Pharmacists' bodies call for phased introduction of initial pharmacy reform

Independent pharmacy. Photo is illustrative.
Independent pharmacy. Photo is illustrative. Source: OÜ Marja Apteek

Both the Estonian Chamber of Pharmacists (EPK) and the Estonian Association of Pharmacists (EAL), say they support Minister of Social Affairs Tanel Kiik's proposal for a phased pharmacy reform, but would also like to see the transition take place within a year instead of the proposed three years.

Both bodies ostensibly represent dispensing pharmacists, as distinct from the Estonian Pharmacies Association (EAÜ) which represents the larger commercial concerns. Pharmacy reform has been a hotly debated topic in recent months, with government amends – arising from the Medicines Act which came into force in 2014 - aimed at placing control more firmly in the hands of dispensing pharmacists as small business scrapped in late 2019, only for its replacement bill, which would have done more or less the reverse and favored the larger chains, being voted down in the Riigikogu in one of the chamber's last significant acts of the year.

Both bodies said in a letter sent to the Riigikogu's social affairs committee of the Riigikogu, as well as prime minister Jüri Ratas and minister Tanel Kiik, that the changes to the law which formed the basis of the pharmacy reform had been on the table for all parties to look at for five years (i.e. since the Medicines Act came into force), which should have been enough.

The 2014 act came into force under a previous, Reform Party-led coalition.

Both organizations support Kiik's proposal to the social affairs committee that pharmacy reform should take place in stages, though with the qualification that this should be done inside one year and not the three Kiik proposed.

"Pharmacists want clarity and certainty, but extending to such a long period would rather be the opposite," the letter stated, according to ERR's online news in Estonian.

The bodies added that the first phase of the reform could begin on April 1, the original date the reforms were supposed to take effect, where general pharmacies would continue to operate in towns with more than 4,000 inhabitants, and the second phase on October 1, when pharmacies in major cities like Tallinn, Tartu,  Pärnu, Rakvere and Jõhvi, which did not comply with the reforms, could start implementing.

The requirements referenced are that pharmacists should own a minimum of 51 percent stake in a concern; depending on whose figures you look at, the vast majority of pharmacies nationwide do not currently conform to this and related requirements.

The start of the third phase was proposed to begin April 1, 2021 by which time, all general pharmacies should be brought into line with the requirements of the pharmacy reform, and retail and wholesale distribution of medicinal products would then be definitively separated off, making only pharmacists eligible to operate pharmacies.

Critics of the reforms, which faced strong opposition from wholesalers said that they would lead to the decimation of the sector in smaller towns. Wholesalers include Magnum  Medical, which operates the Apotheka chain, and Tamro, which runs the Benu chain.

A separate aspect to the reforms debate is making the sale of over-the-counter drugs in kiosks and similar outlets possible, as well as in hospitals. Currently such medicines, including ibuprofen and the like, are only sold in pharmacies.

The letter also called for the clarification of the requirement of a pharmacy ownership so that it could also be shared out between several pharmacists, with the latter together holding at least 80 percent of the shares.

Other criticisms of the original reforms were that they would force dispensing pharmacists who may have no business ownership experience or desire, to become entrepreneurs nonetheless.

"We believe that it is the right time to complete the pharmacy reform as soon as the transition to the pharmacists' system is taken on board by those pharmacists, and [the reform] is needed to better protect public health. We believe that half a year is sufficient to comply with pharmacist requirements in major cities,  Ülle Rebane of the EAL and  Karin Alamaa-Aas of the EPK signed off on the letter.

Following the defeat of the government's bill to amend the Medicines Act, the original date of April 1 as starting point for the reforms should in theory now go ahead.

Following the defeat of the government's bill to amend the Medicines Act, the original date of April 1 as starting point for the reforms is now valid.

Tanel Kiik made a compromise proposal to implement pharmacy reform within three years, at the end of last year. Speaking at the Riigikogu Monday, Kiik said that, in his personal view, one of the initial mistakes or lessons learned from the pharmacy reform saga was that steps should have been set out from the outset, to allow for a smoother transition.

Opposition bill to give hospitals drug imports and retail rights blocked

Meanwhile a bill inisiated by Social Democratic Party (SDE) MPs Jevgeni Ossinovski, Helmen Kütt and Riina Sikkut at Thursday's session, to give hospital pharmacies the opportunity to import their own medicines, was opposed by the government.

The MPs, which include a former health minister (Sikkut) say the move would save money on health insurance and improve competition in the Estonian pharmaceutical wholesale market. 

They also wanted the bill to allow hospital pharmacies to retail medicines, to ensure continuity of care. Under current arrangements, a hospital pharmacy is not authorized to import or sell medicinal products to the general public.

The Ministry of Social Affairs advised the government not to support the bill in its current form, even though it acknowledged that it agreed with the aims of the bill.

The government is to shortly consider proposals by the ministry itself to amend the Medicines Act, including proposals to expand the rights of hospital pharmacies, so that if mass chain pharmacy closures do happen in the wake of reforms coming into force, hospital pharmacies in hospitals can ensure access to medicines.

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Editor: Andrew Whyte

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