EPF Newsletter European Pharmacists Forum Newsletter – English edition July 2019 Issue 55

Twenty years of progress Ornella Barra, Co-Chief Operating Officer, Alliance, looks back at 20 years of progress for the European Pharmacists Forum sharing how it has evolved over the years to become a leading voice for independent pharmacy…

The concept of EPF began when Alliance with the Boots Group and this brought Santé merged with Unichem in 1997 to EPF further opportunities to explore form Alliance Unichem, becoming one of expertise and best practice in healthcare the largest pan-European leaders across and beauty services, to complement the wholesale and retail. With such expertise existing independent pharmacy offer. and economies of scale, how could an independent pharmacist be able to My dear friend, Mike Smith, who is also capitalise on this and ensure they could the EPF’s inaugural President and current be part of the healthcare evolution? Who priority was primarily the dispensing of Chair of the EPF’s Stakeholder Group, would champion their voice? prescription medicines. However, with recently reflected on an early example increasing pressures on margins, many of how the EPF is at the forefront of For those who know me, pharmacy were asking how they could add value innovation in pharmacy. He shared with is in my DNA and I’m a passionate to their business. Through the EPF, we me, “In the late 90s, we held a Forum ambassador of pharmacy being at the were able to leverage the expertise of where there was a focussed discussion heart of healthcare. Alliance Unichem to discuss the potential on the developing role of generics of new pharmacy services that would in pharmacy. At the time there were Twenty years ago, I wanted to show the some who thought they would never power of pharmacists working together. see generics in their country markets By, how sharing ideas and challenging We must keep – however, as pressures on margins ourselves in an open forum to do better changing and increased we now see generics widely for our patients, we could ensure that accepted as an effective and affordable we would be an authoritative influence embracing new alternative to branded medicines.” in the future of pharmacy. It was at this point I created the European Pharmacists things Further evidence of how the EPF Forum in 1999 and invited pharmacy leverages expertise was seen in 2012 leaders to become members. bring innovation to the independent when merged with community pharmacist. Walgreens to become WBA, the first The EPF saw the changing world of In 2006 Alliance Unichem merged global pharmacy-led, health and pharmacy. In the past, a pharmacist’s wellbeing enterprise. The EPF saw how

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www.europeanpharmacistsforum.com www.walgreensbootsalliance.com services, such as flu vaccinations were Over the years, I am proud to see how part of Walgreens national pharmacy the EPF has progressed. It continues to service. We took this to our members as an serve as a unique and valuable platform example of how a service can add genuine My vision is that for sharing best practice and discussing value to independent pharmacy and their community pharmacy strategic issues relating to pharmacy across customers, and today flu vaccination will remain at the Europe. And when I look back, it’s easy services are being introduced in France, for me to see how the EPF has benefited while other member countries are in heart of healthcare independent pharmacy by encouraging a discussion about how they might adopt provision and wider understanding of the activities and them as future development. pharmacists will be the challenges faced by each European market represented. Over the years, the EPF has also proved first point of care to how influential it can be when it comes access health services We have learnt to work together to to the proposal of new legislation and overcome our cultural differences, and we pharmacy regulation. Evidence of this can see the benefits of working collaboratively be seen most recently with the creation in order to further our shared knowledge and implementation of the Falsified However, the relationship between the of different markets and government Medicines Directive (FMD). Through the pharmacist and the patient is sacrosanct. regulation. We’ve proved the benefit EPF, we were able to follow the regulatory As we embrace innovation and digital of understanding what happens in one change that impacted everyone and we transformation, we must never lose country today, could be implemented in were invited by European representatives sight of the trust patients place in their another country in the future. The EPF in Brussels to share our insights and to help pharmacists and the importance of the supports independent pharmacy and helps shape the directive. human touch that only they can provide. members and pharmacists to be better prepared for change and to be able to Throughout the process we supported The EPF members understand that as embrace innovation. members and pharmacists to prepare for pharmacists, we can never standstill, or the changes to come and understand be satisfied with solutions that may have Looking back, we can truly say that it has what it meant for them in their individual worked well in the past. We need to keep been 20 years of progress as we respond markets. reinventing ourselves and transforming to the rapidly changing needs of patients and the provision of healthcare. I am very Although influential, I believe it’s important what we offer to patients, customers and health systems. proud that the EPF members are seen as to note that the EPF has never held an the thought leaders for pharmacy and ambition to play a formal political role. We know that innovation and data are key championing the role of the independent We have proved our strength lies in our to the future of healthcare and we must pharmacist. ability to engage and collaborate with the embrace the new technologies that will Presidents and leaders of local and national transform our ways of working and exploit Finally, I must conclude by expressing how associations on matters of importance the strengths of our strategic partnerships. grateful I am, for without your support that impact independent community We are based in local communities, but and that of my colleagues, I could never pharmacy today, and in the future. our future will be an omni-channel one, have accomplished so much. To achieve delivering the best of both worlds. such success is never an outcome of just For community pharmacy, it’s reassuring one individual. We must continue to work that the EPF is always thinking about As a Forum we directly benefit from WBA’s together to build our expertise, chart a way tomorrow and it continues to evolve commitment to pharmacy, a fact that is forward and realise our goals. This is how in parallel with WBA, supporting the recognised by all the EPF members and we’ll create real impact for independent implementation of global innovation at a exemplified in the investment in Alphega; community pharmacy and ensure the EPF local level. testament to WBA’s continued focus on continues to play a vital role for decades independent pharmacy and patients at the to come. Today’s patients and customers want core of the business. access to affordable, accessible, Thank you. personalised healthcare, and we must all My vision is that community pharmacy will raise our game if we’re to meet their needs. remain at the heart of healthcare provision We need to embrace new technologies and pharmacists will be the first point of to empower our pharmacists, and learn care to access health services - and I firmly Ornella new clinical skills, such as those required to believe the EPF has been, and will continue interpret pharmacogenomic test results or to be, instrumental in helping to make that to administer vaccines safely. vision a reality.

www.europeanpharmacistsforum.com www.walgreensbootsalliance.com 02 EPF meeting Barcelona, 2000 Honouring our long standing members

Pharmacist by profession, Ornella EPF meeting Barra remains at the heart of the EPF, continually pushing the boundaries and Rome, 1999 Where it all began championing the role of community pharmacists across Europe. As Co- Established in 1999 by Ornella Chief Operating Officer for Walgreens Barra, then Executive Director of Boots Alliance, Ms Barra considers her Alliance UniChem Plc, the European involvement in the EPF a personal priority. Pharmacists Forum (EPF) has spearheaded a unified approach to the European pharmacy profession. Bringing together independent The EPF spreads its wings pharmacy representatives from across EPF meeting Europe, the EPF is a unique arena for Istanbul, 2002 The EPF is now well established across sharing best practices and discussing ten countries, and enjoys growing issues relating to pharmacy. It is recognition among pharmacists across now also a respected platform for Europe. With representatives from discussion with key speakers from the UK, France, Italy, Spain, Portugal, healthcare stakeholders such as the Czech Republic, The Netherlands, manufacturers and government or Turkey, Romania and Germany, the EPF events have always attracted an regulatory bodies. impressively high-calibre of speakers, ranging from Government Ministers and senior representatives of pharmaceutical EPF meeting EPF meeting manufacturers, to European Bern, 2002 Nice, 1999 Commissioners and leading academics. Through its quarterly seminars, newsletters and dedicated website, the EPF remains a trusted platform for independent minded and forward- thinking pharmacy professionals, all of whom are influential in their own right.

Did you know..? • Over 7,000 copies of the newsletter are printed each quarter, translated in to seven different languages • There are currently 30 Forum members, representing 10 European countries • Over 70 Forum meetings have been held since 1999, in 22 cities across Europe

EPF 1999 - 2019 03 Honouring our long The presidential Trail-blazing and moving standing members hall of fame independent pharmacy forward

The EPF not only discusses the difficult topics facing pharmacy today, but also looks for solutions, advances and innovations across the sector for the future. Through the formation of its working groups, members Paulo Duarte focus on examining the issues relating to four Portuguese professional pharmacist key areas affecting independent pharmacists:

2018-present day 2018-present and president of the ANF The new models; Expanding the roles of the pharmacist; Working with stakeholders; and Embracing the Digital Revolution. Today the EPF continues to challenge the Inaugural President of the EPF and current pharmacy sector, innovating the role of the Chair of the EPF’s Stakeholder Working Marco Nocentini independent pharmacist for the future. Group, Mike Smith says: Mungai 2016-2018 “Since I first became involved in the EPF Italian professional pharmacist and twenty years ago, a great deal of excellent president of Federfarma in Tuscany work has been accomplished, bringing The EPF White Paper pharmacists across Europe closer together. I very much believe that the EPF has By 2015, the EPF recognised the need to strengthened the position of independent raise the profile of community pharmacy. pharmacy across Europe.” EFP working groups focused on areas where pharmacies can make the maximum impact. Andrew Lane 2012-2015 They collected examples of best practice British professional pharmacist and which could be shared more widely. vice chairperson of the National Pharmacy Association The White Paper “The role of pharmacy in supporting the public’s health” outlined the challenges facing health systems, how pharmacists could contribute, and practical examples from across Europe, as well as the EPF’s vision and a “Call to Action” for collaboration to make this a reality. Joao Silveira The five key areas where pharmacies were 2008-2011 identified as: Portuguese independent professional pharmacist • Improving adherence to medicines • Delivering pharmacist-led vaccination services • Screening for early identification Elvire Kuyck of long-term 2005-2008 conditions Dutch independent professional pharmacist • Supporting self-care and managing minor ailments • Providing public health services to prevent diseases Jean Martineau The White Paper was launched at an event 2002-2005 French independent in Brussels in early 2015. This was attended professional pharmacist by representatives from the European Commission’s Health Directorate and European trade associations. The White Paper was made available in a range of languages to help EPF members and pharmacy associations influence Health Ministries. We can see from the spread of new services, like Mike Smith pharmacy-led vaccinations and screening,

1999-2002 that it has contributed to this success. British independent professional The White Paper can be found on the EPF pharmacist and non-executive advisor of in the UK website. 04 EPF 1999 - 2019 Coming soon... Your new look European Pharmacists Forum website

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Issue 54

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EPF 1999 - 2019 05 AROUND EUROPE

United Kingdom Spain

Pharmacy negotiators seek multi-year New plan to tackle drug supply issues funding deal Spain’s Ministry of Health, Consumption and Social Community pharmacy negotiators are seeking Welfare and regional health authorities have funding arrangements that last for several years as agreed to implement a two-year plan to tackle drug part of discussions with the NHS in England now shortages in the public health system. The policy underway. Simon Dukes, Chief Executive of the includes “special measures” (e.g. sanctions) to secure Pharmaceutical Services Negotiating Committee the supply of essential medicines, improvement of (PSNC), told a conference in London that, in order to management tools, and actions focused on providing achieve the ambitions of the 10-year NHS Long Term therapeutic alternatives. Finally, the plan seeks to Plan, pharmacies would need to make changes that optimise information published by the Spanish could take several years to deliver. Agency for Medicines and Health Products (AEMPS), The UK Government recently agreed five-year and to improve its integration with other information funding arrangements with local doctors and a systems. new version of its five-year pricing agreement with In its statement, the Spanish General Pharmaceutical the pharmaceutical industry. Negotiators are now Council expressed satisfaction that the plan discussing how pharmacies can support urgent care, incorporates some of the suggestions it has presented prevention and medicines safety. Early results from to the AEMPS such as the plan to progressively equip services aimed at sending patients to pharmacies pharmacists with greater competencies to substitute instead of doctors’ surgeries for treatments for minor unavailable drugs with non-reimbursed therapeutic illnesses and to deal with emergency supplies of alternatives, with the patient’s knowledge. medicines are very promising. The national roll- (Source: IHS, May 2019) out of this service, with referrals from the NHS 111 telephone advice line, and the piloting of referrals to community pharmacy from other settings such as doctors and NHS websites, are part of the negotiations. The Netherlands (Source: PSNC)

Pharmacists’ commitment to make sector more sustainable

The Royal Dutch Pharmaceutical Association (KNMP) Publication Director: has signed up to a Green Deal for sustainable care Ornella Barra in the presence of the Minister of Medical Care. The Editorial Director: Laura Vergani applicant organisation, which can be a company, Editor: France industry organisation or NGO, outlines their business Rachel Heath idea, the barriers that stand in its way and potential Contributors: solutions to them. If successful, the government Jonathan Buisson, Arthur Pharmacists to dispense some drugs signs a voluntary agreement (Green Deal) with the Carabia, Tricia Kennerley initiating organisation to work with them for two to without prescription three years. The Green Deal signed by KNMP defines clear actions including: The French Parliament adopted a law allowing pharmacists to dispense certain medicines for minor 1. Increasing the collection of unused medicines Copyright & (+ 20% in 2022) trademark notices ailments (such as conjunctivitis, angina, eczema, and This newsletter is published urinary tract infection therapeutic areas) without 2. Reduce waste of medicines and packaging by on behalf of the European normally required prescriptions from healthcare optimising the issue quantity, exploring re-issue Pharmacists Forum by: professionals. After the publication of the law, a precise of medicines and studies of extending the shelf 2 The Heights list of minor ailments will need to be defined, as well as a life of medicines Brooklands, Weybridge protocol for pharmacists. Under this new law and without 3. Improve the recycling of collected packaging KT13 0NY prior consent from GPs, pharmacists will, in the case of UK 4. Issue a guide for the sustainable procurement shortages, be able to substitute a medicine of major Tel: +44 (0)1932 870550 of packaging therapeutic interest with another medicine in accordance No part of this publication 5. Increase percentage certified paper and may be reproduced with the recommendations of the National Authority for without the permission of the Safety of Medicines and Health. Similar provisions cardboard for transport packaging Walgreens Boots Alliance Communications. are implemented or considered in European countries 6. Replacement of paper leaflets with digital All rights reserved. including Switzerland and the UK. version © Copyright 2019 (Source: IHS, Ordre des pharmaciens, March 2019) (Source: IHS, KNMP, May 2019)

06 EPF July 2019 AROUND EUROPE

Turkey Germany Czech Republic

EU initiates World Trade Minister proposes new measures 250,000 untreated diabetics live Organisation dispute on for pharmacies in the Czechia pharmaceuticals In parallel to a package on the remuneration According to the Czech Pharmacy of pharmacies, the Federal Health Minister Chamber, one million patients suffer The European Commission has requested Jens Spahn proposed a series of new from diabetes in the Czech Republic, the WTO to consider a case against provisions in order to strengthen the local among which a quarter are not treated measures implemented in Turkey to presence of pharmacies and to expand because they do not know about it. localise pharmaceutical production offers to patients. He wants to allow at Since 2016, the Czech Pharmacy and to reduce the health system's regional level and for a period of up to five Chamber (ČLnK) has started to create dependence on imported drugs. It years, flu vaccines in pharmacies to increase a network of pharmacies providing concerns measures that, in some cases, uptake. A prerequisite is medical training professional counselling and consultancy seek to force foreign drug makers to of the vaccination staff in pharmacies as throughout the Czech Republic. At shift manufacturing to Turkey to secure well as suitable rooms and equipment. present, patients can undergo diabetes reimbursement status through the The draft also provides the possibility for screening in 79 certified pharmacies Turkish Social Security Institution (SSI/ patients with chronic illnesses to receive across the country. SGK). prescriptions which they can collect at (Source: Czech Pharmacy Chamber, May 2019) The EU has also cited technology transfer the pharmacy up to three times - for up to requirements enforced by the Turkish one year after issuing the prescription. In government in cases where companies addition, deliveries of drugs by messengers do shift production to Turkey, which can from pharmacies should be facilitated by involve forced transfer on product patent this proposal. rights and a violation of WTO obligations. (Source: IHS, April 2019) The official action by the EU increases pressure on the Turkish government to modify its policy approach, which is already the subject of considerable Portugal controversy because of persistent reports of drug shortages in the country. Romania (Source: IHS, April 2019) Pharmacy pilot project Call for quicker action on increases flu vaccination by medicines reimbursement 32%

Delegates from Romanian patient A new initiative has seen community associations, including Cancer Association pharmacists expanding their services Italy President, Cezar Irimia, Coalition of to offering patients the seasonal flu Organisations for Patients with Chronic vaccination. The pilot project offered Diseases in Romania President, Radu patients aged 65 and over access to flu vaccinations under the same terms Good news for practising Gănescu, and a Crohn's disease group as National Health Service primary pharmacists over retirement age representative, Izabela Grosu, have urged the government to introduce changes care units. Supported by the Ministry to speed up the expansion of the list of of Health and Portugal’s National The Ministry of Work and the Ministry Association of Pharmacies, and with of Economy and Finance have approved reimbursed medicines, particularly for ulcerative colitis, rheumatoid arthritis, no requirement for a prescription and a change to the ENPAF Statute, which no administration fee, the pilot saw an allows practicing pharmacists who Hodgkin's lymphoma, Crohn's disease, and multiple myeloma. increase of 31.8% of people having the receive a pension to pay reduced pension vaccine. contributions of up to one third or 50%. It Cezar Irimia reported cases where (Source: Vaccines Today) applies to not only pharmacy owners, but patients had been waiting for "more than also the collaborators of family businesses half a year" to access new medicines and those who work as self-employed. and called for an increase in budget This was described by Luigi d'Ambrosio and streamlining of procedures. Radu Lettieri, vice president of the Federazione Gănescu highlighted that, even following Ordini farmacisti Italiani as “A further approval, the availability of medicines in step towards the modernisation of the the unconditional reimbursement category regulatory framework of social security can be delayed for up to a year. For many that must be continued with collegiality of these medicines, there is no alternative and common sense." in the market, and some are orphan drugs (Source: Federazione Ordini Farmacisti Italiani (FOFI)) that were approved in 2017. (Source: IHS, March 2019)

EPF July 2019 07 FOCUS Highlights from the first EPF seminar of 2019 The first European Pharmacists Forum of 2019 took place in Milan on 18 and 19 March, bringing together leading pharmacists from across Europe to discuss key issues affecting the pharmacy sector.

Marco Velluti (Managing Director, Alliance across the country, whilst the threat of large fee of €8.35 per pack; Marcello Perego Healthcare Italy) opened the day by sharing chains as part of the European Federation (Italy) confirmed that the main remuneration how the global pharmaceutical market is of Pharmacy Chains (EFPC) are lobbying to is derived from the margin determined by continuing to grow, mainly due to growth convince governments to liberalise markets the medicine price; and Arno van Tilborg in the emerging markets and the arrival even further. He also spoke of the financial (The Netherlands) explained that pharmacists of innovative pharmaceutical products. difficulties independent pharmacists are benefit from a dispensation fee for medicines, He discussed the impact digitisation facing, especially in rural areas. and charge fees for value added services. in Italy is having on the rapid growth Fernando Monteiro (Portugal) explained This group discussion was followed by of e-commerce transactions, and how the e-prescription system in Portugal and opening the remuneration workshop session companies communicate with consumers outlined the regulations for the medicinal which covered: and customers. use of cannabis. He also spoke of the The new models – dispensing fees; pharmacy Ornella Barra (Co-Chief operating Officer, public campaign launched by Portuguese services; Pharmacist pay increases; and Walgreens Boots Alliance) announced pharmacies with a petition entitled ‘Save the safeguarding of relationships with new partnerships between Walgreens Pharmacies to strengthen the NHS’. manufacturers. Suggested a system based Boots Alliance and Microsoft, ALIPAY, and Luis Panadero (Spain) explained the on a fee-for-services model not linked to reiterated the partnership with Verily. Ms pricing system and the latest development prescriptions. Barra presented the WBA video on key CSR in relation to the pharmaceutical supply activities in 2018, including how 160 million Expanding the roles of the Pharmacist – chain (the Falsified Medicines Directive, flu identified two main groups of remuneration: children and women received life-changing vaccine campaign, medicines shortages etc.), vitamins, $71 million was raised for Red margins, and 70% based on dispensing fees. and outlined the main characteristics of the Noted that a fee-based system not linked Nose Day in the USA, and that the Group’s Spanish pharmaceutical market in 2018. carbon footprint was reduced by 9.6%. Ms to products makes it difficult to compare Frank Bruggeman Barra concluded by adding that this year (The Netherlands) systems across countries. marks the 170th anniversary of Boots shared how medicine prices fell during Embracing the digital revolution – looked at UK, and mentioned the recent Alphega 2018 due to the new pricing method, and the possibility of creating a more transparent Pharmacy European Convention held in outlined the impact of medicine price cuts mechanism which risks putting pharmacists March, “Embracing Innovation, Empowering on pharmacists’ remuneration. He stressed at odds with governments. Pharmacy”. how future pressure margins will force small pharmacies to merge with larger pharmacies, Working with stakeholders – the need for a Mehmet Sahin (Turkey) outlined the and potentially a decrease in number of clearer view of how pharmacists’ services are government’s plan for a new healthcare community pharmacies. remunerated, including a method for new ecosystem based on: two new institutions patients, pharmacists’ fees for dispensing Tricia Kennerley (TUSEB and SEDAP); a greater cooperation (VP, Director of and services, and margins. International Public Affairs, WBA) facilitated a with the industry; and how as yet, the role During the round table the group discussed of pharmacy is not included in the plan. He group discussion on pharmacy remuneration Philippe Gaertner the effect liberalisation of the market has clarified how the Turkish pharmaceutical across Europe where: (France) said that by 2020, 73% of pharmacy had on independent pharmacies, agreeing market is evolving, and how the medicines that whilst the competition encourages shortages in 2018 was due to the volatile remuneration will be made up of fees and 27% Walter Taeschner increased value-added services, large chains Turkish Lire and increase in medicine prices. of margins; (Germany) cited that a 3% fixed margin is applied to retain the monopoly on innovation and Jiri Hromada (Czech Republic) spoke of prescription medicines, with a dispensation technological changes. the spectacular growth of the Dr. Max chain

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EPF July 2019 08