Currently, hospitals in Estonia must purchase medicines only from local wholesalers, but the proposed legal amendment would allow them to buy directly from foreign sources. The Ministry of Social Affairs hopes this change will increase competition in the pharmaceutical market, potentially lowering drug prices for hospitals.

"This is a good opportunity for us to try to bring certain medicines in more quickly, try to obtain them directly. We have had experiences where time constraints play a very critical role for us," said Kristjan Kongi, head of the pharmacy at the North Estonia Medical Center.

"It's not always about contractual products, but rather urgent, novel medicines where a patient's life may be at stake," Kongi added.

While hospitals have long awaited this amendment, various representatives of pharmacies, pharmacists and pharmaceutical wholesalers oppose it. According to Kongi, considering the state of the Estonian pharmaceutical market, this opposition is hardly surprising.

"There are three major concerns from the wholesalers' perspective. The first relates to the broader funding of healthcare and the state budget. The entry of hospitals into the wholesale market, which this bill essentially allows, means that public funds will be used in a sector where the private market actually functions," commented Teet Torgo, executive director of the Estonian Pharmaceutical Wholesalers Association.

Although hospitals would be allowed to sell certain medicines, Torgo noted that they would not be subject to many of the obligations that apply to wholesalers, including the requirement to maintain a stock of medicines.

"Otherwise, we end up in a situation where hospitals, acting as wholesalers but not adhering to wholesale rules and lacking supply obligations, can engage in cherry-picking. For existing wholesalers, this increases market uncertainty, ultimately leading to a situation where no one knows who is responsible for supplying a medicine if it becomes unavailable," Torgo explained.

The Estonian pharmaceutical market is currently dominated by two major companies. According to Evelin Pärn-Lee, head of the Competition Authority, any change that helps to open up this market is welcome.

"It can't be bad if we talk about the European Union's internal market and say that other pharmaceutical wholesalers operating within the EU should also be able to offer their medicines to Estonian hospital pharmacies. My logic says that if there are more suppliers, it should also affect prices," Pärn-Lee stated.

According to Pärn-Lee, this could lead to lower medicine prices. However, it is important to monitor the situation to prevent a "waterbed effect," where discounts for hospitals might lead to higher prices in regular pharmacies.

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