This presentation by Sabine Vogler was made at the 2014 Global Forum on Competition (27-28 February) during the session on competition issues in the distribution of pharmaceuticals. Find out more at http://www.oecd.org/competition/globalforum

1. Liberalization in the pharmacy sector
Sabine Vogler
WHO Collaborating Centre for
Pharmaceutical Pricing and Reimbursement Policies
Gesundheit Österreich / Austrian Health Institute
Head of Pharma Team
PPRI Project Manager
Head of WHO Collaborating Centre for Pharmaceutical Pricing and Reimbursement Policies
OECD Global Forum on Competition:
Competition Issues in the Distribution of Pharmaceuticals
Paris, 28 February 2014

2. Disclaimer and acknowledgements
The information and data provided in this presentation was
collected and analyzed by the WHO Collaborating Centre for
Pharmaceutical Pricing and Reimbursement Policies. This is not a
publication of WHO. The presenter is responsible for the views
expressed in this presentation, and they do not necessarily
represent the decisions and policies of the World Health
Organization.
Credits go to the members of the team members in the WHO
Collaborating Centre for Pharmaceutical Pricing and
Reimbursement Policies, particularly to Danielle Arts, Katharina
Habimana and Claudia Habl who worked with the presenter on
the issue of distribution of medicines and liberalization in the
pharmacy sector.
Information used from this presentation has to be correctly
quoted. Commercial exploitation is forbidden.
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3. Outline
» Components of liberalization in community
pharmacy in European countries
» Impact of liberalization in community
pharmacy on medicine prices
» Impact of liberalization in community
pharmacy on accessibility of medicines
» Conclusions
3

4. Methods
» Experiences of European countries which
liberalized the pharmacy sector
» Literature review as of December
2013, including grey literature
» Two previous studies on this topic
4

5. Components of liberalization in com. pharmacy
» Regulation related to the establishment of
new pharmacies
» Ownership regulation
» Sale of OTC medicines outside pharmacies
5

6. Expectations linked to liberalization in c. pharmacy
» Increased accessibility
(more pharmacies and OTC retailers, opening
hours, product range/services)
» Lower medicine prices
» Concerns about deterioration in quality of
pharmacy services
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7. Impact of liberalization on medicine prices
European countries:
» Medicine prices are usually regulated at all price
levels, at least for reimbursable medicines –
independently from the extent of liberalization in
pharmacy
» Impact of liberalization could only be expected for
areas where there is free pricing  non-reimbursable/
OTC (Over-the-Counter) medicines
» Few price studies on OTC medicines
» The identified price surveys could not confirm a
decrease in OTC medicine prices after a liberalization
in the community pharmacy
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8. Impact of liberalization on accessibility/1
» Increase in the number of pharmacies (and OTC
retailers) immediately after liberalization
Sweden
1300
1200
1100
1000
900
800
700
1999
2007
2009
number of pharmacies
2011
2012
Norway
750
700
650
600
550
500
450
400
350
300
250
1990 1995 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
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9. Impact of liberalization on accessibility/2
» Little or no improved accessibility in remote areas
»
Pharmacies: 6% of the new 330 pharmacies are located in areas of
medium accessibility and no new pharmacies in areas of low or very
low accessibility
»
OTC retailers: 4% of the new OTC retailers in areas of low or very
low accessibility
» Other incentives and regulation are required for rural
areas
» Indications for longer opening hours
» Vertical integration  indications for an alignment of
the product range to owners
» Indications for limited product range
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10. Conclusions
» Liberalization in the pharmacy sector does not always
fully meet the expectations
» No evidence for price competition of non-regulated
OTC medicines in the surveyed countries (all of them
with publicly funded HC)
» Accessibility in terms of the number of pharmacies
has improved, but adverse effects related to equitable
access might occur
» Some findings (e.g. distortion of competition due to
unbalanced market power, uneven accessibility of
medicines) are likely be relevant for countries with
less regulated or non-regulated pharmacy sector
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11. Thank you for your attention!
Sabine Vogler
Stubenring 6
1010 Vienna
T: +43 1 515 61-147
F: +43 1 513 84 72
E-mail: sabine.vogler@goeg.at
www.goeg.at
http://whocc.goeg.at