A draft bill proposed by the Conservative People's Party of Estonia (EKRE) as a rival to the "official" government pharmacy reforms due to come into effect on April 1 had some interesting points regarding allowing hospitals to operate pharmacies, according to some experts, but were not realistic.
Appearing on ETV current affairs show "Aktuaalne kaamera" Thursday evening, Agris Peedu, manager at the North-Estonian Regional Hospital (PERH) said that permitting hospitals to retail their own medicines will not solve the current issues surrounding pharmacy reform – principally fears of a breakdown in retail supply as the new law comes into force on April 1.
Peedu noted that drugs in stock in hospitals tend to be in larger, less customer-friendly packs, as well as a larger emphasis on injection-administered drugs rather than tablets as in pharmacy chains.
Even more important, Peedu said, is that there could be a conflict of interests if a hospital operates a retail pharmacy, the implication being prescriptions might be issued simply to get sales.
Another factor is that if PERH were in effect competing with chain pharmacies, it may violate the state aid rules, Peedu said.
At present, a hospital pharmacy provides prescription medicines to those being treated in the hospital, but over-the-counter medicines are not sold. Hospital pharmacies are nonetheless independent companies that rent premises from hospitals, and are not supplied by the hospital itself.
Timo Danilov, head of the Estonian Pharmacies Association (EAÜ), a wholesalers' lobby group, said that the practice would be unprecedented across Europe, noting that since drug prices are agreed with manufacturers it makes no difference whether they are sold at a pharmacy or at a hospital.
Potential conflict of interest
Kristin Raudsepp, head of the State Medicines Agency (Raviamet), also noted that the primary question in any pharmacy reform should be whether those selling the medicine has an interest in so doing.
"If the person who prescribed the medicine to the patient is at the same time interested in selling a large number of drugs, then this is a conflict of interest. If we have a discussion on this within society and conclude it is okay, then it can be done. But it is a good idea to keep these interests separate, as is generally done in the rest of the world," she said.
Raudsepp also noticed in practice the disparity between the densely populated areas where most of the hospitals are but which also have plenty of pharmacies, versus rural areas which have little of either, in arguing competition, while good in theory, may be redundant here.
Hospitals importing their own medicines a good idea?
The EKRE bill would allow hospitals to import their own medicines and bypass wholesalers, which met with more support from the "Aktuaalne kaamera" guests, albeit with a wait-and-see attitude.
Agris Peedu said the move might help, for instance, in crisis situations, and had been proposed by the hospitals themselves in recent years, after expressing dissatisfaction with local wholesalers. IT would, however, take time, as much as a year, to enact, since other laws would need changing too, he claimed.
Kristin Raudsepp said that it was also feasible, though not necessarily needed, as responsibility should lie with the wholesalers to provide a good service.
EKRE tabled its bill on the very same day as SDE did the same. In the latter case, the principle in the government's own reform bill for majority ownership of pharmacies to be transferred to dispensing pharmacists remained, though it would be phased in over a longer time-scale rather than literally overnight on March 31-April 1. EKRE's bill, parts of which are claimed to bear a strong resemblance to an earlier Reform Party bill from 2018, would reverse the ownership emphasis back towards the wholesaler and chain owners. The last time the government tried to do this, just before Christmas, the bill was defeated at the Riigikogu.
Editor: Andrew Whyte