La Farmacia en Europa

1. La Farmacia en Europa Filip BABYLON President Pharmaceutical Group of the European Union RepresentingEuropeanCommunity Pharmacists XVII National Pharmaceutical CongressBlbao 20th October 2010

2. Pharmaceutical Group of European Union Members: Professional Bodies & Pharmacists’ Associations Netherlands Poland Portugal Romania Slovakia Slovenia Spain Sweden United Kingdom Croatia FYR Macedonia Norway Serbia Switzerland Turkey Austria Belgium Bulgaria Cyprus Czech Rep Denmark Finland France Germany Greece Hungary Ireland Italy Latvia Luxembourg 2010: 30 Countries

3. ~1300 2010 • 400.000 Community Pharmacists in Europe • 160.000 Community Pharmacies in Europe • 46 million citizens visit a pharmacy every day

4. 11 december 2008 IFB

7. We have a winner “Pharmacists help people get well, stay healthy, feel better, and save money. We help people safely use vaccines that prevent infections, medicines that cure diseases or prevent them from getting worse, and vitamins, supplements, or special foods to improve health and wellness. But most importantly, we are near your home, easy to talk to, good at answering questions, and care about you and your family.”

8. Regulatory Change

9. Regulatory Change in Europe • Strong tendencies toward liberalisation over the last 10 years e.g. Ireland, Norway, Hungary, Portugal, Italy, Sweden • Now only Spain, France, Austria, Greece and Finland have all three traditional pillars of regulation – ownership rules, establishment rules and OTC monopoly. • European Court Judgement on Ownership prevented ‘big bang’ liberalisation, but left room for change at national level – e.g. did not affect liberalisation in Sweden. Most recent country to liberalise ownership is Latvia (July 2010)

10. Regulatory Change in Europe • Outcome of the Asturias case involving establishment rules in Spain strongly vindicates regulatory approach – European Commission arguments totally dismissed by the Court. • Still strong advocacy from the EU Commission e.g. OTC monopoly • However, still more than 80 per cent of EU pharmacies are pharmacist owned. • Future arguments about ownership will be based on economics e.g. free ownership allows lower prices.

11. Spanish Pharmacy remains a model of how the needs of patients and health systems can be addressed within a regulated system.

14. Reductions in Payments & Margins since 2008 Reduction Planned Reduction N.A.

15. Reductions in Medicine Prices Since 2008 Reduction Planned Reduction N.A.

16. Pharmacist remuneration systems in EU Pure Margin Predominantly Margin Pure fee Predominantly fee Balance of fee/Margin

17. Economic Change The Problem of Falling Prices • There is a tendency both towards increased generics use, and falling generic prices. Margin based and rebate systems stand to lose. • At the same time in some countries more expensive medicines are being distributed through other channels.

18. Economic Change The coming squeeze? • Many EU countries are suffering either direct reductions in statutory remuneration schemes (e.g Ireland, Spain) or declines in remuneration due to falling prices (e.g. Netherlands, Finland). • Pressure is short term (economic crisis) and long term (sustainability) • Distribution increasingly seen as a source of unnecessary cost.

19. The pharmacist’s evolving roleredefining the role Filip BABYLON President Pharmaceutical Group of the European Union RepresentingEuropeanCommunity Pharmacists

20. the role of the pharmacist • The pharmacist must beanactive counsellor • The responsibility is extendingbeyondquality and conformity of productsto a more rational and optimaluse • The pharmacy is becoming a healthcarecentre • Relationshipbasedonconfidence and personal contact

21. Survey Reader’s Digest Trust in professions • Firefighters 92% • Airline pilots 88% • Pharmacists 85% • Nurses 84% • Doctors 82%

22. Pharmaceutical Care Shifting the pharmacist’s focus towards: • The quality of the dispensingactivity(= counseling technique, scientific databases, patient records) • The outcome of the treatment(= registration of activities and results) • The rational and optimaluse of medication(= choice of therapy and compliance)

23. Shift the focus from product to patient = professional service

24. Services provided by pharmacies Source: PGEU Database 2006

25. New Possibilities • Community Pharmacy as a locus of innovative health care services • Self care and community care in an ageing society • The challenge of improving adherence • Connectivity and continuity within the health system

26. The Challenge Reduce and prevent avoidable medication errors Identify, manage and prevent drug-related problems Improve adherence Promote rational and safe medicines use Early identify risk factors Promote healthy lifestyles WHAT SHOULD BE DONE? AT WHAT PRICE? HOW TO VALUE IT? WHO PAYS? HOW TO SHARE THE INVESTMENT RISK? HOW TO USE THE RETURN ON INVESTMENT?

27. Conclusion Re-engineer the profession in 3 steps: • Redefine the role of the pharmacist not only in dispensing medicines but also as a healthcare service provider • Implement quality through Good Pharmaceutical Practice • Adapt the remuneration system going from margins to fees

28. « In evolution it is not the strongest, the most aggressive or even the most intelligent who are likely to survive. Rather, it is those most able to adapt to the demands of environmental change. »

29. www.pgeu.eu 29