Overview of the Activities of Estonian Pharmacies
Number of Pharmacies
There are three types of pharmacies in Estonia: general pharmacies, veterinary pharmacies and hospital pharmacies. Pharmacies may have branch pharmacies and pharmacy-bus as structural units. The licensed general pharmacy can offer the e-pharmacy service. The changes in the total number of pharmacies from 2009–2019 are shown in following table, which gives the number of pharmacies and their branches at the beginning of the year.
Table 1. Number of pharmacies (incl. branches) in Estonia 2009−2019 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 General pharmacies 496 486 477 469 475 478 476 493 490 495 494 Hospital pharmacies 28 26 26 24 25 24 24 24 24 24 24 Veterinary pharmacies 7 7 7 5 4 4 4 4 4 4 4 *The number of pharmacies (inc. branch pharmacies) as of 1st of January
Activity licences had been issued to 350 general pharmacies which had 144 branch pharmacies at the beginning of 2019.
The average number of retail pharmacies in Estonia at 1st of January 2018 was one per every 2665 inhabitants. In most counties the number is below average. However, in Tallinn, Narva and Harju County the number is above 3000 or more residents per pharmacy. The horizontal line illustrates the average in Estonia. The population figures used to calculate the number of people living in each county was obtained from the regional development database of Statistics Estonia.
3 500 3 000 2 500 2 000 1 500
No of inhabitantsof No 1 000 500 0
Figure 1. Number of inhabitants per pharmacy in the beginning of 2018 in major cities and counties compared to the Estonian average
The number of hospital pharmacies remain the same during last years. There were 24 hospital pharmacies and one of them branch pharmacy in 2018. Nine of the hospital pharmacies were located in Harju County, seven of them in Tallinn, three in Ida-Viru County and two in Tartu County. As for other counties there was one hospital pharmacy in each. Valga County and Võru County are the only counties that have no hospital pharmacies.
The number of veterinary pharmacies has decreased many years, since 2013 the number of veterinary pharmacies has remained the same. There were four veterinary pharmacies in Estonia in 2018: in Tallinn, Tartu, Põlva County and Saare County.
Turnover of Pharmacies
The statistics of pharmacies based on quaterly reports of pharmacies. Since 2015 the data are presented all of pharmacies, main and branch pharmacies. Only the turnover of general and veterinary pharmacies includes VAT (value added tax), the turnover of hospital pharmacies without VAT.
The total turnover of all pharmacies and their branch pharmacies was 502 million euros in 2018. The turnover of general pharmacies was 391 million euros (78% of total turnover), the turnover of hospital pharmacies was 110 million euros (22%) and the turnover of veterinary pharmacies was 0.87 million euros (0.2%) in 2018. The proportion of medicines of total turnover in general pharmacies was 73%, in hospital pharmacies 74% and in veterinary pharmacies 52%. 600
1 1 500 1 1 110 1 106 400 1 100 1 96 1 89 1 1 81 300 78 58 61 72
200 391 351 363 316 280 297 235 235 241 261
Turnover in millioneuros in Turnover 100
0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
General pharmacies Hospital pharmacies Veterinary pharmacies
Figure 2. Turnover of pharmacies in 2009–2018
The turnover of medicines in general and hospital pharmacies was 367 million euros in 2018. Dividing the amount by all inhabitants of Estonia the average expenditure on medicines per inhabitant in 2018 was 278 euros per year.
300 278 251 259 229 250 218 203 193 180 200 170 172 216 197 200 150 170 178 153 160 141 142 142 100 Expenditure ineuros Expenditure 59 62 48 52 54 38 41 43 50 29 30
0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Expenditure on medicines In general pharmacies In hospital pharmacies
Figure 3. Expenditure on medicines per inhabitant per year in 2009–2018
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General Pharmacies
In 2018 the turnover of general pharmacies was 391 million euros, which increased 7.9% compared to previous year. The turnover of medicines of general pharmacies was 286 million euros in 2018. The turnover of medicines includes sales of non-prescription medicines, prescription medicines and veterinary medicines. The turnover of non-prescription medicines increased 8.1% compared to previous year reaching over 60 million euros. The turnover of prescription medicines can in turn be divided into turnover of medicines dispensed on the basis of prescriptions the Estonian Health Insurance Fund (EHIF) compensates for or not. The turnover of medicines dispensed on the basis of prescriptions with discounts is the highest (206 million euros) with approximately 92% of the total turnover from prescription medicines. The turnover of veterinary medicines in general pharmacies is relatively modest and remained in 0.9 million euros in 2018. The turnover of the other goods was 106 million euros which increased 6.0% in 2018 compared to the 2017.
450
400
350 106 300 92 100 83 74 250 68 60 58 53 56 47 46 51 49 19 200 43 46 16 17 40 14 36 36 37 12 13
150 11 10 11 11 Turnover in millioneuros in Turnover 100 206 170 190 190 140 143 141 152 156 164 50
0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Reimbursed medicines Non-reimbursed medicines Non-prescription medicines Other goods
Figure 4. Turnover of general pharmacies in 2009–2018
The cost of prescription medicines reimbursed by EHIF divided as follows in 2018: ca. 27% paid by the patient and ca. 73% paid by the EHIF. The average cost of a prescription reimbursed by EHIF is influenced by the quantity of reimbursed medicines dispensed as well as the choice of specific discounted medicines, i.e. whether the chosen medicinal product with the same active ingredient is the more expensive or a cheaper option. The average cost of a reimbursed medicine in 2018 was 23.26 euros.
250
200 56 56 58 150 52 55 50 50 51 51 48 100 149 134 132 106 112 115
50 89 92 93 101 Turnover in millioneuros in Turnover
0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Reimbursed by EHIF Patients co-payment
Figure 5. Turnover of reimbursed medicines in general pharmacies in 2009–2018
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The average turnover of general pharmacies was 0.82 million euros and the average turnover of medicines 0.60 million euros. When we look at the average turnover of general pharmacies in major cities and counties, shows that the average turnover is strongly affected by the sales of Tallinn, Tartu, Pärnu and Narva pharmacies.
1 400 000
1 200 000
1 000 000
800 000
600 000 Turnover in euros in Turnover 400 000
200 000
0
Average total turnover Average turnover of medicines Estonian average total turnover Estonian average turnover of medicines
Figure 6. Average turnover of general pharmacies in major cities and counties in 2018
A quarter of all general pharmacies are located in Tallinn. Almost 75% of all general pharmacies and their branch pharmacies are located in towns and cities.
Table 2. Pharmacies by counties 01.01.2019 Main Main Main Branch Branch Branch City/ County pharmacy pharmacy pharmacy in pharmacy pharmacy pharmacy in in the city rural areas in the city rural areas Harju County 22 12 10 29 7 22 Tallinn 115 115 18 18 Hiiu County 3 2 1 2 2 Ida-Viru County 22 21 1 9 9 Narva 10 10 8 8 Jõgeva County 12 9 3 3 2 1 Järva County 11 8 3 2 2 Lääne County 5 4 1 4 1 3 Lääne-Viru County 22 17 5 8 3 5 Põlva County 8 6 2 6 3 3 Pärnu 16 16 3 3 Pärnu County 10 2 8 8 1 7 Rapla County 8 2 6 4 2 2 Saare County 10 7 3 2 1 1 Tartu 32 32 12 12 Tartu County 11 4 7 14 1 13 Valga County 8 6 2 5 3 2 Viljandi County 13 13 6 1 5 Võru County 12 8 4 1 1 Total 350 294 56 144 75 69 Grand total 494
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The most of general pharmacies located in towns and cities. The turnover of general pharmacies located in cities was 89% of total turnover of all general pharmacies. Only 11% of medicines has sold in general pharmacies in rural areas.
2% 9% 19% 25%
75% 70%
No of general pharmacies in the cities Non-prescription medicines in the cities No of general pharmacies in rural areas Prescription medicines in the cities Non-prescription medicines in rural areas Prescription medicines in rural areas
Figure 7. General pharmacies Figure 8. Turnover of medicines in 2018 in the cities and rural areas
At the same time the distribution of turnover of general pharmacies in cities and general pharmacies in rural areas is quite similar. The turnover of prescription medicines was the highest, 58% in general pharmacies located in cities and 56% in general pharmacies located in rural areas. The turnover of non-prescription medicines was respectively 15% and 16% and the turnover of the other goods respectively 27% and 28% in general pharmacies located in cities and in rural areas.
27% 28%
58% 56% 15% 16%
Prescription medicines in the cities Prescription medicines in rural areas Non-prescription medicines in the cities Non-prescription medicines in rural areas Other goods in the cities Other goods in rural areas
Figure 9.The turnover of general Figure 10.The turnover of general pharmacies in the cities in 2018 pharmacies in the rural areas in 2018
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The average amount spent by an inhabitant of Estonia on medicines in 2018 was 8.55 euros per month, almost 103 euros per year. Compared to 2017 the expenditure on non-prescription medicines increased 7.8% and the expenditure on prescription medicines increased 1.0%.
6
4,71 4,75 5 4,55 4,35 4,11 3,92 3,90 3,83 3,73 3,82 3,80 4 3,37 3,52 3,10 2,89 2,69 3 2,50
2,26 2,22 2,30 Expenditure ineuros Expenditure 2
1
0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Expenditure on prescription medicines Expenditure on non-prescription medicines
Figure 11. Expenditure on medicines per inhabitant per month in 2009–2018
10.4 million prescriptions were handled by general pharmacies in 2018. The largest proportion was medicines dispensed on the basis of prescriptions reimbursed by EHIF (8.8 million prescriptions). The number of prescriptions without discounts was ca. 1.5 million, while the number of EU prescriptions was slightly over four thousand and the number of prescriptions for medicines prepared ex tempore remained nearly 36 thousand. The number of prescriptions of medicines for veterinary purposes was nineteen thousand.
0,19% 14,3% 0,04% 0,6%
85,1% 0,35%
Prescriptions reimbursed by EHIF Non-reimbursed prescriptions Ex tempore prescriptions Veterinary prescriptions EU prescriptions
Figure 12. Prescriptions handled by general pharmacies in 2018
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5% of main pharmacies (18 general pharmacies) prepared medicines ex tempore or officinal formulae or divided them up into smaller packages in 2018. 14% of main pharmacies prepared medicines as officinal formulae, 36% prepared medicines ex tempore and 11% of main pharmacies divided medicines up into smaller packages. 61% of main pharmacies did not prepare or divide up any medicines.
Almost 121 thousand medicine packages were prepared in general pharmacies in 2018, more than 71 thousand of which were prepared ex tempore. The number of medicines prepared ex tempore was highest in Tartu comprising 60% of all medicines prepared ex tempore in general pharmacies in 2018. The number of medicines prepared as officinal formulae was highest in Tartu and Tallinn comprising 72% of all medicines prepared as officinal formulae in general pharmacies in 2018. There were four counties (Rapla, Saare, Tartu and Viljandi County) where no one of pharmacies did not prepared medicines as officinal formulae.
120 000
100 000
80 000
No of packagesof No 60 000
40 000
20 000
0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Prepared as officinal formulae Prepared ex tempore Divided up into smaller packages
Figure 13. Medicines prepared in general pharmacies in 2009–2018
2-5 employees usually work in one main pharmacy or branch pharmacy. The number of general pharmacies with more than 10 employees is highest in Tallinn, while the number of general pharmacies with one employee is highest in Tartu County. 40% of all people working in general pharmacies are employed part-time. The proportion of pharmacists is highest and comprise 40% of all general pharmacy employees in Estonia, pharmacist assistants comprise 33% and other employees 27%.
23 59
101 Pharmacies with 1 employee
Pharmacies with 2-5 employees
Pharmacies with 6-9 employees
310 Pharmacies with 10 and more employees
Figure 14. General pharmacies divided by the number of employees in 2018
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Hospital Pharmacies
The total turnover of hospital pharmacies in 2018 was 110 million euros, of this the turnover of medicines comprised 81 million euros (74%). The turnover of hospital pharmacies is calculated without VAT.
120
100 29 28 29 80 28 26 24 24 60 21 20 21 40 81 71 77 64 68 50 54 57 Turnover in millioneuros in Turnover 20 38 40
0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Medicines Other goods
Figure 15. Turnover of hospital pharmacies in 2009–2018
The turnover of hospital pharmacies is very versatile. The annual turnover of fifteen hospital pharmacies was less than one million euros. There are five medium-sized hospital pharmacies whose turnover remained between one and five million euros, and there are also four large hospital pharmacies in Estonia whose turnover in 2018 exceeded five million euros. In total, the four largest pharmacies comprised 77% of the total turnover of hospital pharmacies. This means that the four largest pharmacies also have a very strong impact on the average annual turnover of hospital pharmacies, which in 2018 was 4.6 million euros. When we look at the remaining pharmacies separately from the four largest, we see that the average annual turnover is considerably smaller 1.3 million euros.
The employees in hospital pharmacies are mostly pharmacists. 71 pharmacists, 39 pharmacist assistants and 39 other employees worked in hospital pharmacies at the end of 2018. Up to five people work in medium-sized hospital pharmacies and only the largest ones employ more than five people.
3 4 Hospital pharmacies with 1 employee
4 Hospital pharmacies with 2-5 employees Hospital pharmacies with 6-9 employees
Hospital pharmacies with 10 and more employees 13
Figure 16. Hospital pharmacies divided by the number of employees in 2018
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Veterinary Pharmacies
The number of veterinary pharmacies and the total turnover of veterinary pharmacies has decreased until 2013. The last years the number of veterinary pharmacies has remained the same and the turnover has started to increase. There were four veterinary pharmacies operating in Estonia in 2018 and the total turnover was 0.87 million euros and the proportion of medicines was 52%.
The veterinarians may purchase veterinary medicines directly from wholesalers. In 2018 wholesalers dispensed around 87% of veterinary medicines directly to operating veterinarians or veterinarians representing agricultural undertakings, 7% to veterinary pharmacies, 5% to general pharmacies and 1% to other institutions.
1 400
1 200 221 1 000 221
150 108 82 800 307 302 101 94 85 253 99 107 600 244 374 239 277 224 221 253 400 639 616 505 524 Turnover in thousandeuros in Turnover 200 386 403 388 430 410 416
0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Other goods Prescription medicines Non-prescription medicines
Figure 17. Turnover of veterinary pharmacies in 2009–2018
Veterinary pharmacies dispense prescription medicines on the basis of order forms and prescriptions. The number of prescriptions handled by veterinary pharmacies has decreased by 79% in the past ten years.
4 000
3 500 3 576
3 000 scriptions 2 923 2 500
2 000
1 500 1 496 Number of of pre Number 1 000 1 048 937 921 935 887 500 845 749
0 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Figure 18. Number of prescriptions handled in veterinary pharmacies in 2009–2018
In 2018 seven veterinarians worked in four veterinary pharmacies.
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