Chain pharmacies take frustration out on clients

Photo: Mihkel Maripuu

The reaction of chain pharmacies to the Riigikogu’s decision from yesterday not to reverse Estonia’s pharmacy reform was swift and decisive. Almost 300 pharmacies belonging to the Estonian Pharmacy Association closed their doors from 2 p.m. after just one hour’s advance notice. The move baffled clients and presented Minister of Social Affairs Tanel Kiik with a perfect opportunity to say how such power plays are precisely why the reform is needed.

The protest most affected people looking to buy medical products. “We came to this particular pharmacy,” a woman said, standing behind the closed door of a Südameapteek pharmacy in the Sikupilli shopping center. A man who was with her said that the protest upended all of their plans and that they need to find a pharmacy that’s open as she has trouble breathing and needs her medicine on the same day.

The closed door of the Benu pharmacy located at the other end of the shopping center greeted a couple for whom it was the fourth one they tried. “We wanted to go to the pharmacy in Peetri, but it was closed. We went to another one before coming to Sikupilli. We don’t know what else to do, where else to go,” they said. “This is pretty sick. I need blood pressure medicine and sleeping pills. Where am I supposed to go?” another man who had arrived said angrily.

Other people approached by Postimees said that they were not affected by the protest. “We are not affected as we don’t have chronic illness in the family that would require us to frequent pharmacies,” a woman explained.

Pharmacies that closed their doors from 2 p.m. until the end of the day yesterday belonged to the Apotheka, Benu, Euroapteek and Südameapteek chains that are all members of the Estonian Pharmacy Association. The latter said the decision to close pharmacy doors was in protest to the Riigikogu rejecting a bill that would have overturned Estonia’s planned pharmacy reform in its current form.

Member of the board of the association Timo Danilov said the goal was to show what will happen when the pharmacy reform takes effect in its current form on April 1, 2020. Provided the pharmacist owners criterion remains. “It is the only way to draw attention to what is happening in the field of public health, especially as concerns availability of medicinal products from April 1,” Danilov said.

The protest sparked a reaction from Prime Minister Jüri Ratas (Center) who described closing pharmacies with so little warning as inadmissible. “It is extremely unfortunate when such methods are brought to bear. It is an inappropriate tactic for putting pressure on politicians and the public,” Ratas wrote on social media. Estonia was ravaged by storm winds at the same time pharmacies decided to close shop yesterday. “Manipulating the availability of a vital service at a time like this is unacceptable and irresponsible,” the PM added.

Lives endangered

Minister of Social Affairs Tanel Kiik (Center) said he has never seen anything as cynical in his ten years in politics. “The health and well-being of a lot of people is being placed in jeopardy, whatever the excuse,” Kiik said yesterday. He added that pharmacy chains will not defeat the government and parliament and that the protest is a telling example of why the reform is needed.

Head of the Estonian Competition Authority Märt Ots said the agency would analyze whether yesterday’s move violated the Competition Act. “It is an unfortunate incident and constitutes pharmacies walking on thin ice in terms of the Competition Act as all manner of specifically coordinated activity between different companies is reprehensible,” Ots said, pointing to signs of a cartel.

Danilov described the protest as a political demonstration by a nonprofit organization. “The association is very clear on what parties can and cannot do, which framework we followed to the letter. There are no agreements between companies involved,” he said.

The law requires a pharmacy that is closed to put up a sign with directions to the nearest alternative and its opening hours. Several pharmacies failed to comply yesterday, at least toward the beginning of the strike, and told clients to search the State Agency of Medicines’ website instead.

“Please accept my sincerest apologies for any inconvenience,” was Danilov’s message to clients of pharmacies belonging to the association.

Minister Kiik, who had not been warned of the protest before it started, quickly assembled a press conference yesterday that also attracted representatives of the pharmacy association and Katrin Altmets, head legal counsel for pharmaceuticals wholesaler Tamro, who asked why Kiik was reacting so painfully to the move.

New proposals

Reform deliberations are set to continue. The Ministry of Social Affairs presented its proposals for amending the reform to the Riigikogu Social Affairs Committee yesterday. “We presented our vision of a gradual entry into force of the reform,” Kiik said. Branch pharmacies that do not meet the reform’s criteria would be forced to close shop from April 1 only in the five largest cities. All general and branch pharmacies that do not meet the requirements elsewhere would be allowed to stay open.

January 2021 would see noncompliant branch pharmacies forced to close doors in all other cities, with general pharmacies allowed to stay open. Starting from January 2022, noncompliant pharmacies that do not have branch pharmacies in settlements with fewer than 4,000 residents would not be allowed to continue operating. The ministry’s plan would see the final entry into force of the reform in 2023 when only pharmacies that are owned by pharmacists and have no ties to pharmaceutical wholesalers would be allowed.

The ministry’s proposal would also give the State Agency of Medicines the right to release medicines directly to hospitals. “Continuity of service needs to be ensured for pharmacies in situations that are not emergencies but where medicinal products are not available to the population for whatever reason,” the proposal reads.

The ministry also wants to change the pharmacist ownership criterion to allow several pharmacists to jointly own a pharmacy in which case their stakes would need to total 80 percent.