MPs from both coalition and opposition parties have proposed ameds to the pharmacy reform bill, which aims to place control of the sector into the hands of dispensing pharmacists and away from the larger wholesalers and their associated chains.

Members of the Conservative People's Party of Estonia (EKRE), together with Center MP Jaanus Karilaid, proposed amends which would give pharmacies the right to buy medicines from non-Estonian wholesalers and extend the right of sale to hospitals and family doctors.

With its proposed changes, EKRE wants to avoid a mass closure of pharmacies this spring as well as improve the accessibility of drugs and increase competition.

The Social Democratic Party (SDE) has also tabled its own alternative bill of amendments as well, signed by former party leader Jevgeni Ossinovski, former health minister Riina Sikkut, and MP Helmen Kütt.

Prime minister: Best to let the reforms go ahead for April 1

Jüri Ratas pointed out that while decisions were made five years ago, as of now, when April 1 rolls around – the date the reforms are due to come into effect – there could be a huge dent in availability of medicines.

"It is my feeling that, in this situation, it would be best to remain with the situation that the Riigikogu last said was irreversible, i.e. the reform will enter into force on 1 April," Ratas said.

"Certainly we agree our group (i.e. Center's) in the Riigikogu that we should discuss all these proposals. But as long as the various reform options are up and running and the green light is still go, but no one knows whether to cross the road or not, we are not really contributing to the trend for more and more pharmacies being owned by the dispensing pharmacist before April 1. Of course we are ready to discuss any suggestions, if that will make things better, be it affordability, be it in pricing and, of course, quality, but we must not turn back," Ratas said.

Social affairs minister: In the pipeline for five years

Minister of Social Affairs Tanel Kiik, under whose remit the reforms largely fall, said there was no justification for canceling the reforms, which had been scrapped by the government late last year, only for the replacement bill, which would have swung things back in favor of the larger pharmaceuticals companies, to be defeated at the Riigikogu just before it closed for Christmas recess.

Minister of Social Affairs Tanel Kiik, under whose remit the reforms largely fall, said there was no justification for canceling the reforms, which had been scrapped by the government late last year, only for the replacement bill, which would have swung things back in favor of the larger pharmaceuticals companies, to be defeated at the Riigikogu just before it closed for Christmas recess.

The reforms have been in the pipeline since the act requiring them passed over five year ago, and the original plan to require dispensing pharmacists to have a stake in the pharmacies they work in, effectively making them small businesspeople, are back on the table.

Kiik opposed EKRE's call to make medicines available from wholesalers other than Estonian ones.

"As for the right of pharmacies to import medicines themselves - this is not really a proposal to improve the market situation. In a case where there are more than 50 wholesalers in Estonia, in a situation where EU law very clearly regulates who can import medicines at all, it is not conceivable that 500 different pharmacies across Estonia will start to import medicines," Kiik said, according to ERR's online Estonian news.

"If we cancel the pharmacy reform, give the wholesaler the right to remain the majority owner of the pharmacy, the question arises how the pharmacy manager, who in this case is a salaried employee, would begin to import the medicines from abroad while being tied to a wholesaler., here comes a completely schizophrenic situation, where he or she can make any budget they please, negotiate with any one, take considerations and translate them into freedom of expression – whereas, in fact, the pharmacy belongs to a wholesaler, in other words to the importer of the drug. In my opinion, this proposal is not very consistent with real life," he continued.

The proposed reforms would require dispensing pharmacists to hold a minimum 51 percent stake in a pharmacy. At the same time, the number of pharmacies currently complying with the proposed reforms, just over two months before they come into effect, is over 300 – with smaller settlements at risk of being left with no pharmacy at all.

Kiik did however say he supports the proposal to extend the right to sell medicines to hospitals and family doctors.

Reinsalu: The proposals need to be discussed

Foreign Minister Urmas Reinsalu (ISamaa) referred to pharmacy reform as one of the major threats, but thought that the amendments tabled by SDE and EKRE, and Jaanus Karilaid, should be discussed.

"I think they should all be discussed," Reinsalu said.

Reinsalu said that the decisions the Riigikogu has to make on pharmacy reform must also bear in mind the issue of legitimate expectations and the existence of a functioning pharmacy network.

Another important issue, he said, concerns pricing.

 "In my opinion, we also have strong reserves to bring down the prices of pharmaceuticals by applying market economy principles," said Reinsalu.

Lobby groups linked to the major wholesalers and chains, such as Magnum Medical, which supplies the Apotheka chain, or Tamro, which does the same for the Benu chain, had fought hard to block the reforms as they currently stand.

Another related but separate issue is whether to permit kiosks, supermarkets and the like to sell over-the-counter medicines like ibuprofen. Currently, pharmacies are the only outlets where these products can be bought.