PGEU

La Farmacia en EuropaLa Farmacia en Europa

Filip BABYLONFilip BABYLONPresidentPresident

Pharmaceutical Group of the European UnionPharmaceutical Group of the European UnionRepresenting European Community PharmacistsRepresenting European Community Pharmacists

XVII National Pharmaceutical Congress Blbao 20th October 2010XVII National Pharmaceutical Congress Blbao 20th October 2010

PGEU

2

AustriaBelgiumBulgariaCyprusCzech RepDenmarkFinlandFranceGermanyGreeceHungaryIrelandItalyLatviaLuxembourg

NetherlandsPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenUnited KingdomCroatiaFYR MacedoniaNorwaySerbiaSwitzerlandTurkey

Pharmaceutical Group of European Union

Members: Professional Bodies & Pharmacists’ Associations

2010: 30 Countries2010: 30 Countries

PGEU

• 400.000 Community Pharmacists in Europe

• 160.000 Community Pharmacies in Europe

• 46 million citizens visit a pharmacy every day

~1300 2010

PGEU

11 december 2008 IFB4

PGEU

PGEU

PGEUWe 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.”

PGEURegulatory Change

8

PGEURegulatory 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)

9

PGEURegulatory 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.

10

PGEU

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

11

PGEU

12

PGEU

13

PGEUReductions in Payments & Margins since 2008

Reduction

Planned Reduction

N.A.

14

PGEUReductions in Medicine Prices Since 2008

Reduction

Planned Reduction

N.A.

15

PGEU

Pure Margin

Predominantly MarginPure fee

Balance of fee/Margin

Predominantly fee

Pharmacist remuneration systems in EU

16

PGEUEconomic 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.

17

PGEUEconomic 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.

18

PGEU

The pharmacist’s evolving roleThe pharmacist’s evolving role

redefining the roleredefining the role

Filip BABYLONFilip BABYLONPresidentPresident

Pharmaceutical Group of the European UnionPharmaceutical Group of the European UnionRepresenting European Community PharmacistsRepresenting European Community Pharmacists

PGEU

• The pharmacist must be an The pharmacist must be an active active counsellorcounsellor

• The responsibility is extending beyond The responsibility is extending beyond quality and conformity of products quality and conformity of products to a more to a more rational and optimal userational and optimal use

• The pharmacy is becoming a The pharmacy is becoming a healthcare healthcare centrecentre

• Relationship based on Relationship based on confidence and confidence and personal contactpersonal contact

the role of the the role of the pharmacistpharmacist

20

PGEUSurvey Reader’s Digest

Trust in professions• Firefighters 92% • Airline pilots 88% • Pharmacists 85% • Nurses 84% • Doctors 82%

21

PGEUPharmaceutical CarePharmaceutical Care

Shifting the pharmacist’s focus Shifting the pharmacist’s focus towards:towards:

• The quality of the dispensing activityThe quality of the dispensing activity(= counseling technique, scientific databases, patient records)(= counseling technique, scientific databases, patient records)

• The outcome of the treatmentThe outcome of the treatment(= registration of activities and results)(= registration of activities and results)

• The rational and optimal use of The rational and optimal use of medicationmedication(= choice of therapy and compliance)(= choice of therapy and compliance)

22

PGEUShift the focus from product to

patient = professional service

PGEUServices provided by pharmacies

0 5 10 15 20 25

Vaccination

Other

Homecare services

Asthma management

Pregnancy test

Hypertension management

Medicines Use Review

Cholesterol measurement

Diabetes management

Glucose measurement

Repeat Dispensing

Emergency Contraception

Smoking Cessation

Blood pressure measurement

Disposal of waste medicines

Weight measurement

Night service

Dispensing Prescriptions

Ser

vice

Typ

e

Amount of countries providing service

YES

NO

Source: PGEU Database 2006

PGEUNew 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

PGEUThe 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?

PGEUConclusion

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 Implement quality through Good Pharmaceutical PracticePharmaceutical Practice

• Adapt the remuneration system Adapt the remuneration system going from margins to feesgoing from margins to fees

27

PGEU

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

28

PGEU

29

www.pgeu.eu