New pharmacy reform plan full of wholesalers’ talking points

Photo: Lee Torrens / PantherMedia / Scanpix

“I’m very disappointed and sad,” pharmacist Liina Pääru says. “I have lived in knowing and hoping that the transitional period will end and I will be able to buy a pharmacy or pharmacies. Now I’m thinking about going into something else entirely.”

Yesterday noon saw major Estonian media houses receive a copy of draft legislation to rework Estonia’s planned pharmacy reform the authors refer to as an in-progress version. Changes included in the document apply the brakes to the recent reform plan from five years ago. What is more, the bill is so heavily influenced by preferences of current pharmacy chains that it cannot be ruled out it is a test to gauge the reactions of concerned parties and the public in the form of proposing an extreme bill. Pharmacy chains would emerge victorious even if only half of what has been proposed is achieved.

Authors’ words that the document is an in-progress version that lacks consensus in the coalition further supports the theory of at attempt at negotiating.

The bill has given representatives of chain pharmacies more than what they suggested. The latter have proposed leaving existing pharmacies in the hands of chains, while only allowing pharmacists to open new ones. Pharmacists saw the proposal as an attempt to close down the market as opposed to a compromise.

The latest bill would retain the current situation where owners are not obligated to sell to pharmacists. “If parties to the coalition look at each other and say these are the changes they want, these will be the changed made,” one of the authors of the text, member of the Riigikogu Social Affairs Committee Priit Sibul said.

The most optimistic scenario would see the in-progress version become an official bill next week. “If we have an agreement, we can hand it over to the parliament next week,” Sibul said.

Sibul’s fellow coalition member Tõnis Mölder (Center Party) remained far more restrained when what he said suggested the in-progress version is meant to test society’s pain threshold so the authors could take a step back if necessary.

“It is very difficult to predict whether and how the pharmacy reform will be changed. I cannot say there is a pharmacy reform debate before we have a final agreement and have sent the bill to the floor. It is also very difficult to say whether this document will ever reach the floor. The coalition will continue working on in-progress versions,” Mölder said.

The main thing abolished

In its current form, the new bill would abolish every single major restriction initially planned. Both the requirement of pharmacist owners and the vertical integration ban that would have prohibited pharmaceutical wholesalers from owning pharmacies.

The branch pharmacy ownership restriction, according to which no pharmacy owner could have stakes in more than four pharmacies in cities with over 4,000 residents, would also be dumped.

“The state is about to do something very stupid,” said Ain Raal, head of the University of Tartu Institute of Pharmacy. He said that there are only poor options. “The choice is between carrying out the reform for a horrible conclusion or perpetuating a horrible situation by opting for the alternative. The latter is folly. The problems with pharmacies are only just beginning.”

Minister of Social Affairs Tanel Kiik (Center) is also critical as the one responsible for the field. “A pharmacy is a healthcare institution and not a shop,” Kiik said yesterday. “The interests of patients and public health must always come first in the field of healthcare. That is why I continue to support the pharmacy reform as social minister,” he added.

Opposition MP Riina Sikkut (SDE) recalled how the idea of the pharmacy reform has been to maintain focus on pharmacies being a part of the healthcare system. “This recent proposal fails to solve a single problem or improve the healthcare system in any way. While it will make it easier for pharmacies to open so-called counters in smaller settlements. Nothing of the old reform’s goals has been retained,” Sikkut added. What is more, she believes the plan unveiled yesterday serves neither the healthcare system nor pharmacists. Considering that we have had a 4,5-year transition period, making a 180-degree turn just six months before the reform deadline is incomprehensible. “The latest bill clearly corresponds to business interests,” Sikkut found.

Members of the working group behind the new bill perceive several dangers in moving forward with the original reform plan. Politicians from all three coalition factions list a number of reasons why the reform needs to be stopped.

Here too, the said reasons are bafflingly similar to those given by the mouthpiece of pharmaceutical wholesalers, the Estonian Pharmacy Association. “It is surprising how easily the state caves when faced with wholesalers’ threats,” said Karin Alamaa-Kaas, head of the Estonian Chamber of Pharmacists.

Day of joy for chain pharmacies

Head of the Estonian Pharmacy Association Timo Danilov was in good spirits yesterday. “This solution will avoid a large number of pharmacies closing doors,” he claimed. “While I read the social minister’s opinion, today’s pharmacies are the most pharmacy-like they’ve been in the history of re-independent Estonia.”

The bill’s explanatory memo also reads that the reform taken forward could see up to 75 percent of pharmacies close doors. Alamaa-Aas said that is not true. “If the coalition reverses Estonia’s pharmacy reform, it will bring a robust consolidation of the pharmacy landscape. Competition will suffer, availability of medicinal products will suffer, pharmacies will increasingly come to operate in major cities, with the leading pharmacies currently owned by pharmacists either bought or forced out,” she said. “It is difficult to see how any of this could benefit the patient.”

That pharmacists have tried to buy pharmacies but had little success is also reflected in the experiences of Liina Pääru. She has made several attempts to buy an existing pharmacy but has had no luck. No one is selling.

“I was at least talking to one owner of a pharmacy, but as soon as talk emerged of the possibility of the reform being cancelled, they disappeared. You cannot buy something that is not for sale.”