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Pharmacies in Norway Deregulation of Establishment and Ownership , Strict Profes Sional Regulation of Operations Index

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Pharmacies in Norway Deregulation of Establishment and Ownership , Strict Profes Sional Regulation of Operations Index 2 Facts and figures 2007 Facts and figures 2007 3 i n d e x 003 Pharmacies in norway: Deregulation of establishment anD ownershiP, strict Professional regulation of oPerations 004 about the Pharmacy traDe Numbers of pharmacies and development Wholesalers and pharmacy chains Employees, training and competence Health personnel in pharmacies 007 the core activities of Pharmacies – gooD Pharmacy Practice Standards for Pharmacy Practice Prescriptions and requisitions p h a r m a c i e s in n o r w a y : Self care Rational prescribing and medicine use deregulation o f establishment Health promotion and ill-health prevention a n d o w n e r s h i p , s t r i c t p r o f e s - 009 Pharmacy finance Pharmacy turnover s i o n a l r e g u l a t i o n o f o p e r a t i o n s Pharmacy turnover by community pharmacies and hospital pharmacies Pharmacy margin according to prescription type Since 2001, Norway has had a liberalised system of 011 sales of meDicines ownership and establishment for pharmacies. The Total sales by main categories in pharmacies Pharmacy Act which was put into force on March 1st Sales by ATC (Anatomical Therapeutic Chemical) group 2001 is based on the following criteria for ownership The 25 most sold substances according to value and establishment: Sales of non-prescription medicines in pharmacies Non-prescription medicines outside pharmacies – pharmacy turnover • Free establishment of pharmacies - no establishment criteria • Free ownership of pharmacies – anyone can own pharmacies, except pharmaceutical manufacturers and doctors 016 meDicine Prices • No limit of the number of pharmacies that can be owned by one pharmacy owner – horizontally integrated pharmacy chains Price regulation for on-patent medicines are allowed Pricing system for generic medicines • Vertical integration between wholesalers and pharmacies / Experience with the “trinnpris” system pharmacy chains are allowed At the same time, the Pharmacy Act is stricter on the professional 018 Price comParisons with other countries regulations, with detailed regulations and quality criteria. The primary goals of the Pharmacy Act are: 020 reimbursement of meDicines • Correct use of medicines, both medically and financially Co-payment • Accessibility for all patients to safe and effective medicines, independent of the patients’ financial situation • Medicines should have as low prices as possible 022 about the norwegian Pharmacy association 4 Facts and figures 2007 Facts and figures 2007 5 Pharmacy chain wholesaler owner Alliance apotek Holtung AS Alliance Boots Limited (English) Vitusapotek NMD Grossisthandel AS Celesio AG (German) Apotek 1 Apokjeden Distribusjon AS Tamro Oy (Finnish)/ Phoenix (German) table 1: structure of ownership apokjeden/ vitusapotek, Public hospital independent other total alliance apotekene, apotek 1, wholly owned pharmacies pharmasies, independent wholly owned wholly owned (no chain pharmacies connections) with a chain connection 135 211 158 33 22 63 622 table 2: number of pharmacies according to ownership by June 2008 a b o u t t h e p h a r m a c y t r a d e numbers of pharmacies As a result of the changes in the Pharmacy Act, the general public wholesalers and In Norway wholesalers are demanded to deliver a complete assort- has considerably better accessibility to pharmacies, as the number ment of medicines all over the country. This might be one reason why and development of pharmacies has increased from 399 in February 2001 to 622 as pharmacy chains the number of medical wholesalers in Norway is only three. of June 2008. Three large international pharmacy chains, each vertically integrated No pharmacy in scarcely populated areas has closed down since with a pharmaceutical wholesaler, own approximately 80 per cent of the pharmacy reform. One reason for this is that the pharmacy the pharmacies in Norway. The three pharmacy chains and the chains have signed an agreement with the Ministry of Health and pharmaceutical wholesalers both have international owners. See table 1. Care Services to guarantee pharmacy coverage in a large number of scarcely populated areas. Table 2 shows the distribution of the number of pharmacies that are 100 % owned by the pharmacy chains, hospital pharmacies which are In 2001, Norway was second last in the OECD ranking of number publicly owned and other pharmacies which are independent or, in of inhabitants per pharmacy. Even if the number of inhabitants per some cases, minority owned by the chains. pharmacy has fallen sharply after the deregulation, Norway still has a relatively low pharmacy coverage compared to many European By June 1st 2008 there are 33 publicly owned hospital pharmacies countries. See figure 1. in Norway. The hospital pharmacies are part of the specialist health care service. These are organised as independent health authori- ties, owned by the regional health authorities. Two of these hospital &)%%% +*% pharmacies are owned by charitable trusts, which have agreements &(*%% with the health authority. &(%%% +%% All the hospital pharmacies and several of the pharmacies which are CjbWZgd[e]VgbVX^Zh &'*%% CjbWZgd[^c]VW^iVciheZge]VgbVXn not wholly owned by a pharmacy chain are members of Ditt Apotek. **% &'%%% Ditt Apotek is an agreement based chain (purchasing and range co- operation) which NMD Grossisthandel AS offers to pharmacists who &&*%% *%% own and run their own pharmacies. &&%%% By June 1st 2008 22 pharmacies are not connected to any chain ex- &%*%% )*% cept through a supply agreement with a wholesaler. Such agreements &%%%% do not hinder supplies from competing wholesalers, as the Pharmacy )%% CjbWZgd[e]VgbVX^Zh .*%% Act allows all pharmacies to use any wholesaler they want. CjbWZgd[^c]VW^iVciheZge]VgbVXn .%%% (*% -*%% -%%% (%% &..+ &.., &..- &... '%%% '%%& '%%' '%%( '%%) '%%* '%%+ '%%, '%%- figure 1: number of pharmacies and inhabitants per pharmacy in norway: Source: The Norwegian Pharmacy Association and Statistics Norway 6 Facts and figures 2007 Facts and figures 2007 7 number of man-labour years cathegory January 1st 2002 January 1st 2008 M.Sc.Pharm (managers and pharmacists) 781 1058 B.Sc.Pharm (prescriptionists) 758 974 Pharmacy technicians 3295 3125 Others (nurses etc) 175 169 total 5009 5326 table 3: number of employees in all pharmacies t h e c o r e activities o f p h a r m a c i e s – g o o d p h a r m a c y p r a c t i c e employees, training and The pharmacies are resource centres for knowledge about medicines standards for Using WHO’s guidelines for Good Pharmacy Practice and their correct use. Rational use of medicines can prevent, allevi- competence ate and cure illness and thereby contribute to good health. Providing pharmacy practice (GPP) in Community and Hospital Settings, trade guidance regarding the rational use of medicines, both to customers standards for pharmacies (Standards for Pharmacy and to health personnel, is an important contribution to the health Practice) in Norway have been developed, defining service. The pharmacies’ customers are the entire population. Many of the customers are elderly, and many need special consideration, four areas as the pharmacies’ core activities: competence and help. • Prescriptions and requisitions • Self care health personnel The professional staff in pharmacies consists of a pharmacy manager, • Rational prescribing and medicine use pharmacists, prescriptionists, pharmacy technicians and sometimes • Health promotion and ill-health prevention in pharmacies nurses. Pharmacy managers, pharmacists and prescriptionists are entitled to dispense medicines according to prescriptions and requisi- The standards describe the role of the pharmacies in relation to cus- tions. Pharmacy managers and pharmacists are educated as M.Sc. tomers/patients, in the health care service and society and express Pharm, prescriptionists as B.Sc.Pharm. the trade’s requirements on itself by making quality demands on the pharmacies’ activities within the four core areas. The pharmacy managers, the pharmacists, prescriptionists, pharmacy technicians and nurses in pharmacies are authorised health person- The trade standards are based on the central principle of the nel. Through the law concerning health personnel, they are subject customers’/patients’ needs and rights. Pharmacists, prescriptionists to the legal framework common for all groups of health personnel. and pharmacy technicians, as authorised health personnel, offer The law concerning health personnel lays down a number of duties health aid related to medicines according to the legal requirements as reflected in the law concerning patients’ rights. This legislation for responsible professional conduct. This is linked to the patients’ in combination with the authorisation system gives the public quality rights in the legislation. assurance for the professional performance in pharmacies and contributes to strengthen the patient safety. The legislation focuses prescriptions and The work of preventing, identifying and solving drug-related on requirements for proper professional conduct, maintenance of problems for individual customers/patients is central. This requires competence, rules regarding secrecy and documentation of health requisitions extensive contact with prescribers and involves considerable aid which is required of health personnel. guidance and advice directed at customers/patients. The aim is to make the customer/patient understand the goal of the treatment The percentage of pharmacist and prescriptionist man-labour years and to empower her to carry it out correctly. These aspects
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