Both pharmacies in the western Estonian town of Paldiski may close as a result of reforms due to take effect on April 1, which would leave the nearest pharmacy for residents of the town of around 4,000 people, and its environs, in Keila, about 25 kilometers away.
However, while the social affairs ministry is looking into a solution to keep the services open, this depends on the decision of the pharmacists themselves.
The planned reforms require dispensing pharmacists to be majority owners (i.e. at least 51 percent stake) of the pharmacies they work in from April 1, with pharmacies not meeting the regulations facing closure.
This time last week, over 30 districts ran the risk of pharmacies closing, which in many cases would have left them without coverage. However, as of Tuesday that figure has dropped to 13, though including Paldiski.
Both of Paldiski's pharmacies are operated by the Benu chain, which in turn is run by Tamro, one of the three major pharmaceuticals wholesalers and as such among the most affected by the reforms. Benu's pharmacies reportedly do not meet the pharmacy reform ownership requirements.
Lääne-Harju Rural Municipality mayor concerned about future of Paldiski pharmacies
The mayor of Lääne-Harju Rural Municipality, where Paldiski is located, Jaanus Saat, wrote to the social affairs ministry last week asking for solutions.
As noted, without a pharmacy in town, residents would have to travel to Keila, which has train and bus connections but is still 25 kilometers away.
The issue is not the first health-related one to blight the city in recent years according to ERR's online Estonian news; in 2019 it lost its specialized medical and dental care provision.
"The country has set itself the goal of developing life in its rural areas, but this reform only stifles that," Saat wrote in his letter.
Saat also expressed concerns over the large numbers of older people and those with special needs in the community in Paldiski who have a higher than average need for medical services, making a local pharmacy all the more vital.
Medicines agency solutions insufficient, says municipality
The State Agency of Medicines (Raviamet) advised the municipality to consider arranging transportation for such people as well as ordering medicines online, but these solutions will not be sufficient to keep pharmacy services easily available to the population, Saat argued.
"As a local authority, we have also provided regular transportation to ensure people have access to public services. However, being dependent on transport hampers meeting the public's urgent medical needs," the municipality responded to the medicine agency's suggestions.
"This would be a major extra burden for the local government if we got tasked with securing the supply of medicines to the public. This is [so far] a part of a home service which involves a small group of recipients of social services."
Similarly, online ordering was unsatisfactory, Saat said.
"Using an online pharmacy is not an optimal solution for all demographic groups," Saat continued, noting also the advice dimension of face-to-face pharmacy interaction.
Social affairs ministry waiting on Benu announcement
Katri Eespere, Health Adviser at the Ministry of Social Affairs, told the Paldiski authorties that they themselves had a wait-and-see attitude, noting that Benu had not kept the ministry informed about its intentions (the deadline for pharmacies to do so was in fact March 1-ed.).
"The current license holder ( Benu pharmacy chain - ed. ) has not provided the medicines agency with information about its plans. No applications have been submitted to the agency to comply with the requirements of the law or to open a new pharmacy. For this reason we have also drawn the attention of the Estonian Chamber of Pharmacists (EPK) and the Estonian Association of Pharmacists (EAL – both organizations represent the interests of dispensing pharmacists-ed.) to actively work to ensure that provision of pharmacy services is not interrupted in Paldiski," Eespere wrote.
"Therefore, we remain very hopeful that the current pharmacist will announce their intentions concerning Paldiski as soon as possible."
Eespere added that at a meeting late last year, the EPK told both the ministry and the municipality that there was a pharmacist interested in running a pharmacy in Paldiski.
"We are currently in active communication with the municipality and pharmacists to help find the right solution," Eespere said.
EPK: The solution also depends on Benu
The EPK itself has passed-the-parcel of the decision to Benu, saying that they felt the chain would fall in line with the reforms, and hand over control to its dispensing pharmacists.
"I think nothing will happen in Paldiski. They ( Benu-ed.) only last week were searching for a new pharmacist in Paldiski and offering a stable job," said Karin Alamaa-Aas of the EPK.
Alamaa-Aas added that any pharmacist who would be ready to set up a pharmacy in Paldiski would continue to exist autonomously, though it would not be wise to open a third pharmacy beside Benu's existing two – which, again, awaits the decision of the pharmacy chain.
Ülle Rebane, a board member of the EAL, also assumed that Benu was looking for a solution in Paldiski, making it unwise for any newcomer pharmacist to enter the market there.
"Benu is handing over [control of] its pharmacies all over Estonia, so it would be very risky to start another pharmacist at one pharmacy there. One [sic] in Paldiski is plenty - that's enough," said Rebane.
Nonetheless, no application for opening any pharmacy has been registered in Paldiski with the medicines agency yet, ERR reports.
Rebane said she also sent a letter to Benu's representatives to investigate the pharmacy chain's plans in Paldiski, but no response has yet been received as to whether the current pharmacist is interested in the business transfer and has found a dispensing pharmacist willing to take on the role.
"What matters is Benu's answer right now; what they do next. If they continue, it makes no sense to add a pharmacy there," Rebane said.
The other two major chains in Estonia, Magnum Medical, operator of the Apotheka chain, and Lithuanian-owned Euroapotheca, owner of the Euroapteek chain, have taken a different approach nationwide to the reforms.
Magnum via its owner Margus Linnamäe conceded on the issue earlier in the year following the voting-down of a bill just before Christmas which would have reversed course, placing ownership back in favor of the large wholesalers. Linnamäe said he would be seeking damages from the state, however.
Euroapteek has founded over a dozen new firms recently which are thought to be a franchise-based solution to the changes; in other words, dispensing pharmacists would nominally be owners but real control would remain in the hands of the wholesaler. Euroapteek rejects this charge, however.
The reforms themselves date back five years and were a provision of the Medicinal Products Act. Three more recent bills aimed at either softening the blow of the transfer or altering the structuring, ownership and wholesaler ordering aspects of the sector, put forward by the Social Democratic Party (SDE) and the Conservative People's Party of Estonia (EKRE) were also voted down at the Riigikogu, leaving the way open for the reforms to come into effect on their due date of April 1.
Editor: Andrew Whyte