Do online pharmacies fit European internal markets?

The aim of this article is to consider the suitability of online pharmacies into European internal market area. This required considering the models of present online pharmacies in respect to the existing legislation. Data on online pharmacy settings was collected by looking some online pharmacies, which were found by using Goggle search machine with term "online pharmacy" and by studying websites of some well-known online pharmacies. European legislation and policy were studied from European Union's official website. Online drug markets seem to be increasing in popularity for reasons related to their ready availability and cost benefits. Few online pharmacies are based in Europe, yet online markets are worldwide. Community legislation does not stipulate on the legality of online pharmacies on European internal markets. Instead Community legislation offers framework for electronic commerce that could also include online pharmacy practise. National legislation, however, may rule them out either directly or indirectly. Regardless of European internal markets online pharmacies' cross-border operations are particularly complicated. Preliminary ruling from the European Court of Justice concerning one European online pharmacy's cross-border practise is awaited 2003-2004 and will offer some aspects for future.     

Competition among pharmacies and the typology of services delivered: The Portuguese case

ObjectiveTo analyze the impact of individual and market characteristics (such as competition) on the typology of services delivered by a community pharmacy after a recent Portuguese pro-competitive regulatory change.MethodsIn this paper, market concentration indices are used to identify market competition groups in the sample. These competition groups are then described with regard to the typology of services on offer by pharmacies within the group. Finally, a system of structural equations is estimated to verify if the decision of a pharmacy to offer or not to offer each of the studied pharmaceutical services is affected by local market regulated competition.ResultsIn some cases, pharmacies belonging to different competition groups do not present significant differences in terms of the typology of services on offer, but according to our regressions, it seems that vaccines and medicines administration services, pharmaceutical care programmes and medicines management programmes are more likely to be offered in pharmacies located in higher competitive markets. These are also urban areas, in which there is already easy access to products sold in pharmacies, and to health services in general.ConclusionsAccess to additional pharmacy services may in some cases increase as market competition increases. Thus, pro-competitive regulatory measures may have led to an asymmetric distribution of pharmacy services across the country, favouring more competitive urban marketplaces. If policy-makers are interested in a more symmetrical distribution of pharmacies services all over the country, they are recommended to take action to ensure equitable access to these services.     

Do Higher-Priced Generic Medicines Enjoy a Competitive Advantage Under Reference Pricing?

Background: In many countries with generic reference pricing, generic producers and distributors compete by means of undisclosed discounts offered to pharmacies in order to reduce acquisition costs and to induce them to dispense their generic to patients in preference over others. Objective: The objective of this article is to test the hypothesis that under prevailing reference pricing systems for generic medicines, those medicines sold at a higher consumer price may enjoy a competitive advantage. Method: Real transaction prices for 179 generic medicines acquired by pharmacies in Spain have been used to calculate the discount rate on acquisition versus reimbursed costs to pharmacies. Two empirical hypotheses are tested: the discount rate at which pharmacies acquire generic medicines is higher for those pharmaceutical presentations for which there are more generic competitors; and, the discount rate at which pharmacies acquire generic medicines is higher for those pharmaceutical forms for which the consumer price has declined less in relation to the consumer price of the brand drug before generic entry (higher-priced generic medicines). Results: An average discount rate of 39.3% on acquisition versus reimbursed costs to pharmacies has been observed. The magnitude of the discount positively depends on the number of competitors in the market. The higher the ratio of the consumer price of the generic to that of the brand drug prior to generic entry (i.e. the smaller the price reduction of the generic in relation to the brand drug), the larger the discount rate. Conclusions: Under reference pricing there is intense price competition among generic firms in the form of unusually high discounts to pharmacies on official ex-factory prices reimbursed to pharmacies. However, this effect is highly distorting because it favours those medicines with a higher relative price in relation to the brand price before generic entry.     

Separating online piracy from counterfeit medicines: The need for policy reform and a call to action

The recent public backlash against proposed federal anti-piracy legislation provides important lessons regarding promoting public policy for public health and patient safety online. Anti-piracy legislation contained many novel regulatory strategies that may have had an impact on combating counterfeit medicines sold by online pharmacies, but was derailed due to non-health related considerations and concerns about intellectual property rights protection. Instead, effective policy to regulate online pharmacies needs to focus on health and patient safety issues separate from intellectual property considerations to combat this online crime.     

Competition in the off-patent medicine market in Spain: The national reference pricing system versus the regional system of tendering for outpatient prescription medicines in Andalusia

Spain has a reference price system (RPS) for off-patent medicines since 1997. In addition, from 2012, Andalusia is running a series of tenders for procuring off-patent medicines dispensed by community pharmacies, for those medicines included in the system of homogenous clusters within the national reference price system. Such tenders offer additional savings to the regional payer – in the form of rebates (“economic improvements”) from companies winning the tender. This paper estimates that the regional savings were between €43 M to €54 M over the period of study (April – September 2015). The paper also estimates that Spain could have made between 14 and 17 times higher savings than the national reference pricing system savings, had the Andalusian-type tender been implemented at national level over the same period of study. Based on our analysis, we have four remarks. First, the national RPS in Spain is not generating enough price competition for off-patent products dispensed in primary care pharmacies. Second, tenders can be a useful way to generate competition and financial savings in the off-patent market. Third, tenders can lead to discounts offered by medicine providers being redistributed from pharmacies to payers. And fourth, before implementing a national tender in Spain, several key issues need to be addressed to ensure it provides the right incentives both in the short and long run.     

Marketing and pricing strategies of online pharmacies

Internet and e-commerce have profoundly changed society, the economy, and the world of health care. The web offers opportunities to improve health, but it may also represent a big health hazard since it is a basically unregulated market with very low consumer protection. In this paper we analyze marketing and pricing strategies of online pharmacies (OPs). Our analysis shows that OPs use strategies that would be more suitable for a commodity market than for drugs. These strategies differentiate according to variety (brand or generic), quality, quantity, and target group. OPs are well aware that the vacuum in the legislation allows them to reach a target of consumers that pharmacies cannot normally reach, such as those who would like to use the drug without consulting a physician (or, even worse, against the physician's advice). In this case, they usually charge a higher price, reassure the users by minimizing on the side effects, and induce them to bulk purchase through sensible price discounts.This analysis suggests that the selling of drugs via the Internet can turn into a “public health risk”, as has been pointed out by the US Food and Drug Administration.     

A mixed-method study of community pharmacy staff's use,perceptions and acceptance of barcode scanning technology: Pharmacy's experience of scanning technology

IntroductionIncreasing technology is a strategic goal within pharmacy to facilitate medicines’ dispensing. Barcode scanning technology (BST) is considered low cost and reliable with potential safety benefits. A barrier to BST implementation within hospital pharmacy includes staff resistance; however, few studies explore BST within community pharmacy. To address this, pharmacy staff's use, perceptions and acceptance of BST within Scottish community pharmacies were examined.MethodsCommunity pharmacies within Scotland using BST to scan medicines were identified using Twitter, eNewsletters and snowball sampling; 57 pharmacies were identified. Between May-Aug 2019, managers/owners participated in semi-structured interviews to explore BST use, and staff operating BST completed an online questionnaire to examine perceptions and acceptance. Interview data underwent content analysis and questionnaire data presented as medians (IQR).ResultsBST was used for various purposes, most commonly for dispensed item verification (n = 43 pharmacies) and to identify falsified medicines (n = 10 pharmacies). Twenty pharmacy managers/owners were interviewed which revealed multiple scanners and BST functionalities. Thirty-five participants from 16 pharmacies participated in the questionnaire. Staff considered BST as easy to use. There were positive perceptions and acceptance of BST for dispensed item verification, and negative perceptions and less acceptance of BST for identifying falsified medicines.DiscussionBST implementation was identified in a minority of Scotland's 1,254 community pharmacies, and greater effort may be needed to increase technology utilisation. The variation of BST use may affect safety due to increased complexity. BST's purpose may underpin staff perceptions and acceptance. Future studies should explore barriers and observe BST use in practice.Public interest summaryBarcode scanning technology (BST) may help pharmacy staff to dispense medicines safely. Hospital pharmacy staff have reported disliking using BST to scan medicines; however, no similar research has been carried out within community pharmacy. This study examined Scottish community pharmacies’ use of BST to scan medicines, and the pharmacy staff's views. Fifty-seven pharmacies were identified. BST was most commonly used to verify that the correct medicine was selected during dispensing (n = 43 pharmacies) and to identify ‘falsified medicines’ which were not safe to dispense (n = 10 pharmacies). Staff considered BST as easy to use, but were more positive and accepting of BST for verifying the correct medicine than for identifying falsified medicines. This suggests BST's purpose may underpin pharmacy staff perceptions and acceptance. A small number of pharmacies in Scotland used BST for this purpose, therefore more efforts may be needed to promote technology use.     

Advice-giving in community pharmacies in the UK

OBJECTIVES: To review (1) the published evidence on the information provided with prescribed and purchased medicines by pharmacists and pharmacy assistants, (2) clients' expectations of advice about medicines from community pharmacies and their experience and use of it, and (3) appropriateness and rigour of study methods used. METHODS: Papers, published between 1980 and 1995 inclusively, were identified based on searches of on-line databases, a published literature index, key pharmacy practice journals and cited references in the bibliographies of published papers. Those papers selected reported research findings on any aspect of medicines-related communications and the provision of advice about medicines to members of the public who visited pharmacies in the UK. The comparatively small volume of work and lack of design consistency meant that a subjective assessment, rather than a criteria-based objective review, was deemed appropriate. RESULTS: Forty-two suitable studies were identified and are reviewed. No common definition of 'advice' has emerged. Most studies reported were quantitative, concentrating on the frequency of advice-giving in community pharmacies and only one study considered the impact of advice on outcome. The quality of advice given was judged highly variable, although pharmacists' referrals, where made, were considered appropriate. Given that pharmacy assistants appear to make most of the medicine sales, remarkably few studies addressed their contribution to advice-giving. The review can provide little insight into what determines when advice is provided, but it does illuminate the disparity between the advice that clients say they want and what they actually seek. CONCLUSIONS: Where there appears to be a consensus that advice-giving in community pharmacies is wanted, this review reveals a lack of shared understanding between consumer bodies and the pharmacy profession about who needs advice and when and how it should be given. The need for unsolicited advice-giving associated with the sale of medicines is particularly contentious. With the current programme of deregulation of medicines, this is an increasingly important issue to resolve. The authors suggest a need for a consensus-building forum to generate guidelines that meet shared expectations between clients, community pharmacists, government and the pharmaceutical industry.     

药店在政府激励性管制下的战略选择——基本药物制度的视角

2009年8月18日,307种药物进入基本药物目录,这是政府在推进基本药物制度坚实有力的一步。药品零售市场是一个极具潜力的市场,但由于有医保定点药店的存在,中国的药品零售市场是一个相对较弱的垄断市场。基本药物制度是政府在推进新医改过程中的激励性管制,有利于整合药品零售市场的资源,增加了药店经营的自主性,但是在价格和进入机制方面设立了障碍。在这种政府激励性管制的形势下,药店在经营过程中应该从多元化、更加注重药学服务和与社区医疗和上游的处方药供应商建立良好的关系等方面做出自己的战略选择。     

武汉市公立医院药品价格水平实证研究

目的了解武汉市公立医院的药品相对价格水平,揭示药品市场现存的问题。方法选择全国市场销售排名前100位的药品全部纳入研究样本,收集武汉市12家公立医院和14家零售药房的药品价格数据,对定量资料进行统计分析,对公立医院间及其与零售药房间的药品价格进行差异性比较。结果公立医院的药品均价高于零售药房同商品名药品的均价;公立医院间同商品名的药品均价差异不显著,但同通用名的药品价格差异有较大的波动性。结论与建议进一步建立健全药品监管制度,加快削弱公立医院的垄断地位,严格药品招标采购管理,建立健全国家基本药物制度。