Pharmacy reform in Estonia is to go ahead as planned on April 1, with 10 pharmacies so far announcing their closure as a result, on top of dozens which have already closed. Pharmacy chains had asked for the reform's entry into force date to be postponed due to the coronavirus pandemic. Most of the closures are in larger population centers already well-served by the sector, though the South Estonian town of Viljandi is seeing significant closures.
Exactly a week before the reforms come into effect, 210 of Estonia's over 500 pharmacies do not qualify for the ownership requirements – where dispensing pharmacists should own a minimum 51 percent stake in the pharmacies they work in – though 167 of these have already applied to the State Agency of Medicines (Raviamet) for registration of compliant ownership, and 10 saying they will have to close.
The State Agency of Medicines says it expects to receive these plus additional requests by the deadline, and has authorization committees meeting several times per day for this purpose.
As things stand, there would be at least 443 pharmacies operating in Estonia from April 1.
"I am pleased that in the short time remaining after the final decision of the Riigikogu, both current entrepreneurs, new pharmacist owners and pharmacy managers have worked very closely with the agency," said Kristin Raudsepp, agency director general.
"I'm really seeing a courage to act, despite the emergency situation. As of April 1, the location of pharmacies for most of the Estonian populace will not change, meaning the availability of medicines will not deteriorate," Raudsepp said.
Raudsepp added that the processing was being done in line with all social restrictions issued by the government in the current emergency situation.
The Ministry of Social Affairs also told ERR that the April 1 date remained in place.
"There is a week left to complete the pharmacy reform. The State Agency of Medicines and the ministry are aware that the transition period will end on 1 April," said Katri Eespere, health advisor at the Ministry of Social Affairs.
"We will make every effort to ensure that the transition is completed as smoothly as possible."
Ten pharmacies closing their doors
An application to close a pharmacy has been submitted by ten pharmacies, four in Tartu, which has one of the highest amount of pharmacies per capita, according to ERR's online news in Estonian.
Many of those closing were franchises which had previously been Südamapteek chain outlets.
- Tartu: Raatuse pharmacy (Raatuse 20), three Südamapteek pharmacies (Küüni 7, Ringtee 60a, Puusepa 3).
- Pärnu: Ülejõe pharmacy (Sadama 15), Linnapu Kreenholm pharmacy (Vertervalli 15).
- Kohtla-Järve: Oru district pharmacy.
- Viljandi: Vana apteek (Tallinna 2).
- Tapa: Südamapteek (Valgejõe pst 14/2).
The new law, which was a requirement of the Medicinal Products Act passed five years ago, prohibits branch pharmacies from operating in their old form, though these can continue if the required ownership requirements are met.
One exception is the Kohtla-Järve pharmacy listed above, which was owned by the dispensing pharmacist but did not meet requirements nonetheless, ERR reports.
Biggest changes in cities
Critics of the reforms, which saw several bills aimed at either reversing the course of the reforms or modifying them in key areas voted down in the Riigikogu in late 2019 and early 2020, said that they would decimate the sector in rural areas and smaller centers of population.
However, according to ERR most of the closures, including those which have already taken place, are in larger towns.
In October last year, there were 44 pharmacies operating in Tartu; there are now 30. In Narva there were 18 pharmacies; come April 1 there will be 10. There were 19 pharmacies operating in Pärnu six months ago; once the reforms come into effect there will be 11, and in Viljandi, which had 20 pharmacies last October, there will only be four outlets remaining in operation.
"While just a few months ago we were looking at figures of more than 300 non-compliant pharmacies and 35 critical areas ahead of pharmacy reform. Things are much better today. We have another week to go, so we are prepared and looking forward to hearing about any changes that current and new entrepreneurs are going to make or are already making," Kristin Raudsepp said.
The three main chains in Estonia took a different approach in the months leading up to the reforms. Magnum Medical, operator of the Apotheka chain, acquiesced to the reforms in early February, though owner Margus Linnmäe says he will be seeking damage from the state. Tamro and its associated Benu chain had had issues with the ownership requirements in some of its branches, and was one of the companies calling for a postponement of the April 1 date. Lithuanian-owned Euroapteek has been setting up multiple companies in recent weeks, reportedly enabling its dispensing pharmacists to act as franchisees.
Pharmacies are one of the key retailers which will continue to operate after further government restrictions come into effect on Friday, as part of its efforts to combat the coronavirus pandemic. Movement within pharmacies for customers is restricted, however, meaning they cannot "wander" around the store and will have all items they previously would have been able to pick up off shelves, brought to them by the pharmacist. Restrictions on the number of packages of over-the-counter drugs which can be bought are also in place, set at two packs per purchase, in an effort to stave off panic buying.
Editor: Andrew Whyte