through non/pharmacy outlets such as supermarkets, petrol stations, newsagents, etc. Poland No Yes Yes Portugal Yes Yes Yes Slovakia No No Yes Slovenia No Yes Yes Spain No No Yes Switzerland No Yes Yes Turkey No No Yes UK No Yes Yes GSL medicines may be sold in pharmacies (at the front of the shop) and through non/pharmacy outlets such as supermarkets, petrol stations, newsagents, etc. The Irish Medicines Board produces a list of GSL medicines that may be sold in non/pharmacy outlets. p.31/46

32 II.V Internet Sales of Medicines II.V.I. INTERNET SALE OF MEDICINES Country Can NPM be sold via internet? Is the internet sale done via Website linked to comm. Pharm? Can POM be sold via internet? Is this internet sale of POM done via Website linked to comm. Pharm? Austria No* / No / Belgium Yes Yes No / Denmark Yes Yes Yes Yes Estonia No No No No Finland Yes Yes Yes Yes France No No No No Germany Yes Yes Yes Yes Ireland Yes Yes No / Italy No* / No / Lithuania Yes Yes No / FYR Macedonia No No No No Netherlands Yes Yes Yes Yes Norway Yes Yes No / Poland Yes Yes No / Portugal Yes Yes No / Slovakia Yes Yes No / Slovenia Yes Yes No / Spain No* / No / Sweden Yes No Yes No Switzerland Yes Yes No / Turkey No / No / UK Yes No Yes No * There is a legislation permitting NPM sales over Internet, however it is not implemented yet. p.32/46

33 II.V.I.a INTERNET SALE OF NPMs II.V.I.b INTERNET SALE OF POMs p.33/46

34 III. PHARMACY ECONOMY III.I. Prescriptions III.I.I PRECSRIPTION VOLUMES AND VALUE Country Prescriptions per year 2011 (x1000) Average value of prescription (eur) Has there been an annual increase of prescriptions in volume in the last 3 years? Prescriptions per year (x1000) 2009 FYR Macedonia ,9 / / Croatia ,8 Yes 41850,9 Slovakia Yes 1005 UK N/A Italy ,09 No Spain ,76 Yes Poland Yes / Estonia ,4 No / Turkey Yes Denmark 57772,8 22,5 Yes Belgium No Germany ,05 No Slovenia Yes Sweden ,2 Yes Finland ,6 Yes Portugal ,65 Yes France ,59 Yes Norway Yes Switzerland Yes Ireland / Yes Netherlands Negotiable Yes Number of prescribed medicine packs; number of prescriptions is not available. 2 There was an increase in year 2008 and 2009, no increase in 2010 and decrease for p.34/46

35 III.I.II PRECSRIPTION VOLUMES IN 2009 AND 2011 Italy Germany Spain UK France Turkey Poland Netherlands Belgium Switzerland Slovakia Ireland Portugal Denmark Sweden Finland Croatia Norway Slovenia FYR Macedonia Estonia Prescriptions per year (x1000) 2009 Prescriptions per year (x1000) 2011 p.35/46

36 III.I.III PRECSRIPTION VALUES Average value of prescription (eur) Ireland Switzerland Norway France Portugal Finland Sweden Slovenia Germany Belgium Denmark Turkey Estonia Poland Spain Italy UK Slovakia Croatia FYR Macedonia III.I.IV PRECSRIPTION VOLUMES PER PHARMACY Denmark Netherlands Switzerland Italy UK Germany Finland Spain Slovakia Slovenia Sweden Norway Croatia Ireland Belgium France Portugal FYR Macedonia Poland Estonia Turkey Prescriptions(*000)/Pharmacy p.36/46

37 III.II. VAT III.II.I VAT FOR MEDICINES Country VAT on POM % VAT on NPM % VAT on non/pharmaceuticals % Austria Belgium Bulgaria Cyprus Croatia Czech Rep Denmark Estonia Finland France 2,5 7 19,6 Germany Greece 6,5 6,5 23 Hungary Ireland Italy Latvia Lithuania Luxembourg FYR Macedonia Netherlands Norway Poland Portugal Romania Serbia Slovakia Slovenia 8,5 8,5 20 Spain Sweden Switzerland 2,5 2,5 8 Turkey UK Most non-pharmaceuticals are subject to a VAT rate of 21%, some products however, such as baby food or other food products, are subject to the lower VAT rate of 6%. 4 VAT is not payable on oral medicines. VAT on non-oral medicines, e.g. creams, ointments, injectables, is 21%. p.37/46

38 III.III. Patient co-payment III.III.I PATIENT CO-PAYMENT Country Is there a patient copayment Fixed fee? If yes, specify amount (s) in EUR Percentag e of total price If yes, specify percentage Austria Yes Yes 5,1 / / Belgium Yes No / / / Croatia Yes / Denmark Yes 5 / / / / Estonia Yes No / / / Finland Yes / / Yes 42%, 72%, France Yes Yes 0,5 Yes 0%, 35%, 70% Germany Yes / / Yes 10% Ireland Yes 6 / / / / Italy Yes Yes / / / Lithuania Yes No / Yes 20%, 50%, 80%, 90%, FYR Macedonia Yes Yes / / / Netherlands Yes 7 / / / / Norway Yes 8 / / / / Poland Yes Yes 0,8 Yes 0/99% Portugal Yes / / Yes 9 15%, 37%, 69%, 90% Slovakia Yes / / Yes / Slovenia No / / / / Spain Yes / / Yes 30%/40% Sweden Yes / / / / Switzerland Yes / / Yes 10% Turkey Yes / / Yes 10% /20% UK Yes Yes 8 / / 5 The reimbursement intervals in 2011 are ( the amount are the annual purchase including VAT): From 0 to 115 euro 0 % reimbursement (children 60 %) From 115 to 188 euro 50 % reimbursement (children 60 %) From 188 to 405 euro 75 % reimbursement Above 405 euro 85 % reimbursement Chronically ill persons pays maximum 3555 kr. (475 euro). 6 Family (as a whole) must pay the first 120 per month; after that, the State picks up the bill. 7 X, GVS, clusters of therapeutically equivalent medicines, average price is calculated, more expensive medicines fall under copayment % of prescription value, but no more that 67.5 per prescription, max 235 per year in total co-payment for reimbursable drugs and visits to doctors, psychologists, x-ray, test samples, and private specialists. No co-payment for chlidren and pensioneers on a minimum pension. 9 a) Normal Scheme: Category A = 90% (or for live-saving pharmaceuticals); Category B = 69%; Category C = 37%; Category D = 15%. Pharmacotherapeutic groups included in each reimbursement category are pre-defined in legislation The patient co-payment depends on the level of essentiality to life maintenance, level of disease (chronic and/or serious disease) and economic and social situation of patients (last approval in September 2010) p.38/46

39 III.III.II PATIENTS EXCLUDED FROM CO/PAYMENT Country Do co/paym ents apply to all patients Cathegories excluded from co/payment schemes Pensio ners Childre n Unempl oyed Full/time students People on low incomes Austria No / / / / / People in need of public social assistance may be exempted from prescription charges. Belgium Yes / / / / / Croatia No Yes Yes Yes Yes Denmark No / / / / / There is no co/payment for terminal ill patients. Estonia No Finland Yes / / / / / France No Yes Yes Yes Yes Yes Germany No / Yes / / / Patients who exceed the annual prescription charge limit of 2% of their gross annual income and chronically ill patients who exceed the limit of 1%. If the price of a drug is 30% below the fixed reimbursement price ( Festbetrag ) that drug can be exempted from co/payment. Further, Statutory Health Insurers can reduce co/payment by 50% or fully exempt drugs from co/pay if the Insurer has negotiated a rebate/ contract for that drug and attains cost savings even after reduction of or exemption from co/pay. Ireland No / / Yes / Yes Italy No Yes Yes Yes Yes Yes Lithuania No For some chronic conditions some of vital medicines are free of charge. Other p.39/46

40 FYR Macedonia No / Yes / / / Children with special needs, and patients after organ transplantation. Netherlands Yes / / / / / Norway No Yes Yes / / / Poland No / / / / / For veterans of war and soldiers prescription only medicines are free of charge. For some chronic conditions some of vital medicines are free of charge. Portugal No / / / / / Special Scheme: Pensioners whose income is below the minimum wage has an extra 5% reimbursement to the Category A and an extra 15% reimbursement to the Categories B, C and D. June 2009 reimbursement increase to for all generics in special scheme (withdraw one year later). June 2010 reimbursement only for the 5 cheapest medicines in a homogeneous group (internal Reference Price System) for special scheme. October % reimbursement only for the 5 cheapest medicines in a homogeneous group for special scheme. Slovakia Yes / / / / / Spain No Yes Yes No No No Sweden Yes / / / / / There are solutions and alternatives for people in need to receive help through Social Services with drug costs. This accounts those people not being able to use the part/payments system. There are also solutions for different county councils to support certain groups of Patients with medicines that are free of charge, ex. Birth control pills for young girls and Some selected STD/medicines. Switzerland Yes / / / / / Turkey No / / / / / UK No Yes Yes Yes / Yes p.40/46

41 Other Night services Homecare services Vaccination Hypertension management Asthma management Diabetes management Smoking Cessation Pregnancy test Weight measurement Glucose measurement Cholesterol measurement Blood pressure measurement Provision of Emergency Medicines Use Review Disposal of medicines Repeat dispensing Dispensing prescriptions Country IV. PHARMACY SERVICES AND QUALITY ASSURANCE IV.I. Pharmacy Services IV.I.I PHARMACY SERVICES Austria Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes / Belgium Yes Yes Yes No Yes No No No No No Yes No No No No Yes Yes / Croatia Yes Yes Yes No Yes No No Yes No No No No No No Yes Denmark Yes No Yes Yes Yes Yes Yes Yes Yes No Yes No Yes No No Yes Yes / Estonia Yes No Yes Yes No No No No No No No No No No No No Yes Finland Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes No Yes Yes France Yes Yes Yes Yes Yes No No No Yes Yes Yes Yes Yes Yes No Yes Yes / Germany Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes / Ireland Yes No Yes No Yes Yes Yes Yes Yes Yes Yes No No No Yes No No Yes Italy Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No / FYR Macedonia Yes Yes Yes No Yes Yes Yes Yes Yes Yes No No No No No No Yes / Netherlands Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Norway Yes Yes Yes Yes No Yes No Yes No No Yes No Yes No No No No Yes Poland Yes No Yes No No Yes No No Yes No Yes Yes Yes Yes No No Yes Portugal Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Slovakia Yes No Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No No No Yes / Slovenia No Yes Yes Yes No Yes Yes Yes Yes No No Yes No Yes No No Yes / p.41/46

42 Spain Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes 10 Sweden Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes / Switzerland Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Turkey Yes No Yes Yes Yes Yes No Yes Yes Yes No No No Yes No No Yes / UK Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes / / / Yes Yes Yes / IV.I.I.a PHARMACY SERVICES Number of Countries HIV test, Methadone replacement therapy, Needle exchange, Health Campaigns, Health Information, Early Disease Detection Services, Screening Services, Pharmaceutical Care Services, Dosset Boxes, etc. p.42/46

43 IV.II. Quality Assurance IV.II.I QUALITY ASSURANCE SYSTEMS Country Quality Certification Quality Assessment Reporting and Learning Systems Good Pharmacy Practice Other Quality Standards Professional Audits Mystery Shoppers Other Austria Yes / Yes Yes / / Belgium Yes 11 Yes Yes 12 Yes / Yes Denmark Yes Yes Yes No Yes Yes Finland No ISO/ EFQM / Yes / / Germany Yes 13 Yes Yes Yes Yes Yes 14 Ireland Yes 15 / Yes 16 Yes / Yes Italy No / No No / No Luxembourg FYR No / Yes 17 Yes / Yes Macedonia Netherlands Yes 18 Yes Yes Yes Yes Norway Yes 19 Yes 20 / / Yes 21 Yes 22 Poland No / No No / No Portugal Yes Yes / / / / Slovenia Yes 23 Yes 24 Yes No / No Spain Yes Integral Quality Yes / / No 11 Elaboration of a Quality Manual in each pharmacy 12 By the authorities, the professional organisations, by consumer organisations. 13 The Ordinance on the Operation of Pharmacies (Apothekenbetriebsordnung), which is a federal ordinance, gives general standards on Good Pharmacy Practice, for example state, size and equipment of pharmacy premises qualification and competences of the personnel information sources preparation and quality assurance of extemporaneous preparations rsp. Drugs kept in stock in larger quantities stockpiling storage delivery of drugs information and advice pharmaceuticals risks and handling of non-marketable drugs documentation stand by duty 14 Documentation and reporting of drug risks to surveillance authority: - quality problems of drugs - adverse reactions of drugs (side effects, interaction, resistance, abuse, addiction) 15 The PSI has produced standards and practice guidelines for pharmacies which they must adhere to 16 The PSI conducts inspections in pharmacies and also sends Mystery Shoppers to pharmacies to assess standards 17 It is expected to be implemented with new law on Health Protection in the next months, and it will be managed by The Pharmaceutical Chamber 18 NAN from 1996 and general guidelines and disease specific guidelines 19 Cooperation between the pharmacies and the unions 20 Sales of OTC, Advice on infants, Sales of syringe 21 This is being taken care of by the pharmacies themselves 22 This is being taken care of by the pharmacies themselves 23 Through the professional supervision and councilors 24 A few pharmacy chains have ISO 9001 standard. Chamer has no information on total number of these pharmacies. p.43/46

44 Programme Sweden Yes 25 / Yes Yes / Yes Switzerland Yes Yes 26 Yes Yes / No Turkey Yes / Yes No / / UK Yes 27 / Yes Yes / Yes 25 In cooperation between the Swedish pharmacy Association and the Swedish academy of pharmaceutical sciences. 26 Standard of pharmasuisse: pharmacy isas qms-pahrma QMS has to be done by law, but not a specific standard 27 GPhC inspection - PCT contract Monitoring Visits p.44/46

45 Glossary A Registered Pharmacist is a person who has successfully completed a university master degree in Pharmacy Pharmaceutical Sciences (according to EU Directive EC) and who is formally authorized in hisher country to practice the profession of pharmacist. Pharmaceutical intern pharmacy student under internship. Pharmacy assistants work alongside pharmacy technicians and under the supervision of a registered pharmacist. They have a pharmacy/specific vocational training, much of which is provided in the pharmacy. Depending on the country they can have dispensing rights. Pharmacy technicians have a university bachelor degree. Prescriptionist has a university bachelor degree (3 years). Protected title in the Nordic countries Prescriptionists ( Receptars ), who are entitled to run a branch pharmacypharmacy outlet and fill prescriptions. Pharmacies owned by one pharmacist. This is the classic independent pharmacy. This category also applies when a pharmacist owns more than one pharmacy. Pharmacies owned by company/owned chains. This category would apply to chains such as Boots and Lloyds. Pharmacies owned by statepublicly/owned chains. This category applies, for example, to the Swedish national chain and to the Italian municipal or communal pharmacies. Continuing education (CE): A structured set of well defined learning activities (e.g. on site courses; e/learning; conferences) for updating knowledge and skills applicable to the practice of pharmacy. Continuing professional development (CPD): CPD includes but goes beyond CE. It encompasses a range of learning activities (not only formal learning; e.g. peer discussions; reading; learning by doing; mentoring; etc) and provides a framework for such activities to be considered as valid to ensure that the person who does it retains hisher capacity to practise safely, effectively and legally within hisher evolving scope of practice throughout hisher career. Education is meant to refer to courses taught at an educational establishment or a combination of such teaching and practice. General practitioner (family doctor) should be understood as the doctors working in the primary health care sector, within the social security or national health scheme. International Non Proprietary Names (INN) identifies pharmaceutical substances or active pharmaceutical ingredients. Each INN is a unique name that is globally recognized and is public property. A nonproprietary name is also known as a generic name. Generic substitution refers to the right of the pharmacist to substitute a brand name medicine prescribed by a physician with a branded or unbranded generic version of the same medicine. Initial prescription should be understood as a prescription initiated by the pharmacist without the intervention of a doctor. This should not include generic substitution. p.45/46

46 PGEU May 2012 All rights reserved p.46/46