April 1 marks the end of a years-long pharmacy reform that saw several attempts to appeal it. "I am entirely certain that the Medicinal Products Act will be changed again," State Agency of Medicines director Kristin Raudsepp said in an interview with ETV's "Aktuaalne kaamera." "We don't yet know what direction it will take."
Aktuaalne kaamera: Critics of the pharmacy reform are saying that the entire reform is an illusion, because no new independent, pharmacist-owned pharmacies have been added; these are chain pharmacies operating on the basis of franchise agreements. Does this claim hold true?
Kristin Raudsepp: It's clear that as of Wednesday, the more than 50 percent owners of all pharmacies in Estonia are pharmacists, and no dominant influence on the part of wholesalers has been identified. This is the most important and a fundamental change. It's also true that lawmakers have not prohibited new owners from concluding franchise agreements, and many have made use of this opportunity as well. Time will tell how things will be going forward, what transactions are made, and what obligations are taken on.
AK: You have previously seen in your work that everything is seemingly fine, but in reality, a wholesaler maintains a dominant influence over a pharmacist. In how many cases did the State Agency of Medicines suspect that something was off while formalizing documentation?
KR: In the course of this work, negotiations have been held, things have been explained with many businesses and the Competition Authority has also provided its own orders regarding pharmacy ownership. But as all of these things have been sorted out, the State Agency of Medicines has not had to refuse anyone.
AK: How many times has the State Agency of Medicines suspected that a pharmacist is a dummy owner?
KR: The contracts that have been forwarded to us have all been reviewed line by line, and they have all likewise been assessed by the Competition Authority.
AK: Have you also prohibited the concluding of any agreements?
KR: As everything that was initially unclear or pointed toward unclear terms has been sorted out, the State Agency of Medicines has not had to reject anything.
AK: You said earlier that time will tell what will come of franchise agreements signed right now. When might this clarity reach the pharmacy market?
KR: As all of these changes largely started taking place at the end of February, when the final bill to change the pharmacy reform was rejected in the Riigikogu, then everyone has had fairly little time. These things have clearly been done very quickly for business-owners too. Let's give them some time now to do their work and for new owners to start operating. They'll decide what steps they will continue with. They have been given the opportunity to arrange their own pharmacy services, achieve independence in their activity and, unlike before, stand up for their rights.
AK: While the fate of the pharmacy reform was yet unclear, it was said that the Apotheka chain, for example, had decided to distribute its pharmacies so that one pharmacist owns four pharmacies. That is how many pharmacies a pharmacist is permitted to own by law. How many such pharmacists are there?
KR: Most pharmacists have more than one pharmacy.
AK: Do most pharmacists find it reasonable to operate four pharmacies?
KR: We have all different variations, including the maximum four permitted pharmacies plus branch pharmacies.
AK: Now that the reform is ending, Karin Alamaa-Aasa, chairwoman of the board of the Estonian Chamber of Pharmacists, told daily Eesti Päevaleht (EPL) that the law needs to be changed. It would suffice, for example, if drugs were prepared on-site at just one of four pharmacies owned by a pharmacist. Is there anything else that should be reformed in the pharmacy sector in the near future?
KR: I am entirely certain that the Medicinal Products Act will be changed again. We don't yet know what direction it will take. But if they want to give pharmacists more freedom, there is still a lot that can be done. Lawmakers will now decide what direction things will go.
AK: What are you basing your opinion on that the law will be changed again, and what can be done to ensure that pharmacists are even more independent?
KR: Throughout this transition period, it was brought up that current pharmacist owners are renting space from companies tied to wholesalers. Does this make them dependent? We can certainly continue to discuss this issue. And there are more such variations. I believe that once new pharmacist owners have gotten used to this life somewhat, they themselves will come up with new ideas for the development of pharmacy services. That is actually why this entire pharmacy reform was taken on. I am very much looking forward to the new owners starting to offer up options for the development of pharmacy services. This was all entirely sidelined the entire time confusion abounded regarding the pharmacy reform.
AK: This may be an ignorant question, but how can a pharmacist be an independent owner if they have a franchise agreement and they are renting pharmacy space from a wholesaler?
KR: Yes, but we'll ask lawmakers these questions. This is what is permitted, and this is what has been done.
Editor: Aili Vahtla