Pharmacy reform, 3 years later — success or not?

Pharmacy in Tallinn.
Pharmacy in Tallinn. Source: Siim Lõvi/ERR

April 1 will mark three years since the entry into force of Estonia's nationwide pharmacy reform, which was aimed at making pharmacies independent of drug wholesalers. Looking back over the past three years, however, there are mixed opinions regarding whether the reform was a success or not.

Kaidi Sarv, chief pharmacist at the Estonian Pharmacists' Association (EAL), said that based on the objectives set for it, the pharmacy reform implemented nearly three years ago now seems to have been a success.

Yet many unanswered questions remain, such as how many pharmacies are actually pharmacist-owned and how many only appear to be.

"For example, the director and owner of the pharmacy has the company through which a pharmacy operates — that is theirs — but everything in the pharmacy, for example, and the space where the pharmacy operates are the property of a wholesaler or a person connected to one," Sarv explained. "Is that still full independence, or do they depend on a wholesaler?"

The EAL is of the opinion that situations like the one described still constitute dependency.

Juhan Põldroos, director of the Supervisory Department of the Competition Authority, likewise said that a considerable number of pharmacies still have franchise agreements in place with drug wholesalers, and that from a competition policy perspective, the pharmacy reform has not achieved its targets.

"The ownership reform has led to a situation where a new wholesaler would have a very difficult time entering the market, as they would then have to find pharmacies not already under franchise as well as some pharmacists who are willing to work with them, but in this case it would be very difficult to do," Põldroos explained.

Nonetheless, Sarv said that the pharmacy reform was an absolutely essential step without which there wouldn't have been any chance of changing course on the pharmacy market.

"This pharmacy reform, i.e. increasing pharmacists' independence, increasing their decision-making powers — it actually provided the opportunity to play a greater role in primary healthcare and be better integrated as well," she highlighted.

The same approach has been outlined in the recently completed foundations of drug policy as well.

According to the association's chief pharmacist, some 20 pharmacies were closed from 2018-2023. This figure is confirmed by a State Agency of Medicines overview as well.

Liis Prii, director of the Department of Supervision at the State Agency of Medicines, highlighted that in rural areas, for example, compared with pre-reform numbers, just one pharmacy has been closed. Thus from an accessibility perspective, Prii believes the reform can be considered a success.

"Based on which we can conclude that the number of pharmacies has not decreased in small settlements," the department director said. "No significant changes in the locations of pharmacies have taken place either. Pharmacies have been closed and opened, but pharmacy service access has nonetheless been preserved in the majority of settlements. Quite a few online pharmacies have cropped up as well which serve the entire country."

Prii added that the reform's other objective, to make pharmacies more patient-focused and higher quality, will take place over a longer period. She noted, however, that it can already be said that counseling services have already improved as well.

"If prior to the pharmacy reform there were concerns regarding counseling in as many as nearly 15 percent of inspected cases, by last year, for example, counseling was found to be inadequate at 2.6 percent of pharmacies we inspected, and this improving trend has kept up throughout these three years."


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Editor: Aili Vahtla

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