PGEU La Farmacia en Europa Filip BABYLON President Pharmaceutical Group of the European Union Representing European Community Pharmacists XVII National Pharmaceutical Congress Blbao 20th October 2010

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

PGEU Community Pharmacists in Europe Community Pharmacies in Europe 46 million citizens visit a pharmacy every day ~

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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.”

PGEU Regulatory Change 8

PGEU 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) 9

PGEU 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. 10

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

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

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

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

PGEU 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. 17

PGEU 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. 18

PGEU The pharmacist’s evolving role redefining the role Filip BABYLON President Pharmaceutical Group of the European Union Representing European Community Pharmacists

PGEU The pharmacist must be an active counsellorThe pharmacist must be an active counsellor The responsibility is extending beyond quality and conformity of products to a more rational and optimal useThe responsibility is extending beyond quality and conformity of products to a more rational and optimal use The pharmacy is becoming a healthcare centreThe pharmacy is becoming a healthcare centre Relationship based on confidence and personal contactRelationship based on confidence and personal contact the role of the pharmacist 20

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

PGEU Pharmaceutical Care Shifting the pharmacist’s focus towards: The quality of the dispensing activity (= counseling technique, scientific databases, patient records)The quality of the dispensing activity (= counseling technique, scientific databases, patient records) The outcome of the treatment (= registration of activities and results)The outcome of the treatment (= registration of activities and results) The rational and optimal use of medication (= choice of therapy and compliance)The rational and optimal use of medication (= choice of therapy and compliance) 22

PGEU Shift the focus from product to patient = professional service

PGEU Services provided by pharmacies Source: PGEU Database 2006

PGEU 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

PGEU 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?

PGEU 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 PracticeImplement quality through Good Pharmaceutical Practice Adapt the remuneration system going from margins to feesAdapt the remuneration system going from margins to fees 27

PGEU « 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. » 28

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