Download - ABOUT THE ABDA
ABOUT THE ABDA
» The ABDA – Federal Union of German Associations of Pharmacists is the foremost organisation for
pharmacists in Germany. The ABDA represents the interests of the pharmaceutical healthcare professions
in politics and society while promoting high-quality, comprehensive pharmaceutical care in Germany.
» The ABDA has 34 members: 17 regional chambers of pharmacists and 17 regional associations of
pharmacists – one from each of Germany’s 16 federal states plus an additional representative from
North Rhine-Westphalia which has been divided into North Rhine and Westphalia-Lippe due to its size.
» The 17 chambers of the Federal Chamber of Pharmacists (BAK) and the 17 associations in the German
Pharmacists’ Association (DAV) are combined under one roof in ABDA. Membership in the Chamber of
Pharmacists is mandatory for all pharmacists while membership in associations for pharmacy owners,
on the other hand, is voluntary.
» ABDA’s Executive Board is composed of 13 members: the president, the vice president, an employed
pharmacist from a community pharmacy along with five members each from the BAK and DAV
executive boards.
» The annual general assembly for pharmacists takes place once per year as part of German Pharmacist Day.
The annual general assembly is used to form political positions. Its resolutions are binding for the ABDA
committees’ actions.
» The offices of ABDA, BAK and DAV are in Berlin and are run by the general manager. In addition to the
four business areas, a) pharmacy, b) pharmaceuticals, c) economics and d) law, there are staff positions
for a) finances, personnel and administration, b) communications and c) European affairs.
» European representation for ABDA is headquartered in Brussels (Belgium) and is responsible for represent-
ing its interests in European Union (EU) institutions.
» The ABDA is a member of the German Federation of Independent Professionals (BFB), the Pharmaceutical
Group of the European Union (PGEU), and the International Pharmaceutical Federation (FIP).
» The ABDA receives professional support from many institutions, including the Drug Commission of German
Pharmacists (AMK), the German Institute for Drug Use Evaluation (DAPI) as well as the Central Laboratory of
German Pharmacists (ZL).
PHARMACIES IN GERMANY
» The red pharmacy A (with chalice and snake) is the identifying symbol for community pharmacies in Germany.
This registered trademark of the German Pharmacists Association (DAV) enjoys special legal protection
throughout Germany and Europe.
» In order to work as a pharmacist in Germany, one must study for 5 years at university: 2 years each of basic
and main studies and 1 year of practical training. Each course of study ends with a state examination. Upon
successful completion, one must apply for a license to practice pharmacy, which is authorisation to exercise
the profession.
» Pharmacists with a foreign pharmaceutical diploma or certificate need to have it recognised prior to starting
to work. There is a responsible authority for the recognition in every federal state. The responsible authority
will check the equivalency level of the qualification. If there are significant divergences in the qualification,
the responsible authority might propose measures to compensate the gaps. Moreover, applicants need to
give proof of their language skills in German. Additionally, citizens from outside the European Union (EU) or
the European Economic Area (EEA) will need a work and residence permit and eventually a visa for entry,
residence and employment in Germany.
» Pharmacists in Germany are not only part of the healthcare professions (like doctors) and freelance
professions (such as architects), but also pharmacy owners which means they are also merchants who
are therefore required to pay business taxes.
» Freedom of establishment has been created for pharmacists in Germany. According to this principle, a
pharmacist may establish a pharmacy anywhere and anytime, provided that he complies with the law.
This also means that no pharmacist is protected from unwanted competition in the vicinity.
» In Germany, the owner / operator of a pharmacy must always be a pharmacist. This third-party ownership
ban emphasises a pharmacist’s personal responsibility and liability – and decouples the provisioning of
pharmaceuticals from corporate profit goals.
» The ownership of multiple pharmacies is forbidden in Germany. However, a pharmacist may, in addition to the
main pharmacy, operate up to three subsidiary pharmacies in the nearby local vicinity. Each of these locations
must also have a pharmacist in place as subsidiary manager. There are no pharmacy chains in Germany.
» Selling pharmaceuticals via mail order is allowed in Germany. Approved mail order pharmacies are “normal”
community pharmacies with a special mail order permit. According to a list from the Federal Ministry of
Health, the mail order trade is also allowed from a few other European countries.
» Prices for prescription-only pharmaceuticals are uniform nationwide; this is stipulated by the Drug Price
Ordinance to protect patients and pharmacists. Since the Pharmacy Strengthening Act (VOASG) came into
force in December 2020, mail order pharmacies have been prohibited from offering discounts on prescrip-
tion drugs to SHI-insured patients. The amendment to § 129 German Social Code V (SGB V) thus restored
equal pricing / nationwide fixed prices between community pharmacies and mail order pharmacies. In con-
trast, all pharmacies are free to set their own price for non-prescription medications.
» The pharmacist’s fee for consultation on a prescription medication is regulated by the Drug Price Ordinance.
Broadly speaking, this is a fixed fee of 8,35 euros per package. Each pharmacist may calculate their own
fee for non-prescription pharmaceuticals.
» Pharmacists in Germany assume an obligation for the common good of society. This is not individually
remunerated but, rather, it is individually subsidised. This includes creating formulations, dispensing
narcotic substances and performing comprehensive evening and emergency services.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 32
LOWER SAXONY
BREMEN
WESTPHALIA-LIPPE
NORTH RHINE
Düsseldorf
HanoverMünster
Bremen
Hamburg
Kiel
Schwerin
Berlin
Potsdam
Dresden
Erfurt
Munich
Stuttgart
Saarbrücken
Wiesbaden
Mainz
Magdeburg
RHINELAND-PALATINATE
SAARLAND
BADEN-WUERTTEMBERG
BAVARIA
THURINGIAHESSE
SAXONY
BRANDENBURG
MECKLENBURG-WESTERN POMERANIA
SCHLESWIG- HOLSTEIN
NORTH SEA
THE NETHERLANDS
BELGIUM
LUXEM-BOURG
FRANCE
SWITZERLAND
AUSTRIA
CZECH REPUBLIC
POLAND
DENMARKBALTIC SEA
HAMBURG
SAXONY-ANHALT
BERLIN
MAP OF GERMANY “APOTHEKE 2030” PERSPECTIVE PAPER
» The policy paper “Pharmacy 2030 – Perspectives on provision of pharmacy services in
Germany” (“Apotheke 2030”), was adopted by a vast majority on German Pharmacist Day
2014 in Munich. This was preceded by an opinion-forming process in which several
thousand pharmacists participated over the course of an entire year.
» The preamble reads as follows: “Pharmacists in Germany are experts in pharmaceuticals.
Based on this core competency, they make an indispensable contribution to patients’
well-being in outpatient care. As freelance health professionals, they carry out their legal
mandate of comprehensive pharmaceutical provisioning to the German public via public,
owner-operated pharmacies.”
» The healthcare system in Germany faces great challenges such as demography, a lack of
professionals and financial pressure on resources. Therefore, for the benefit of our patients,
the healthcare role of the pharmacy must be actively defined so that healthcare may
maintain a key role in the future as well.
» “Apotheke 2030” describes how the pharmacy’s role and range of services should be
advanced as a pillar of the healthcare system. Essentially, it concerns ways in which phar-
macies may strengthen their role in healthcare while collaborating as part of a network with
doctors and other specialised professionals thus making true medication management for
patients possible.
» Three issues are at the forefront when strategically implementing the document: First,
pharmacists must define the correct way in which to systematically implement medication
management. Secondly, provisioning frameworks must be adapted for the future. Thirdly,
pharmacists must determine what the future holds regarding pharmacist qualification
(education, advanced and continuing education).
» Pharmacies in Germany wish to continue offering medication management as a crucial
instrument for safe, effective and economical pharmaceutical therapy in the future. In so
doing, all of a patient’s medication, including self-medication, will be continually analysed.
The goal is to avoid, detect, and solve problems related to pharmaceuticals and, in so
doing, increase the effectiveness and efficiency of pharmaceutical therapy.
» Pharmacists wish to collaborate collegially both among each other and with other health-
care professions as part of a healthcare network. Pharmacies will actively co-design the
healthcare network with clearly defined competencies and interfaces. As an integral com-
ponent of the network, they will assume responsibility for pharmaceuticals, the safety of
pharmaceutical therapy and the optimization of practices.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 54
CONTENTS
PHARMACIES’ PROVISION, SUPPLY AND SERVICES
Overview of Patient Care and Services .................................................................................................................. 9
Pharmacies in the Pandemic Response .............................................................................................................. 10
Night-Time and Emergency Service ..................................................................................................................... 12
Formulations ....................................................................................................................................................... 14
Standard Formulations ........................................................................................................................................ 15
Delivery Services ................................................................................................................................................. 16
Digital Pharmacy ................................................................................................................................................. 17
Telematics Infrastructure and the e-prescription .................................................................................................. 18
PHARMACY LANDSCAPE
Number of Pharmacies ........................................................................................................................................ 19
Number of Pharmacies by German Federal State ............................................................................................... 20
Geographical Coverage ....................................................................................................................................... 21
Subsidiary Structure ........................................................................................................................................... 22
Specific Types of Pharmacies .............................................................................................................................. 23
Mail Order Trade ...................................................................................................................................................24
EMPLOYMENT IN PHARMACIES
Number and Age of Pharmacists ......................................................................................................................... 25
Jobs in Pharmacies ............................................................................................................................................ 26
Personnel Planning .............................................................................................................................................. 27
Trainee Positions in Pharmacies ......................................................................................................................... 28
Pharmacy Students and Approbations ............................................................................................................... 29
Places of Study ................................................................................................................................................... 30
Continuing Professional Education and Postgraduate Specialisation ................................................................... 31
PHARMACEUTICALS IN GERMANY
Pharmaceuticals Approved in Germany ............................................................................................................... 32
Pharmaceutical Price Index ................................................................................................................................ 33
Pricing for Pre-Packaged Pharmaceuticals ......................................................................................................... 34
Pricing for Standard Formulations ...................................................................................................................... 35
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE
Breakdown of Total SHI Expenditures ................................................................................................................ 36
Miscellaneous Health Insurance Fund Expenditures ............................................................................................ 37
SHI Expenditures for Pharmaceuticals ............................................................................................................... 38
Pharmaceuticals by Price Classes ....................................................................................................................... 39
Pharmacy and Manufacturer Markdowns ............................................................................................................ 40
Rebate Pharmaceuticals ...................................................................................................................................... 41
Patient Co-Payments .......................................................................................................................................... 42
Co-Payment Exemptions .................................................................................................................................... 44
QUALITY ASSURANCE
Guidelines and Working Aids .............................................................................................................................. 45
AMK: Reporting of Pharmaceutical Risks ............................................................................................................ 46
Management of Delivery Shortages .................................................................................................................... 48
Consequences of Delivery Shortages ................................................................................................................. 50
Quality Assurance of Formulations ...................................................................................................................... 52
securPharm ........................................................................................................................................................ 53
Challenges Involving Polymedication .................................................................................................................. 54
Risks Involving Pharmaceutical Misuse ............................................................................................................... 56
SPECIFIC COVERAGE AREAS
Pharmaceuticals for Serious Illnesses ................................................................................................................. 58
Pharmaceuticals with Specific Requirements ...................................................................................................... 59
Antibiotics .......................................................................................................................................................... 60
Antidiabetics and Blood Sugar Test Strips ........................................................................................................... 61
Pain Relievers ...................................................................................................................................................... 62
Consultation-Intensive Pharmaceuticals .............................................................................................................. 63
Medical Cannabis ................................................................................................................................................ 64
OTC Pharmaceuticals: Leading Indication Areas ................................................................................................. 65
Non-Prescription Pharmaceuticals: Special Treatment Services and Therapies .................................................. 66
Green Prescriptions ............................................................................................................................................. 67
Dispensing of Contraceptives ............................................................................................................................. 68
Substitution Therapy .......................................................................................................................................... 69
Provision of Medical Aids and Bandages ............................................................................................................. 70
Vaccines .............................................................................................................................................................. 71
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 76
OVERVIEW OF PATIENT CARE AND SERVICES
Pharmacies have the legal mandate to ensure the provision of pharmaceuticals to the population. This affects
every single pharmacy, but also the nationwide distribution of all pharmacies throughout Germany. As well as
providing pre-packaged medications, pharmacies fulfil obligations to the common good, such as night-time and
emergency services or the preparation of formulations.
Source: ABDA statistics, Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH, infas Institut für angewandte Sozialwissenschaft, marpinion GmbH
18,753 community pharmacies provide medication to the population in
Germany.
1 billion patient interactions in community pharmacies every year.
3.3 million patients are served in community pharmacies each day.
300,000 courier deliveries are performed daily.
6 million industrially manufactured pharmaceuticals are inspected
by pharmacists annually.
88 % of patients who regularly take three or more medications usually
patronize the same pharmacy.
83 % of German citizens trust and have confidence in their pharmacist.
93 % of Germans say they are satisfied, or even very satisfied, with their
local pharmacies.
OPERATING RESULTS
Pharmacies by Sales Revenue Categories .......................................................................................................... 73
Operating Results of the Average Pharmacy ....................................................................................................... 74
Development of Pharmacy Remuneration ........................................................................................................... 75
Future Expectations of Pharmacies ..................................................................................................................... 76
Pharmacy Operation and Investment ................................................................................................................... 79
Sales Structure and Dispensed Packages ........................................................................................................... 82
Supplementary Products Commonly Found in Pharmacies ................................................................................ 85
PHARMACIES AND EUROPE
Professional Language Proficiency Exams for Foreign Pharmacists ................................................................... 86
Pharmacy-Related Legal Stipulations in Europe ................................................................................................. 88
Pharmacy Density in Europe .............................................................................................................................. 90
Value-Added Tax on Pharmaceuticals ................................................................................................................. 91
Comparison of Countries: Vaccination in Pharmacies .......................................................................................... 92
LEGAL NOTICE
The following may contain variations in totals due to the rounding of figures.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 98
PHARMACIES’ PROVISION, SUPPLY AND SERVICES
VERSORGUNGSLEISTUNGEN DER APOTHEKEN
PHARMACIES IN THE PANDEMIC RESPONSE
Since the beginning of the Corona pandemic in spring 2020, public pharmacies in Germany have not only
continued to ensure that the nation’s medicinal needs are met but have also taken on several additional tasks.
These not only include protecting against new infections, but also things such as providing home delivery to
patients in home quarantine. Delivery services, disinfection, protective masks, rapid tests, and vaccines – these
represent only a part of the wide and partially new range of services for pharmacies during this pandemic.
Pharmacies were able to adapt to major legal mandates, often within days, to best support their patients
during these difficult times.
Source: ABDA statistics, Apothekenklima-Index 2020 (marpinion GmbH), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH,
infas Institut für angewandte Sozialwissenschaft GmbH
Source: ABDA statistics, Apothekenklima-Index 2020 (marpinion GmbH), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH,
infas Institut für angewandte Sozialwissenschaft GmbH
450 thousand
Delivery services per day (+50 percent) were
performed by local pharmacies during the
first wave of the pandemic in March 2020
to reduce personal contacts.
99.8 percent
of pharmacies were on duty. At the end of
April 2020, only 30 of 19,000 pharmacies
had been forced to close temporarily due to
possible infection among the staff.
16.7 million
unavailable rebate-contract medications
were substituted with replacement
preparations by pharmacists in 2020.
The true scope of the supply
bottlenecks is even larger. 40.6 percent
less time has been spent by pharmacies on the
management of delivery shortages since the start of
the pandemic and the loosening of legal requirements
for dispensing of rebate-contract medications.
25 percent
more revenue with SHI (statutory health
insurance) prescriptions in March 2020
because many patients secured supplies
of their vital medications before the first
lockdown. As a result, sales were lower than
usual in May and June.
19.3 million
doses of flu vaccine were delivered
by pharmacies to physicians and medical
specialists in 2020. The 2019 / 2020 season
ended late and vaccinations began early
in 2020 / 2021.
At least 1 million
doses of corona vaccines per week
have been distributed by pharmacies to
doctors’ practices since Easter 2021 –
at a growing rate, and generally
without any problems.
1,200 pharmacies
perform free-of-charge rapid corona
tests – they can all be found
according to city and postal code at
www.mein-apothekenmanager.de
(April 2021).
510 million
FFP2 protective masks for 34 million
people were procured, prepared and
distributed. Pharmacies were given
this supply mandate between
15 December 2020 and 15 April 2021.
11.0 percent
is the minimum amount of working
time pharmacy employees spend
managing delivery shortages.
5.1 million
litres of disinfectant were produced by the
pharmacies themselves between March and
May 2020 to cover delivery shortages of
industrial products.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 1110
PHARMACIES’ PROVISION, SUPPLY AND SERVICES PHARMACIES’ PROVISION, SUPPLY AND SERVICES
Night-time and Emergency Service Shifts in 2020 450,000
of these full shifts (8 p.m. to 6 a.m.) 400,000
partial shifts 50,000
Open Pharmacies per Night-time and Emergency Shift 1,200
Patients Served per Night-time and Emergency Shift 20,000
The performance of emergency and night-time services by each pharmacy varies. This is shown by an example
taken from the state of Bavaria: a pharmacy in the city of Munich has 14 shifts annually. During the same period,
one in the comparatively rural community of Rothenburg performs these services more than 70 times.
NIGHT-TIME AND EMERGENCY SERVICE
Night-time and emergency services are one of the most important services performed for the common
good of society. The chamber of pharmacists responsible for each region regularly defines and assigns these
service duties to each pharmacy according to need. Pharmacies receive financial assistance for the additional
expenditure from the Emergency Service Fund of the German Pharmacists’ Association, which is financed by
the addition of a surcharge on each package of prescription medication dispensed. Apothekenfinder 22 8 33
is a service which helps patients to quickly and easily find the nearest available (emergency) pharmacy.
Source: Night-time and Emergency Service Fund, aponet.de, German Institute for Drug Use Evaluation (DAPI)
Prescriptions without Emergency Service Fees for SHI Insured 2020
Many patients visit pharmacies during night-time and emergency service hours because of urgent self-
medication needs (e. g., “morning-after pill”) or to fill prescriptions. These include, for instance, private
prescriptions or pink prescriptions charged to the SHI. If a doctor performing emergency services has marked
the “noctu” (Lat. night) field on the pink prescription, the patient is not required to pay the emergency service
fee of 2.50 euros and the fee is, instead, covered by their insurance fund. In 2020, this fee was waived on more
than one million packages for patients with this statutory health insurance exemption.
prescription-only pharmaceuticals
860,000
non-prescription pharmaceuticals
260,000
Total
1,120,000 packages
* As of 1 January 2020, the fixed mark-up to support the night-time and emergency services
fund was raised from € 0.16 to € 0.21 per package of prescription-only pharmaceuticals.
Source: aponet.de, Night-time and Emergency Service Fund
Emergency Service Charge per Full Shift Performed (in euro)
Apothekenfinder 22 8 33
0
150
300
450
4th Quarter3rd Quarter2nd Quarter1st Quarter
291.
88
411.
53
284.
34
345.
36
280.
09
348.
96
292.
81
392.
94
2019
Average: 287 euros
2020 *
Average: 369 euros
www.aponet.de (9,900,000)
Mobile-Web
(1,460,000)
Smartphone app
(420,000) Telephone, Text Message and Mobile (140,000)
Retrievals in 2020:
11.92 million
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 1312
PHARMACIES’ PROVISION, SUPPLY AND SERVICES PHARMACIES’ PROVISION, SUPPLY AND SERVICES
FORMULATIONS
In many cases, there are no ready-made pharmaceuticals for a patient’s specific pharmaceutical needs.
Pharmacies fill this gap by providing individually prepared formulations according to doctors’ prescriptions.
In 2020, an estimated 13 million formulations were prepared for those insured under statutory health
insurance (SHI).
0
3
6
9
12
15
202020192018
1.46
2.17
6.98
2.39
0.1413.14 12.92
1.65
2.11
6.36
2.27
1.56
2.08
6.72
2.35
12.660.21
0.27
Cannabis Preparations
Individually-prepared Parenteral Solutions
Cytostatic Preparations
Preparations for Substitution Therapy
Standard Formulations
in millions
Change in classification and data source compared to the previous year’s publication.
Source: National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), ABDA statistics
STANDARD FORMULATIONS
Each year, pharmacies prepare more than six million standard formulations for SHI-insured patients according
to doctors’ prescriptions. All pharmacies are able to prepare them individually according to the patient’s needs,
whether these are skin creams or fever suppositories. Children, in particular, benefit from this service; for instance,
when a medication is not available as a pre-packaged pharmaceutical at a specific dosage. Many pensioners and
seniors also require “special preparations”.
Standard Formulations by Age Groupsper 1,000 SHI Insured
0
40
80
120
160
122
118
112
69
63
59
66
62
58
115
107
122
86
81
76
Children
(less than 15 years)
Youth
(15 to under 20 years)
Adults
(20 to under 65 years)
Seniors
(65 years and older)
ø All SHI insured
(average)
Source: German Institute for Drug Use Evaluation (DAPI)
2018 2019 2020
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 1514
PHARMACIES’ PROVISION, SUPPLY AND SERVICES PHARMACIES’ PROVISION, SUPPLY AND SERVICES
DELIVERY SERVICES
Nearly all pharmacies (97.6 %) offer delivery services in particular for, but not only to, immobile patients. This
service is performed approximately 300,000 times daily. At the peak of the first corona outbreak, this number
rose to over 450,000. Consultation regarding the medications occurred either beforehand at the pharmacy, on
the telephone, or by pharmacy staff upon delivery. Since April 2020, a portion of the delivery services can be
billed to statutory health insurance funds due to the creation of a subsidy grant.
* Survey as part of the ABDA-Datenpanels 2020
Source: ABDA-Datenpanel, German Pharmacists’ Association (DAV), German Institute for Drug Use Evaluation (DAPI)
DIGITAL PHARMACY
Digitalisation in the healthcare sector is picking up speed and pharmacies began using information technology
(IT) for their daily work even earlier than other providers. This includes not only ordering medicines from wholesalers
and managing stock levels while implementing rebate contracts. It also involves things such as database-supported
testing of side effects and interactions of medicines or billing with health insurance companies via the computer
centres. The digitalisation of processes and services in the run-up to the pharmacy has also started to gain
momentum – with e-prescriptions, the e-medication plan, or e-patient files. The aim is to improve patient care.
Source: ABDA – Federal Union of German Associations of Pharmacists, ABDATA, securPharm e. V., aponet.de
34 million times per week: medications are scanned in the pharmacies in order
to rule out counterfeit drugs with the help of a data matrix code in the
securPharm system.
15.33 million data sets are stored in the pharmacy computer systems for allocating
rebate contracts to health insurance companies, manufacturers and
pharmaceuticals (January 2021).
11.92 million times per year: patients usually search for the nearest emergency
pharmacy online using the “Apothekenfinder 22 8 33”, where current
opening hours and address details are stored.
550,000contract and pre-qualification checks per week are carried out by
pharmacies on the online contract portal (OVP) to provide their
patients with medical aids.
100,000medications approved in Germany can be called up in the pharmacy
computer systems using their pharmaceutical registration number (PZN)
(January 2021).
19,300different medications (pharmaceutical registration numbers) covered
by health insurance companies are listed as discount medicines
(January 2021).
9,000 images of pre-packaged pharmaceuticals are stored in the ABDA
database to improve drug safety in pharmacies.
Frequency of Delivery Services * 2020
more than once daily 41.7 %
once daily 50.0 %
2 to 3 times weekly 7.8 %
once weekly 0.5 %
Patient Groups Served by Delivery
Billed Delivery Services for SHI Insured 2020 Total: 19,880,000 (ID Code 06461110)
0 10 20 30 40 50 60 70 80
67.7%
60.2%
54.2%
49.8%
13.3%
5.2%
4.4%
3.0%
410,
000
0
500,000
1,000,000
1,500,000
2,000,000
2,500,000
3,000,000
DezNovOktSepAugJulJunMaiApr
2,35
0,00
0
2,37
0,00
0
2,43
0,00
0
2,22
0,00
0
2,43
0,00
0
2,45
0,00
0
2,54
0,00
0
2,69
0,00
0
more chronically ill
more mobility-challenged people
more acute cases
shut-in or immobile for other reasons
other
more in-home patients (stationary)
unknown
no change
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 1716
PHARMACIES’ PROVISION, SUPPLY AND SERVICES PHARMACIES’ PROVISION, SUPPLY AND SERVICES
Source: Apothekenklima-Index 2020 (marpinion GmbH)
SETUP FOR THE E-PRESCRIPTION
The upcoming introduction of the e-prescription is a decisive change for pharmacies. Surveys show that the
attitude towards the e-prescription is ambivalent. Six out of seven pharmacy owners (86.6 percent) fear more mail
order business due to e-prescriptions. Electronic prescriptions will replace the pink paper prescription by 2022.
The technical standards for this are defined by gematik GmbH on behalf of the Federal Ministry of Health (BMG).
What expectations do pharmacy owners associate with the introduction of electronic prescriptions?
Integration into the Telematics Infrastructure (as of March 2021)
More mail order for pharmaceuticals 86.6 %
Less regular customer loyalty 55.4 %
Fiercer competition among community pharmacies 52.8 %
Faster and more comfortable medication supply for patients 36.6 %
Fewer falsified prescriptions 29.2 %
Fewer doctor consultations 18.2 %
Fewer refusals for reimbursements from the health insurance companies 21.4 %
Reduction of unnecessary contacts such as in the Corona pandemic 16.6 %
None of the expectations mentioned 3.6 %
NUMBER OF PHARMACIES
The number of community pharmacies in Germany has been declining since 2009. In 2020, it reached 18,753,
the lowest level since the mid-1980s. Causes include healthcare-related political conditions as well as competition
among individual pharmacies. To date, comprehensive pharmaceutical care for the population continues to be
unthreatened.
Year-end figures
* Pharmacies with an operating licence pursuant to Section 2 of the German Pharmacies Act (Apothekengesetz)
Source: ABDA statistics
17,000
19,000
21,000
23,000
25,000
2020201520102005200019951990
1990 1995 2000 2005 2010 2015 2018 2019 2020
Number of Pharmacies
(incl. subsidiaries) 19,898 21,119 21,592 21,476 21,441 20,249 19,423 19,075 18,753
of which are
Main / Individual
Pharmacies * 19,898 21,119 21,592 20,248 17,963 15,968 14,882 14,473 14,110
Subsidiaries — — — 1,228 3,478 4,281 4,541 4,602 4,643
New Openings — 372 187 326 263 154 97 107 85
Closings — 156 185 242 370 346 422 455 407
Development / Change — +216 +2 +84 −107 −192 −325 −348 −322
90 % of all pharmacies (approx. 17,000) possess the institution cards (SMC-B)
75 % of all pharmacies are linked to the healthcare network of the telematics
infrastructure via roughly 14,000 so-called E-Health connectors (March 2021)
60 % of all pharmacy owners and managers (approx. 11,000) possess the electronic
healthcare professional card (HBA)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 1918
PHARMACY LANDSCAPEPHARMACIES’ PROVISION, SUPPLY AND SERVICES
APOTHEKENLANDSCHAFT
NUMBER OF PHARMACIES BY GERMAN FEDERAL STATE
The number of community pharmacies in the individual federal states depends, among other things, on the
number of inhabitants, the population’s demographic makeup and the size of the state. The most populous state,
North Rhine-Westphalia, also has the highest number of pharmacies – 3,952 – and is divided into the two
chamber districts of North Rhine and Westphalia-Lippe.
Federal State Community Pharmacies of these Main /
Individual Pharmacies *
of these
Subsidiaries
Number Pharmacy Density **
Baden-Wuerttemberg 2,368 21 1,742 626
Bavaria 3,020 23 2,279 741
Berlin 765 21 601 164
Brandenburg 567 22 415 152
Bremen 140 21 89 51
Hamburg 389 21 282 107
Hesse 1,420 23 1,072 348
Mecklenburg-Western Pomerania 386 24 295 91
Lower Saxony 1,839 23 1,377 462
North Rhine-Westphalia 3,952 22 2,974 978
North Rhine 2,125 22 1,617 508
Westphalia-Lippe 1,827 22 1,357 470
Rhineland-Palatinate 939 23 730 209
Saarland 285 29 229 56
Saxony 952 23 725 227
Saxony-Anhalt 577 26 432 145
Schleswig-Holstein 626 22 472 154
Thuringia 528 25 396 132
Total 18,753 23 14,110 4,643
Year-end figures 2020
* Pharmacies with operating licence pursuant to Section 2 of the German Pharmacies Act (Apothekengesetz)
** Pharmacies per 100,000 residents
Source: ABDA statistics Source: ABDA statistics
GEOGRAPHICAL COVERAGE
On average, there are 23 pharmacies for every 100,000 residents in Germany. There are, however, regional
differences between the Baltic Sea and the Alps: depending on the number of inhabitants, the size and structure
of towns and districts, the density of pharmacies can vary. At present, comprehensive pharmaceutical care for
the population remains guaranteed nationwide.
up to 21
(135 districts)
22 – 24
(137 districts)
25 or more
(129 districts)
Pharmacy Density by Administrative Districts 2020
Pharmacies per
100,000 residents
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 2120
PHARMACY LANDSCAPE PHARMACY LANDSCAPE
SUBSIDIARY STRUCTURE
At the end of 2020 there were 14,110 pharmacy owners responsible for 18,753 places of business. Expansion,
meaning the opening of subsidiaries, is on the rise. Following the introduction of the SHI Modernisation Act
of 2004, a main pharmacy is now allowed to have up to three additional locations. All main and subsidiary
pharmacies must be in close physical proximity to one another and each subsidiary must have a pharmacist
acting as the manager.
2005 2010 2015 2018 2019 2020
Pharmacies without Subsi-
diaries (Singular Pharmacies) 19,148 15,277 12,851 11,655 11,205 10,811
Main Pharmacies
with One Subsidiary 989 2,057 2,229 2,231 2,257 2,278
Main Pharmacies
with Two Subsidiaries 94 466 612 678 688 698
Main Pharmacies
with Three Subsidiaries 17 163 276 318 323 323
Main / Individual
Pharmacies
20,248 17,963 15,968 14,882 14,473 14,110
Year-end figures
Source: ABDA statistics
0
4,000
8,000
12,000
16,000
20,000
202020192018201520102005
19,148
1,100
15,277
2,686
12,851
3,117
20,248
17,963
15,968
10,811
3,299
14,110
11,655
3,227
14,882
11,205
3,268
14,473
Pharmacies without subsidiaries Pharmacies with at least one subsidiary
Baden-Wuerttemberg 117 North Rhine-Westphalia 40
Bavaria 138 North Rhine 3
Berlin 0 Westfalia-Lippe 37
Brandenburg 73 Rhineland-Palatinate 74
Bremen 0 Saarland 8
Hamburg 0 Saxony 116
Hesse 158 Saxony-Anhalt 124
Mecklenburg-Western Pomerania 92 Schleswig-Holstein 46
Lower Saxony 105 Thuringia 77
Total 1,168
SPECIFIC TYPES OF PHARMACIES
Hospital pharmacies do not belong to the category “community pharmacies”. All community pharmacies
are owner-operated with some pharmacies legally operated as a general partnership by several pharmacists
(German: OHG). Leased pharmacies also exist on a temporary basis, e. g., when the owner can no longer
operate the pharmacy due to age. To ensure coverage at the local level, prescription collection points can
also be approved, through which prescriptions are transmitted digitally in some cases and supplied by an
authorised pharmacy.
* German: Apothekengesetz (ApoG)
** German: Apothekenbetriebsordnung (ApBetrO)
Source: ABDA statistics, IQVIA Commercial GmbH & Co. OHG
Prescription Collection Points(Section 24 Ordinance on the Operation of Pharmacies) 2020
2018 2019 2020
Hospital Pharmacies (Section 14 German Pharmacies Act *) 375 372 371
Pharmacies Supplying Hospitals (Section 1a Para. 1 Ordinance
on the Operation of Pharmacies **) 169 164 162
OHG Pharmacies (Section 8 German Pharmacies Act) 722 749 754
Leased Pharmacies (Section 9 German Pharmacies Act) 732 657 605
Branch Pharmacies (Section 16 German Pharmacies Act) 11 10 10
Emergency Pharmacies (Section 17 German Pharmacies Act) 0 0 0
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 2322
PHARMACY LANDSCAPE PHARMACY LANDSCAPE
MAIL ORDER TRADE
Mail order trade of prescription and OTC medications has been allowed in Germany since 2004. In the area
of self-medication, the mail order business has already achieved a double-digit percentage market share.
The market share for prescription pharmaceuticals is considerably lower.
* Valued at the effective sales price
** Without non-pharmaceutical articles
*** Prescription medications account for the majority of SHI expenditures.
**** Professional web shop and listing with price search engines
Source: Insight Health GmbH & Co. KG, Datamed IQ GmbH, Federal Ministry of Health (BMG), ABDA statistics, own calculations
Pharmacies with a Mail Order Trade Licence (Section 11a German Pharmacies Act)
SHI pharmaceutical expenditure ***
3,036Pharmacies with
Mail Order Trade Licence
(Section 11a German
Pharmacies Act)
of which approx. 150 are actively enga-
ged in mail order trade ****
Sales Volume 2020 Sales Revenue * 2020
OTC Pharmaceuticals **Packages
in millions
Change from
Previous Year
Market
Share
Packages
in millions
Change from
Previous Year
Market
Share
Community Pharmacies 547 −11.2 % 80.4 % 5,311 −9.1 % 79.8 %
Mail Order Trade
(Domestic and Foreign) 120 11.1 % 19.6 % 1,341 13.5 % 20.2 %
Change in data source compared to the previous year’s publication.
2016 2017 2018 2019 2020
in million
euros
Market
Share
in million
euros
Market
Share
in million
euros
Market
Share
in million
euros
Market
Share
in million
euros
Market
Share
Community
Pharmacies32,355 98.9 % 33,607 98.8 % 34,384 98.7 % 35,409 98.8 % 37,559 98.8 %
Foreign
Mail Order
Trade 367 1.1 % 407 1.2 % 437 1.3 % 422 1.2 % 457 1.2 %
NUMBER AND AGE OF PHARMACISTS
At the end of 2020, there were over 68,000 working pharmacists in Germany – and the trend is growing.
The overwhelming majority work in community pharmacies. However, pharmacists are also employed more
broadly in the pharma industry, in hospital pharmacies, universities and government agencies. Nearly three
quarters of all licensed pharmacists are women.
Active Pharmacists in: 2018 2019 2020 Percentage of
Women 2020
Community Pharmacies 52,048 52,876 52,996 73.3 %
of which are Head Pharmacists * 15,476 15,067 14,649 49.3 %
Hospital Pharmacies 2,445 2,539 2,677 72.2 %
Industry, Administration, Associations, Science 11,287 11,767 12,183 61.7 %
Pharmaceutical Industry 6,851 7,221 7,436 62.5 %
Federal Armed Forces 228 231 242 36.0 %
Government Agencies and Statutory Corporations 1,009 1,062 1,140 65.8 %
Universities 1,216 1,240 1,307 49.9 %
Educational Institutions and Vocational Schools 494 546 551 80.8 %
Other Areas 1,489 1,467 1,507 61.6 %
Total 65,780 67,182 67,856 71.2 %
Age of Occupationally Active Pharmacists in: total female male
Community Pharmacies 47.2 45.7 51.2
of which are Head Pharmacists 51.5 50.0 53.0
of which are Licensed Staff 44.7 44.2 47.4
Hospital Pharmacies 43.0 40.5 48.1
Industry, Administration, Associations, Science 41.5 39.8 44.1
All Areas of Activity 46.2 44.8 49.5
* Owners (incl. OHG partners), leaseholders and administrators; excl. employed subsidiary managers
** Last elevation dated 31 Dec. 2014
Source: ABDA statistics
Average Age of Pharmacists **
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 2524
EMPLOYMENT IN PHARMACYPHARMACY LANDSCAPE
BESCHÄFTIGUNG IN DER PHARMAZIE
JOBS IN PHARMACIES
More than 160,000 people were employed in community pharmacies in 2020. About one-third of these
are approbated (licensed) pharmacists. Two-thirds work as pharmaceutical technical assistants (PTA) or
pharmaceutical commercial employees (PKA).
2018 2019 2020 Percentage of
Women 2020
Pharmacists 52,048 52,876 52,996 73.3 %
Pre-Approbation Trainee
Pharmacists (PhiP) 1,612 1,641 1,656 76.6 %
Pharmacist’s Assistants,
Pharmaceutical Engineers 5,298 4,975 4,661 96.8 %
Pharmaceutical Technical
Assistants (incl. interns) 66,906 68,277 68,765 96.8 %
Pharmaceutical Commercial Employees *33,277 32,819 32,376 98.1 %
Total Number of Positions 159,141 160,588 160,454 89.1 %
* incl. pharmacy assistants, skilled workers, assistants, pharmaceutical assistants and PKA in training
Year-end figures
Source: ABDA statistics
PERSONNEL PLANNING
In addition to the ascertainable number of employees, plans for hiring and firing in pharmacies also play a role in
the assessment of personnel requirements. More than half of the pharmacy owners plan to hire qualified staff in
the next two to three years. Nine out of ten owners do not plan to lay off employees. Overall, jobs in pharmacies
are therefore very secure.
Source: Apothekenklima-Index 2020 (marpinion GmbH)
Are pharmacy owners planning to hire in the next two to three years?
Are pharmacy owners planning layoffs in the next two to three years?
0
30
60
20202019201820172016
52.9
%
44.5
%
6.6
%
5.5
%
6.3
%
56.4
%
55.7
%
42.3
%
8.6
%
45.2
% 53.2
%
10.2
%
54.0
%
44.2
%
41.4
%
No, no recruitment
planned
Yes, recruitment of
pharmaceutical
personnel planned
Yes, recruitment
of non-pharmaceutical
personnel planned
0
19
38
57
76
95
20202019201820172016
90.0
%
7.3
%
3.7
%
5.1
%
4.9
%
89.3
%
90.6
%
88.4
%
6.4
%
9.0
%
3.6
%
89.2
%
7.8
%
4.0
%
7.4
%
No, no layoffs
planned
Yes, layoff of
pharmaceutical
personnel planned
Yes, layoff of non-
pharmaceutical
personnel planned
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 2726
EMPLOYMENT IN PHARMACY EMPLOYMENT IN PHARMACY
TRAINEE POSITIONS IN PHARMACIES
Pharmacies offer apprenticeships for around 7,300 young people who either complete their practical
training there as part of a dual PKA (pharmaceutical commercial employee) apprenticeship, a school-based
PTA apprenticeship or in the final stage of their pharmaceutical studies. About half of the pharmacies are
currently training staff.
2018 2019 2020
Pharmaceutical Commercial Employees (PKA) in
Training 3,680 3,603 3,504
Pharmaceutical Technical Assistants (PTA) in Training 2,072 2,131 2,119
Pre-Approbation Trainee Pharmacists (PhiP) 1,612 1,641 1,656
Total Number of Trainee Positions 7,364 7,375 7,279
Source: ABDA statistics, Apothekenklima-Index 2020 (marpinion GmbH)
Do pharmacy owners currently provide training in their (main) pharmacy?
No, I am not currently training anyone 56.6 %
Yes, one or more PTA interns 20.4 %
Yes, other apprenticeships 19.6 %
Yes, one or more PKA interns 16.0 %
Yes, one or more PhiPs (pharmaceutical interns) 15.0 %
PHARMACY STUDENTS AND APPROBATIONS
The number of pharmacy students and newly-approbated pharmacists in Germany is increasing, as is the
demand for pharmacists across the job marketplace in general, e. g., in industry and hospitals. 22 universities
in 14 federal states offer pharmacy programmes. The programme is structured into three sections: basic
studies (two years), main studies (two years), and practical training (one year).
Academic Year Students New Students Approbations Promotions
2019 / 2020 16,123 2,780 2,304 362
2018 / 2019 15,986 2,833 2,281 372
2017 / 2018 15,894 2,775 2,233 374
2016 / 2017 15,682 2,766 2,202 415
2015 / 2016 15,548 2,752 2,025 385
2014 / 2015 15,268 2,748 2,079 407
Source: Federal Statistics Office (Destatis), State Agencies
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 2928
EMPLOYMENT IN PHARMACY EMPLOYMENT IN PHARMACY
Federal State University Registrations Winter
Semester 2019 / 2020
Registrations Summer
Semester 2020
Baden-Wuerttemberg
Freiburg 90 0
Heidelberg 45 0
Tübingen 140 0
Bavaria
Erlangen-Nurnberg 117 0
Munich U 102 100
Regensburg 131 0
Würzburg 69 58
Berlin Berlin FU 75 68
Brandenburg — — —
Bremen — — —
Hamburg Hamburg 63 0
HesseFrankfurt / Main 90 68
Marburg 145 95
Mecklenburg-Western
Pomerania Greifswald 64 64
Lower Saxony Braunschweig 81 70
North Rhine-Westphalia
Bonn 78 77
Düsseldorf 65 65
Münster 85 75
Rhineland-Palatinate Mainz 45 46
Saarland Saarbrücken 32 33
Saxony Leipzig 48 0
Saxony-Anhalt Halle-Wittenberg 135 0
Schleswig-Holstein Kiel 60 60
Thuringia Jena 75 0
Total 1,835 879
Source: Foundation for University Admissions (ZVS)
PLACES OF STUDY
2018 2019 2020
Events 3,241 3,351 2,141
Participants 173,389 187,651 185,122
Area Field
General Pharmacy 9,888 Naturopathy Treatment and Homeopathy 2,263
Clinical Pharmacy 1,819 Nutritional Consultation 2,190
Pharmaceutical Analysis 827 Geriatric Pharmacy 859
Pharmaceutical Technology 526 Prevention and Health Promotion 508
Medication Information 500 Oncological Pharmacy 283
Pharmaceutical Analysis and Technology 251 Infectiology 217
Toxicology and Ecology 202 Care Services 177
Theoretical and Practical Education 100 Medication Management in Hospitals 78
Public Healthcare 75
Clinical Chemistry 4
Specialised Pharmacist Titles – Total 14,192 Field Designations – Total 6,575
Source: Federal Chamber of Pharmacists (BAK)
CPE Events offered by the State Chambers of Pharmacists (LAK) and State Pharmacists’ Associations (LAV)
2018 2019 2020
Number of Educational Programmes Completed 536 475 364
Postgraduate Specialisation Completions per Year (by area and field)
Pharmacists with Postgraduate Specialisation (end of 2020)
CONTINUING PROFESSIONAL EDUCATION AND POSTGRADUATE SPECIALISATION
Continuing professional education (CPE) serves to refresh and expand upon existing knowledge. Postgraduate
specialisation refers to the acquisition of specialised knowledge and skills in a specific field or area of pharmacy.
A three-year training programme in one of these areas entitles a pharmacist to the right to call themselves a
specialised pharmacist. Following a one-year programme in one of these fields, the corresponding designation
may be used.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 3130
EMPLOYMENT IN PHARMACY EMPLOYMENT IN PHARMACY
Prescription-only Narcotic Pharmaceuticals * 2,370
Pharmaceuticals Requiring a Special Prescription (T-prescription) ** 7
Other Prescription-only Pharmaceuticals 45,510
Pharmacy-only Pharmaceuticals 17,667
Unrestricted OTC Pharmaceuticals 34,911
Total Number of Marketable Pharmaceuticals 100,465
PHARMACEUTICALS APPROVED IN GERMANY
More than 100,000 different pharmaceuticals are governmentally approved in Germany. Each packaging size,
potency or dosage form is considered an individual pharmaceutical even if the brand name is the same. About
half of all pharmaceuticals are prescription-only. Governmental approval may be granted at either the federal
level in accordance with the Medicinal Products Act (AMG) or at the European level.
* Pharmaceuticals subject to regulations for prescribing narcotics due to their effects (BtMVV), e. g., strong painkillers
** Pharmaceuticals that may only be used under very specific circumstances because of their potential for risk and endangerment, e. g., containing thalidomide
As of: January 2021
Source: Federal Institute for Drugs and Medical Devices (BfArM)
prescription-only pharmaceuticals
47,887
non-prescription pharmaceuticals
52,578
PHARMACEUTICAL PRICE INDEX
The pharmaceutical price index describes the average price development (incl. VAT) of pharmaceuticals
which are prescribed at the expense of statutory health insurance (SHI). Pharmaceutical prices have been
on the decline for 15 years while consumer prices have, however, risen continually.
* Pharmacy markdowns, manufacturer markdowns, savings resulting from rebate contracts and patient co-payments are not taken into account.
Source: AOK Research Institute (WIdO), Federal Statistical Office (Destatis)
2010 2015 202020050
25
50
75
100
125
100.
0
101.
5
103.
2
105.
5
108.
2
108.
6
109.
8
112.
1
114.
4
116.
0
117.
2
117.
8
118.
4
120.
1
122.
3
124.
0
100.
0
99.5
97.2
95.9
94.5
94.9
94.8
92.6
91.4
91.7
90.6
88.5
87.1
86.3
85.1
84.4
124.
682
.1
Pharmaceutical Price Index * Consumer Price Index
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 3332
PHARMACEUTICALS IN GERMANY PHARMACEUTICALS IN GERMANY
ARZNEIMITTEL IN DEUTSCHLAND
PRICING FOR PRE-PACKAGED PHARMACEUTICALS
The selling prices for prescription pharmaceuticals and the pharmacy fee are determined according to legal
stipulations laid out in the Drug Price Ordinance (AMPreisV). To ease the financial burden on health insurance
funds, lawmakers have stipulated markdowns and discounts along with co-payments from insured individuals.
Example of a Prescription-only, Pre-Packaged Medication
Manufacturer Sales Price (ApU) 50.00 euros
+ maximum wholesale mark-up (3.15 % of the ApU + 0.70 euros) 2.28 euros
= Pharmacy Purchase Price (AEP) 52.28 euros
+ pharmacy mark-up (3 % of the AEP + 8.35 euros) 9.92 euros
+ emergency services mark-up (0.21 euros) 0.21 euros
= Net Pharmacy Sales Price (net AVP) 62.41 euros
+ value-added tax (19 % of the net AVP) 11.86 euros
= Gross Pharmacy Sales Price (AVP) 74.27 euros
− statutory co-payment from the insured individual (10 % of gross AVP) 7.43 euros
− statutory pharmacy markdown (1.77 euros) 1.77 euros
− statutory manufacturer markdown * (7 % of ApU) 3.50 euros
= Effective Expenditures for Statutory Health Insurance (SHI) ** 61.57 euros
* The manufacturer markdown for pharmaceuticals, which are not bound to fixed prices amounts to 7 percent for patent-protected originals and 16 percent for
generics. The amount for generic medication that is bound to fixed prices is, however, 10 percent. The manufacturer markdown is waived if the pharmaceutical
price lies 30 percent under the fixed price (§ 130a SGB V).
** Rebate contracts which reduce costs for statutory health insurance (SHI) are not taken into account.
Source: ABDA statistics
PRICING FOR STANDARD FORMULATIONS
The sales pricing for standard formulations is determined according to legal stipulations laid out in the Drug
Price Ordinance (AMPreisV) in a fashion similar to industrially produced, prescription medications. Discounts
and mark-ups are precisely defined therein. The rules governing remuneration for standard formulations were
adjusted in 2017.
Example for a Prescription-only Ointment (100 g)
Pharmacy purchase price (AEP) for an active ingredient (1 g powder), base
(99 g ointment base) and container (1 dispenser for 100 g) 5.00 euros
+ fixed mark-up (90 % of AEP) 4.50 euros
+ formulation mark-up for production
(6.00 euros for preparation of ointments up to 200 g) 6.00 euros
+ fixed fee 8.35 euros
= Net Pharmacy Sales Price (net AVP) 23.85 euros
+ value-added tax (19 % of the net AVP) 4.53 euros
= Gross Pharmacy Sales Price (AVP) 28.38 euros
− statutory co-payment from the insured individual
(10 % of AVP, minimum 5 euros) 5.00 euros
− statutory pharmacy markdown (1.77 euros) 1.77 euros
= Effective Expenditures for Statutory Health Insurance (SHI) 21.61 euros
Source: ABDA statistics
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 3534
PHARMACEUTICALS IN GERMANY PHARMACEUTICALS IN GERMANY
BREAKDOWN OF TOTAL SHI EXPENDITURES
Of the more than 260 billion euros that the statutory health insurance (SHI) spent in 2020, the largest percentage
went to hospitals and doctors. Pharmaceutical expenditures (incl. pharmacies) ranked third with 14.3 percent.
At only 2.1 percentage points, the costs of pharmacies and their services in the system continue to decline,
accounting for less than half of SHI administrative expenditure (4.5 percent).
Note. Expenses for integrated care are no longer listed separately. These are now placed within the individual service areas.
* from community pharmacies (excl. foreign mail trade, hospital pharmacies and others)
** preliminary
Source: Federal Ministry of Health (BMG), ABDA statistics
2020 ** 262.64 16.8 5.7 6.9 31.0 4.5 20.9 14.3 2.1
2019 252.25 16.3 6.0 7.0 31.6 4.4 20.8 14.0 2.1
2018 239.27 16.5 6.1 6.7 31.9 4.8 19.7 14.4 2.2
2015 213.67 16.1 6.3 6.4 32.5 4.9 19.0 14.6 2.3
2010 175.99 15.4 6.5 6.0 33.0 5.4 18.1 15.6 2.5
2005 143.81 15.2 6.9 6.2 33.7 5.7 16.3 15.9 2.8
Total SHI Expenditure 2020 **: 262.64 billion euros
Miscellaneous Expenditures 20.9 %
Administrative 4.5 %
Remedies and Medical Aids 6.9 %
Dentists (incl. dentures) 5.7 %
Hospitals 31.0 %
Pharmaceuticals from Pharmacies 14.3 %
of which is pharmacy added-value
share as per Drug Price Ordinance
(AMPreisV) 2.1 %
Doctors 16.8 %
Tota
l SH
I Exp
endi
ture
s
(bill
ion
euro
s)
Doc
tors
of w
hich
in %
Den
tists
(inc
l. de
ntur
es)
Rem
edie
s an
d M
edic
al A
ids
Hos
pita
ls
Adm
inis
trat
ion
Mis
cella
neou
s Ex
pens
esP
harm
aceu
tical
s *
of w
hich
is p
harm
acy
adde
d-
valu
e sh
are
as p
er D
rug
Pric
e
Ord
inan
ce (A
MP
reis
V)
MISCELLANEOUS HEALTH INSURANCE FUND EXPENDITURES
Miscellaneous SHI fund expenditures include, among other things, sick pay, home nursing and travel expenses.
“Pharmaceuticals from Others / Mail Order Trade” refers to overseas mail order pharmacies or health authorities.
“Vaccinations including doctor’s fees” are also included under miscellaneous expenditures.
* 1.0 % corresponds to 2.59 billion euros, of which 457 million euros is attributable to the foreign mail order business (see chapter Mail-Order
Trade). Until 2018, pharmaceuticals from hospital pharmacies were included in miscellaneous expenditures and are now shown separately.
Source: Federal Ministry of Health (BMG), ABDA statistics
6.1 % Sick Pay
2.8 % Home Nursing
2.7 % Travel Expenses
0.9 % Early Diagnosis
1.0 % Pharmaceuticals from
Hospital Pharmacies
0.7 % Dialysis Material Costs
in Doctor’s Offices
0.8 % Vaccinations incl. Doctor’s Fees
0.6 % Pregnancy, Maternity
0.3 % Services Abroad
2.8% Other
1.0 % Pharmaceuticals from Others / Mail
Order Trade *
1.2 % Outpatient & Inpatient Preventative
and Rehabilitation Benefits
Miscellaneous Expenditures
2020 total: 20.9 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 3736
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI) PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
ARZNEIMITTELVERSORGUNG IN DER GKV
SHI EXPENDITURES FOR PHARMACEUTICALS
Approximately two-thirds of statutory health insurance’s (SHI) pharmaceutical expenditures went to the
pharmaceutical industry. Expenditures for value-added tax (VAT) on pharmaceuticals exceeded those
for pharmacy services despite the temporary reduction of the VAT for the 2nd half of 2020.
* preliminary
** Pre-packaged pharmaceuticals, formulations and bandaging materials from community pharmacies (excluding foreign mail order and other)
Source: Federal Ministry of Health (BMG), ABDA statistics
2018 2019 2020 *
In billion
euros
In billion
euros
In billion
euros
Pharmaceutical Industry
and Advance Services
(such as raw materials) 22.46 65.3 % 23.28 65.7 % 25.36 67.5 %
Pharmaceutical Wholesaling 1.10 3.2 % 1.13 3.2 % 1.16 3.1 %
VAT (state) 5.49 16.0 % 5.65 16.0 % 5.59 14.9 %
Pharmacies 5.33 15.5 % 5.35 15.1 % 5.45 14.5 %
Total SHI Expenditures
for Pharmaceuticals **
34.38 100.0 % 35.41 100.0 % 37.56 100.0 %
Pharmacies 14.5 %
VAT (state) 14.9 %
Pharmaceutical Industry and Advance
Services (such as raw materials) 67.5 %
Pharmaceutical
Wholesaling 3.1 %
SHI Expenditures on Pharmaceuticals 2020: 37.56 billion euros
PHARMACEUTICALS BY PRICE CLASSES
The pharmacy sales price (AVP) for every prescription-only medication is legally regulated by the Drug Price
Ordinance (AMPreisV) and based on the manufacturer sales price (ApU). For nine out of ten medications,
this amounts to 100 euros or less. Despite a lower number of actual packages, higher-priced, innovative
medications account for a growing percentage of the total sum spent.
Sales Volume Percentage of SHI Prescription-only, Pre-packaged Medications
Sales Revenue Percentage of SHI Prescription-only, Pre-packaged Medications
Source: German Institute for Drug Use Evaluation (DAPI)
0 20 40 60 80 100
2018
2019
2020 89.7 %
90.0 %
90.3 %
8.8 %
0.8 %
0.6 %
0.7 %
0.5 %
0.7 %
0.5 %
8.7 %
8.6 %
0 20 40 60 80 100
2018
2019
2020 24.3 %
25.2 %
25.4 %
10.2 %
9.3 %
9.1 %
34.9 %
33.1 %
31.8 %
30.5 %
32.5 %
33.8 %
8,8 %
8,7 %
8,6 %
0 20 40 60 80 100
2018
2019
2020 89.7 %
90.0 %
90.3 %
8.8 %
0.8 %
0.6 %
0.7 %
0.5 %
0.7 %
0.5 %
8.7 %
8.6 %
0 20 40 60 80 100
2018
2019
2020 24.3 %
25.2 %
25.4 %
10.2 %
9.3 %
9.1 %
34.9 %
33.1 %
31.8 %
30.5 %
32.5 %
33.8 %
8,8 %
8,7 %
8,6 %
to 100.00 euros
to 100.00 euros
100.01 – 500.00 euros
100.01 – 500.00 euros
500.01 – 1,500.00 euros
500.01 – 1,500.00 euros
more than
1,500.00 euros
more than
1,500.00 euros
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 3938
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI) PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
PHARMACY AND MANUFACTURER MARKDOWNS
Over the years, lawmakers have introduced various instruments to limit statutory health insurance (SHI)
expenditures for pharmaceuticals. Pharmacies, as well as pharmaceutical manufacturers, must grant mark-
downs to the SHI when dispensing prescription-only pharmaceuticals. The pharmacy markdown is currently
set at 1.77 euros (incl. VAT). This amount must be reimbursed to the health insurance fund from the pharma-
cist’s fees for each package dispensed at the expense of the SHI. The discount amounts to more than one
billion euros per year.
Source: German Pharmacists’ Association (DAV)
0
300
600
900
1,200
1,500
1,800
202020192018
1,647
1,100
1,522
1,097
1,567
1,109
In million euros
Pharmacy Markdowns
Manufacturer Markdowns
(without rebate contracts)
Rebate Pharmaceuticals: Comparison of Agreements and SHI Savings
REBATE PHARMACEUTICALS
Since 2007, health insurance funds have been able to enter into rebate contracts with manufacturers to
dispense pharmaceuticals at a lower cost. There are currently more than 32,000 fund-specific rebate contracts
stipulating which insured person can receive which pharmaceutical from which manufacturer. Taking into
account the growing number of these contracts in patient care means a high administrative effort for the
pharmacies, but savings in the billions for the health insurance companies.
Source: ABDATA, Pro Generika e.V., Federal Ministry of Health (BMG), IQVIA Commercial GmbH & Co. OHG
2018 2019 2020
Number of Rebate Contracts at Year’s End 28,000 31,300 32,700
SHI Savings in Year 4.5 Billion Euros 5.0 Billion Euros 5.0 Billion Euros
5.0 billion euros SHI savings from rebate contracts in 2020
32,700 number of rebate contracts at the end of 2020
19,300 number of rebate pharmaceuticals (pharmaceutical registration numbers) at the end of 2020
220 number of pharmaceutical companies involved at the end of 2020
23 % Percentage of rebated, prescription-only pharmaceuticals either exempt from or having reduced co-payments at the end of 2020
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 4140
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI) PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
PATIENT CO-PAYMENTS
SHI (statutory health insurance) insured patients must make co-payments to their health insurance funds for
certain services. This amounts to ten percent of a pharmaceutical’s price for prescribed medications and must
lie between a minimum of five but no more than ten euros. There is a 3.00 euro average due to co-payment ex-
emptions for some medications and insured persons. The co-payments, which community pharmacies are legally
required to collect from patients, have saved health insurers two billion euros annually, and this figure is rising.
Source: German Pharmacists’ Association (DAV)
0
2,100
2,200
2,300
202020192018201720162015
2,243
2,084
2,1432,149
2,180
2,212
Patient Co-payments for Pharmaceuticals in million euros
0
2.6
2.7
2.8
2.9
3.0
202020192018201720162015
3.00
2.80 2.80
2.90 2.90
3.00
Average Co-payment per Package in euros
Source: German Pharmacists’ Association (DAV)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 4342
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI) PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
CO-PAYMENT EXEMPTIONS
A hardship provision in section 62 of the Social Insurance Code (SGB V) stipulates a co-payment maximum
limit of two percent of an insured patient’s gross annual income. This is reduced to one percent for chronically
ill persons. One in thirteen of the approximately 73 million SHI insured people in Germany are exempt from
additional co-payments. This ratio has been in decline for years.
Co-payment Exemptions 2014 2015 2016 2017 2018 2019
Chronically Ill Patients in Millions 6.4 6.2 6.0 5.9 5.8 5.5
Other Patients in Millions 0.4 0.3 0.3 0.3 0.3 0.3
Total Number of People Exempt
from Co-payments in Millions 6.8 6.5 6.3 6.2 6.1 5.8
Percentage of SHI Insured Exempt
from Co-payments 9.6 % 9.2 % 8.8 % 8.6 % 8.4 % 7.9%
Source: Federal Ministry of Health (BMG)
GUIDELINES AND WORKING AIDS
The Federal Chamber of Pharmacists’ guidelines, including commentary and working aids, are recommendations
addressing common situations and designed to ensure a high quality of service and skills in pharmacies.
They consider applicable laws and regulations as well as the current state of the art in science and technology.
They do not, however, relieve individuals of the responsibilities that come along with their healthcare profes-
sion. Materials are available for the following pharmacy-related topics and activities:
1. Pharmaceutical Information
2. Pharmaceutical Risks
3. Asthma
4. Blood Pressure Measurement
5. Blood Tests
6. Dosage Forms
7. Diabetes
8. Nutritional Consultation
9. Influenza Vaccination (Model Project)
10. Supply to Care Homes and Centres
11. Hygiene Management
12. Hospital Supply
13. Manual Repackaging
14. Medication Analysis
15. Opiate Substitution
16. Production of Parenterals
17. Inspection of Source Materials / Primary Packaging
18. Inspection of Proprietary Medicinal Products
19. Prescription Delivery
20. Preparations / Formulas
21. Self-Medication
Materials at: www.abda.de/fuer-apotheker/qualitaetssicherung/leitlinien/leitlinien-und-arbeitshilfen
Source: Federal Chamber of Pharmacists (BAK)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 4544
QUALITY ASSURANCEPHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
QUALITÄTSSICHERUNG
AMK: REPORTING OF PHARMACEUTICAL RISKS
Pharmacists check the quality of pharmaceuticals and report any deficiencies to the Drug Commission
of German Pharmacists (AMK). The AMK collects and evaluates reported drug safety issues and, when
necessary, issues warnings. This helps greatly in protect consumers and their safety.
Issues Reported to the Drug Commission of German Pharmacists (AMK)
* Reported suspicious cases: pharmaceuticals and other product groups
** Manufacturer defect / technological errors
Source: Drug Commission of German Pharmacists (AMK)
2018 2019 2020
Absolute Absolute Absolute Percentage
Change from
Previous Year
Undesired Pharmaceutical Reac-
tions * and Other Reported Issues 2,959 3,110 2,371 27.2 % −23.8 %
Packaging Errors 2,883 3,046 2,652 30.5 % −12.9 %
Galenic Deficiencies ** 1,403 2,141 1,406 16.1 % −34.3 %
Mechanical Errors 1,269 1,335 1,512 17.4 % 13.3 %
Declaration Errors 628 748 499 5.7 % −33.3 %
Other 344 402 267 3.1 % −33.6 %
Total 9,486 10,782 8,707 100.0 % −19.2 %
27.2 %
3.1 %5.7 %
17.4
%
16.1 %
30.5 %
Other
Packaging Errors Galenic Deficiencies **
Mechanical Errors
Declaration Errors Undesired Effects * and
Other Reported Issues
Risks by Pharmaceutical Group
* OTC = Over-the-counter
Source: Drug Commission of German Pharmacists (AMK)
OTC Pharmaceuticals *
Non-pharmaceuticals
Prescription-only
Pharmaceuticals 15.6 %
81.4 %
3.0 %
2020
Absolute Percentage
Prescription-only Pharmaceuticals 7,089 81.4 %
OTC Pharmaceuticals * 1,357 15.6 %
Non-pharmaceuticals 261 3.0 %
Total 8,707 100.0 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 4746
QUALITY ASSURANCE QUALITY ASSURANCE
Source: Apothekenklima-Index 2019 (marpinion GmbH)
Percentage of Pharmacy Staff Working
Time Spent Managing Supply Shortages Pharmacy Owners 2019
Less than 1 Percent 1.2 %
1 to 5 Percent 11.2 %
6 to 10 Percent 25.4 %
11 to 15 Percent 24.0 %
16 to 20 Percent 20.4 %
More than 20 Percent 17.8 %
MANAGEMENT OF DELIVERY SHORTAGES
Delivery shortages are a risk to the high-quality supply of medicines, affect different active ingredients and
have been one of the biggest annoyances in the day-to-day operation of pharmacies in recent years – and the
tendency is rising. The majority of pharmacy owners state that more than ten percent of employees’ working
hours are spent on procuring substitute products. In 2020 alone, pharmacists had to make a “divergent filling”
due to “unavailability of rebate pharmaceuticals” for 16.7 million packages.
Percentage of pharmacy owners who consider supply shortages to be one of the biggest annoyances in their daily work.
35.5 %
58.0 %
57.5 %
91.2 %
84.8 %
0 20 40 60 80 100
2016
2017
2018
2019
2020
Unavailable Pharmaceutical Packages 2018 2019 2020
Number of Packages of all SHI Pre-packaged
Pharmaceuticals Dispensed 651,000,000 651,600,000 642,900,000
Number of Packages with Special “not Available” Indicator 9,300,000 18,000,000 16,700,000
Source: German Institute for Drug Use Evaluation (DAPI)
Most Common Supply Shortages
by Active Ingredients 2020
Pharmaceutical Grouping
for the Main Indication
Number of Packages
with “not Available”
1 Candesartan Antihypertensive Medication 2,150,000
2 Metformin Diabetes Medication 710,000
3 Pantoprazole Antacid / Acid Blockers 680,000
4 Ibuprofen Pain Relievers 600,000
5 Metoprolol Antihypertensive Medication 510,000
6 Diclofenac Pain Relievers 510,000
7 Venlafaxine Antidepressants 440,000
8 Etoricoxib Pain Relievers 350,000
9 Allopurinol Gout Treatment Medication 340,000
10 Esomeprazole Antacid / Acid Blockers 340,000
All Others 10,070,000
Total 16,700,000In a representative survey from March 2020, pharmacy owners said they had reduced the time spent on
managing supply shortages by an average of 40.6 percent since the German legal requirements concerning
the substitution of available replacement medications had been relaxed (SARS-CoV-2-Arzneimittel-
Versorgungsverordnung / Medicines Provision Act).
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 4948
QUALITY ASSURANCE QUALITY ASSURANCE
CONSEQUENCES OF DELIVERY SHORTAGES
According to surveys, supply shortages have not only become one of the biggest annoyances in the day-to-day
life of pharmacies. Despite all the efforts of local pharmacies, they also lead to a deterioration in the pharma-
ceutical therapy of patients in many cases, as missing preparations cannot be replaced in an equivalent way. This
was confirmed by a reference pharmacy survey conducted by the Drug Commission of German Pharmacists
(AMK) on the range and effects of supply shortages.
How often, in the last three months, have you experienced supply shortages at your pharmacy that, in your opinion, led, or could have led to health issues for the patients involved?
Community Pharmacies Hospital Pharmacies
never 11.4 % 19.4 %
< 5 times 27.6 % 25.0 %
5 – 10 times 28.2 % 33.4 %
11 – 15 times 10.4 % 2.8 %
> 15 times 22.4 % 19.4 %
100 % 100 %
Blood and Hematopoietic
Organs (19.2 %)
Other Indication Areas
(30.8 %)
Antineoplastic and
Immunomodulating
Substances * (11.5 %) Hormones, Systemic
(excl. sexual hormones)
(15.4 %)
Anti-Infectives for
Systemic Dosage
(23.1 %)
Hospital Pharmacies
* For use in cancer therapies
Source: Drug Commission of German Pharmacists (AMK) 2017
Cardiovascular System
(38.0 %)
Other Indication Areas
(12.3 %)
Alimentary
System and
Metabolism
(10.9 %)
Nervous Systems
(19.7 %)
Anti-Infectives for
Systemic Dosage
(19.1 %)
Community Pharmacies
Which observations have you made in your pharmacy in the last three months concerning delivery and supply shortages which have occurred (multiple answers are possible)?
0 15 30 45 60 75
54.9 %72.7 %
56.1 %63.6 %
15.0 %
25.8 %6.1 %
18.8 %21.2 %
39.4 %
20.1 %21.2 %
60.4 %18.2 %
A less suitable pharmaceutical agent
was prescribed (“2nd Choice”).
A less suitable delivery / dosage form
was applied.
Treatment was discontinued.
Patient risk was involved.
Essential therapy was not
possible or was delayed.
The substitute pharmaceutical was
used incorrectly (medication error).
The patient’s therapy was impaired
or interrupted while the substitute
pharmaceutical was being used.
Additional Observations *
* Increased expenditure of time and consultation, increased uncertainty of the patient, etc.
Source: Drug Commission of German Pharmacists (AMK) 2017
Hospital PharmaciesCommunity Pharmacies
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 5150
QUALITY ASSURANCE QUALITY ASSURANCE
QUALITY ASSURANCE OF FORMULATIONS
The Central Laboratory of German Pharmacists (ZL) in Eschborn contributes, by means of ring trials, to ensure
the quality of formulations. Any pharmacy may participate by preparing and submitting a formulation specified
by the ZL, which is then tested for the identity, quantity and distribution of the active ingredient as well as other
testing parameters such as pH values, particle size, density, etc. More than a third of pharmacies voluntarily have
their formulations tested at least once a year.
* Community pharmacies and hospital pharmacies (number of participants includes multiple participation by individual pharmacies)
Source: Central Laboratory of German Pharmacists (ZL)
Year Number of Participants
(Formulations Examined)
Number of
Pharmacies *
Participation Percentage
(of Total Number of Pharmacies)
2020 8,709 6,706 35.1
2019 8,899 6,862 35.3
2018 8,945 6,684 33.8
2017 8,600 6,437 32.0
2016 7,733 6,019 29.5
2015 7,674 6,086 29.5
2014 8,079 5,706 27.4
2013 6,578 4,955 23.5
2012 5,877 4,191 19.6
2011 4,845 3,490 16.1
2010 4,738 3,286 15.0
Ring Trials of the Central Laboratory of German Pharmacists (ZL)
SECURPHARM
The European Anti-Counterfeiting Directive came into force in 2019. In Germany, this protective shield against
plagiarised pharmaceuticals is known under the name “securPharm”. While pharmaceutical companies upload
each individual package of prescription drugs into a manufacturer database, pharmacies book each package from
a corresponding system when it is given to the patient. Since every package with serial number and first-opening
protection is unique, a second checkout would trigger a suspected counterfeit alarm that would be thoroughly
investigated. In this respect, “securPharm” makes medications from German pharmacies even
safer than before.
Source: securPharm e. V.
Key Parties 2020
Pharmaceutical Companies 416
Pharmaceutical Wholesalers 708
Community Pharmacies 18,753
Hospital Pharmacies 361
Transactions
per Week
Products Subject
to Serialization
Uploaded
Package Data
2020 34 million 62,465 2.1 billion
2019 20 million 62,404 1.05 billion
securPharm System and Usage in Numbers
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 5352
QUALITY ASSURANCE QUALITY ASSURANCE
* Percent missing to 100 percent = “don’t know”
Source: Forsa Gesellschaft für Sozialforschung und statistische Analysen mbH (survey 2021)
* Percent missing to 100 percent = “don’t know”
Source: Forsa Gesellschaft für Sozialforschung und statistische Analysen mbH (survey 2021)
CHALLENGES INVOLVING POLYMEDICATION
Polymedication (or “multi-medication”) is defined as the situation in which a patient regularly takes several
different medications for a prolonged period. Leading definitions require a minimum of three to five such
medications. Approximately every fourth German regularly takes three or more medications. Several initiatives
for medication management such as ARMIN (“Pharmaceutical Initiative Saxony-Thuringia”) or PRIMA (Primary
System Integration of Medication Plans with Acceptance Examination) exist to address the risks involved in
polymedication.
Prolonged Use of Several Medications 55 % of adults over 70 take three or more medications on a prolonged, regular basis.
None One or Two Three FourFive or
MoreThree or
More (total)
Total 2021 46 % 29 % 9 % 6 % 10 % 25 %
Detailed Results 2021
Men 51 % 24 % 8 % 6 % 11 % 25 %
Women 41 % 35 % 9 % 6 % 9 % 24 %
18–29 Years of Age 66 % 30 % 2 % 1 % 1 % 4 %
30–49 Years of Age 59 % 31 % 5 % 2 % 3 % 10 %
50–69 Years of Age 37 % 31 % 12 % 8 % 12 % 32 %
70 Years and Older 22 % 23 % 16 % 14 % 25 % 55 %
Percentage of Prescription Only Medications Of all medications taken regularly over a prolonged period (3 or more medications) 74 % require a prescription.
AllMore
than Half HalfLess
than Half None *
Total 2021 74 % 20 % 3 % 2 % –
Detailed Results 2021
Men 77 % 19 % 2 % 1 % –
Women 71 % 21 % 4 % 3 % 1 %
18–29 Years of Age 63 % 23 % 6 % 6 % 2 %
50–69 Years of Age 78 % 18 % 2 % 1 % –
70 Years and Older 75 % 21 % 2 % 2 % –
Polymedication due to Several IllnessesFour out of five patients are being treated for two or more illnesses.
One Illness Two Illnesses Three IllnessesFour or More
Illnesses *
Total 2021 19 % 36 % 30 % 15 %
Detailed Results 2021
Men 20 % 36 % 29 % 15 %
Women 17 % 36 % 31 % 15 %
18–29 Years of Age 32 % 37 % 19 % 10 %
50–69 Years of Age 18 % 36 % 30 % 15 %
70 Years and Older 15 % 35 % 33 % 16 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 5554
QUALITY ASSURANCE QUALITY ASSURANCE
* Survey conducted by Forsa on behalf of the ABDA among 5,008 Germans between the ages of 16 and 70.
Data was collected between 15 December, 2017 and 5 January, 2018.
Source: Federal Chamber of Pharmacists (BAK), German Centre for Addiction Issues, Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH
Experience with Consuming of Non-prescription Medications without Medical Necessity *
56 %
1 %26 %
17 %
43 %
2 %
25 %
30 %
No, but it is possible /
imaginable
Yes
Don’t know
No, not imaginable
Willingness to Take Non-prescription Medication without Medical Necessity *
to improve mood or to reduce
fear / anxiety
to improve mental performance
0 5 10 15 20 25 30 35
13 % 20 %
5 % 22 %
3 % 10 %
2 % 9 %
0 5 10 15 20 25 30 35 40
13 % 26 %
19 %19 %
9 % 11 %
5 % 11 %
to improve physical appearance
to improve physical performance
RISKS INVOLVING PHARMACEUTICAL MISUSE
Approximately four to five percent of all prescribed pharmaceuticals in Germany are associated with the
potential for abuse, misuse or dependency. The total number of affected persons is estimated at 1.4 to
1.5 million. Dependency on sleeping aids and sedatives is most common. For substances which lead to a
physical dependency, a differentiation must be made between addiction and misuse. For substances which do
not lead to physical dependence, only misuse is possible. In terms of the entire range of products, 10 to 12
percent of all self-medication packages contain ingredients with a potential for misuse.
Experience with Consuming of Prescription-only Medications without Medical Necessity *
56 %
1 %
26 %
17 %
43 %
2 %
25 %
30 %
Willingness to Consume Prescription-only Medications without Medical Necessity *
0 5 10 15 20 25 30 35
13 % 20 %
5 % 22 %
3 % 10 %
2 % 9 %
0 5 10 15 20 25 30 35 40
13 % 26 %
19 %19 %
9 % 11 %
5 % 11 %
to improve mood or to reduce
fear / anxiety
to improve mental performance
to improve physical appearance
to improve physical performance
No, but it is possible /
imaginable
Yes
Don’t know
No, not imaginable
No, but it is possible / imaginableYes No, but it is possible / imaginableYes
* Survey conducted by Forsa on behalf of the ABDA among 5,008 Germans between the ages of 16 and 70.
Data was collected between 15 December, 2017 and 5 January, 2018.
Source: Federal Chamber of Pharmacists (BAK), German Centre for Addiction Issues (DHS), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 5756
QUALITY ASSURANCE QUALITY ASSURANCE
PHARMACEUTICALS FOR SERIOUS ILLNESSES
Recently, innovative pre-packaged pharmaceuticals have played an important role, especially oncological
medications (to combat cancer) and immunosuppressants (to combat the body’s own rejection reactions).
The costs are presented alongside their respective therapeutic uses. Specially formulated, individually
prepared formulations (cytostatics) are used in oncology treatments alongside pre-packaged pharmaceuticals.
In addition, there are also parenteral solutions; some of which with monoclonal antibodies. The manufacture
of all these individual formulations is subject to special technical requirements, which are met by around 300
pharmacies throughout Germany using a special cleanroom laboratory in accordance with section 35a of the
Pharmacy Operating Regulations (ApBetrO).
3.9
2.9
4.1
3.1
4.4
3.3
0.0
2.5
5.0
202020192018
4,98
8
3,60
2
5,59
2
4,15
6
5,86
7
4,74
4
0
1,000
2,000
3,000
4,000
5,000
6,000
202020192018
Sales Revenue in million euros
Cytostatic
Sales Volume in millions of packages
Special formulations prepared in community pharmacies at the expense of the SHI system.
Change in data source compared to the previous year’s publication.
Source: German Institute for Drug Use Evaluation (DAPI), National Association of Statutory Health Insurance Funds (GKV-Spitzenverband)
OncologyImmunosuppressants
2018 2019 2020
Prescriptions
(millions)
Sales
(million euros)
Prescriptions
(millions)
Sales
(million euros)
Prescriptions
(millions)
Sales
(million euros)
Cytostatic Preparations 2.2 988 2.1 948 2.1 964
Parenteral Solutions 1.5 2,951 1.6 3,492 1.7 3,952
Including: with
Monoclonal
Antibodies 1.0 2,755 1.1 3,294 1.2 3,759
Pre-packaged pharmaceuticals dispensed in community pharmacies and charged to the SHI.
PHARMACEUTICALS WITH SPECIFIC REQUIREMENTS
Certain pharmaceuticals are subject to special requirements. For instance, narcotics (strong painkillers)
require a special prescription and documentation in order to avoid misuse or undesired effects. The same is true
of pharmaceuticals containing Thalidomide (T-prescription). There are also special regulations in place to ensure
the safety and quality of temperature-sensitive pharmaceuticals. Due to a change in the law since September
2020, roughly 4,000 patients with haemophilia now receive their essential medication from public pharmacies.
Sales Volume in Packages 2018 2019 2020
Narcotics (Pre-packaged Pharmaceuticals) 10.6 million 10.9 million 11.1 million
Narcotics (Formulations) 7.1 million 7.1 million 7.2 million
Pharmaceuticals Prescribed with a T-prescription 81,000 96,000 116,000
Blood Products as per German Transfusion Act
and Haemophilia Preparations 325,000 319,000 460,000
Refrigerated Articles (Storage Temp. max. 8 °C) 19.2 million 19.2 million 19.6 million
Temperature-sensitive Pharmaceuticals * 8.8 million 10.0 million 11.7 million
* Must be kept between 2 °C and 8 °C without interruption during the entire delivery and storage chain (e. g., vaccines)
Pre-packaged pharmaceuticals, Formulations and vaccines dispensed in community pharmacies at the expense of SHI.
Source: German Institute for Drug Use Evaluation (DAPI)
1,600
1,600
2,300
1,500
1,900
2,000
2,500
2,400
8.6
7.8
9.1
6.6
6.5
8.7
10.0
9.1
0 20,000 40,000
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
0 20 40 60 80
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
28,100
33,500
33,300
37,300
52.1
62.6
65.7
69.4
Haemophilia Preparations 2020
Packages Dispensed Sales (AVP) in millions
Total: 148,100
Total: 316.0
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 5958
SPECIFIC COVERAGE AREAS SPECIFIC COVERAGE AREAS
SPEZIFISCHE VERSORGUNGSBEREICHE
ANTIBIOTICS
Antibiotics are essential for the treatment of bacterial infections. However, incorrect or excessive use leads to
the development of resistant bacterial strains on which certain antibiotics have no effect. The proper handling of
antibiotics includes using them only as prescribed by a doctor. The use of antibiotics in Germany has been on the
decline since 2013. The stark reductions in 2020 might be explained by a general decline of infectious diseases
as a result of hygiene and distancing measures related to the coronavirus.
Oral Antibiotics
Oral antibiotics dispensed in community pharmacies at the expense of SHI. Prescriptions from dentists are not taken into account.
Source: German Institute for Drug Use Evaluation (DAPI)
Packages Dispensed in Millions
0 5 10 15 20 25 30 35 40
2012
2013
2014
2015
2016
2017
2018
2019
2020
31.3
28.6
21.3
32.8
34.3
35.0
34.7
38.2
36.4
0 100 200 300 400 500 600 700 800
2012
2013
2014
2015
2016
2017
2018
2019
2020
584
542
414
607
635
650
645
700
648
0 5 10 15 20 25 30 35 40
2012
2013
2014
2015
2016
2017
2018
2019
2020
31.3
28.6
21.3
32.8
34.3
35.0
34.7
38.2
36.4
0 100 200 300 400 500 600 700 800
2012
2013
2014
2015
2016
2017
2018
2019
2020
584
542
414
607
635
650
645
700
648
Sales Revenue in Million Euros
ANTIDIABETICS AND BLOOD SUGAR TEST STRIPS
8 million currently live with diabetes mellitus in Germany. Around 95 percent suffer from type 2 diabetes. The
progression and prognosis of diabetes are significantly dependent upon the actions of the individual patient.
Diabetic patients receive their medications from community pharmacies along with ongoing consultation and
monitoring as necessary or requested. This not only includes the dispensing of pharmaceuticals, but also the
supply of blood glucose meters and the dispensing of associated blood sugar test strips. For this purpose, the
pharmacists’ associations conclude supply contracts with health insurance companies on a federal and state level.
2020
Sales Volume per 1,000
SHI insured
Sales Revenue per 1,000
SHI insured
Oral Antidiabetics 245 14,900 €
Insulin 153 18,400 €
Other Subcutaneous ** Antidiabetics 19 5,400 €
All antidiabetics 418 38,700 €
* Antidiabetics dispensed in community pharmacies at the expense of SHI.
** To be injected under the skin
*** Blood-sugar testing strips dispensed in community pharmacies at the expense of SHI (excluding in-office / consultation needs).
Source: German Institute for Drug Use Evaluation (DAPI), German Health Report Diabetes 2021
Active Ingredients Used Mainly in the Treatment of Diabetes *
2018 2019 2020
Packages Dispensed in millions 22.4 20.6 18.9
Quantity in millions 1,158 1,062 973
Sales in million euros (incl. VAT) 584.9 533.5 479.4
Blood Sugar Test Strips ***
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 6160
SPECIFIC COVERAGE AREAS SPECIFIC COVERAGE AREAS
CONSULTATION-INTENSIVE PHARMACEUTICALS
In 2020, pharmacies dispensed approximately 181 million pharmaceuticals which – independent of their active
ingredient – required high levels of consultation due to their dosage form. This represents 28 percent of all
pre-packaged pharmaceuticals dispensed at the expense of statutory health insurance funds. One example
of complex, intensive consultation can be seen in the case of an asthma spray where proper use of the inhaler
must be demonstrated.
3.6 % Pre-packaged pharmaceuticals for inhalation
13.6 % Pre-packaged pharmaceuticals which may not be divided *
3.5 % Pre-packaged pharmaceuticals
for injection
1.7 % Other
0.7 % Pre-packaged pharmaceuticals for
rectal application
1.2 % Pre-packaged pharmaceuticals
for nasal application
1.4 % Pre-packaged firm pharmaceuticals which cannot simply be swallowed (e. g., efferves-cent, chewable or sublingual tablets)
2.5 % Pre-packaged pharmaceuticals
for application in the eyes
* Dosage forms such as gastrointestinal drugs or delayed-release drugs that should not be divided without consulting the doctor or pharmacist.
German Institute for Drug Use Evaluation (DAPI)
All dosage forms requiring complex, intensive consultation: 28.2 %
PAIN RELIEVERS
Pain relief medications belong to the most commonly used pharmaceuticals. They do, however, carry
the serious potential for abuse (doping, dependency, etc.). Prescription pain relievers – including so-called
narcotics – make up the highest percentage of revenues in euros. At the same time, their sales volume in
packages is lower than that of self-medication products. For non-prescription, pharmacy-only pain relievers –
often tablets or gels – the pharmacy is often the only institution where a patient’s self-diagnosis can be reviewed
and corrected together with a professional. The use of pain relievers for more than a few days is generally
ill-advised, and a visit to a doctor is recommended.
Top 10 Active Ingredients by Volume 2020
prescription-onlyin millions of
packagesnon-prescription
in millions of
packages
1 Metamizole 30.9 Ibuprofen 41.1
2 Tilidine + Naloxone (narcotic) 6.5 Paracetamol 25.0
3 Tramadol 3.0Acetylsalicylic Acid +
Paracetamol + Caffein8.0
4 Fentanyl (narcotic) 2.1 Acetylsalicylic Acid 3.7
5 Hydromorphone (narcotic) 1.5 Acetylsalicylic Acid + Ascorbic Acid 2.9
6 Oxycodone (narcotic) 1.4 Diclofenac 2.7
7 Sumatriptan 1.3 Naratriptan 1.5
8 Oxycodone + Naloxone (narcotic) 1.3 Ibuprofen + Caffein 1.3
9 Morphine (narcotic) 1.2 Paracetamol + Caffein 0.7
10 Tapentadol (narcotic) 1.0 Acetylsalicylic Acid + Paracetamol 0.3
All Others 3.8 All Others 0.8
Total 54.0 Total 88.0
Sales Revenue in million euros
Sales Volume in millions of packages
0
500
1,000
1,500
2,000
2,500
3,000
202020192018
2,5592,5902,451
1,980 2,113 2,102
471477 457 142145144
0
40
80
120
160
200
202020192018
93 92 88
51 53 54
non-prescriptionprescription-only
Dispensing of Pre-Packaged Pharmaceuticals in Public Pharmacies
Source: Insight Health GmbH & Co. KG
All SHI Pre-Packaged Pharmaceuticals 2020 (642.8 million packages)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 6362
SPECIFIC COVERAGE AREAS SPECIFIC COVERAGE AREAS
* incl. also respiratory ailments
** Predominantly gastrointestinal ailments
*** Remedies for skin-related ailments
incl. only that dispended in public pharmacies
Source: Insight Health GmbH & Co. KG
OTC PHARMACEUTICALS: LEADING INDICATION AREAS
OTC (over-the-counter) medications are non-prescription, pharmacy-only or freely saleable medications sold
primarily for use in self-medication. Consultations are, in these situations, particularly important as they can
re-examine the patient’s own diagnosis. Large variations in demand are common due to seasonal fluctuations
in cold and flu viruses or pollen allergies.
21.1 %
24.5
%
13.9 %
12.3 %
7.2
%
21.0 %
27.4 %
18.7 %
19.4 %
12
.0 %
4.8%
17.7 %
21.1 %
24.5
%13.9 %
12.3 %
7.2
%
21.0 %
27.4 %
18.7 %
19.4 %
12
.0 %
4.8%
17.7 %
Alimentary System +
Metabolism ** 1.14 billion
euros (without VAT)
Alimentary System +
Metabolism **
102 million Packages
Sales Revenue 2020total 4.52 billion euros
(without VAT)
Sales Volume 2020total 547 million Packages
Respiratory System * 0.95 billion
euros (without VAT)
Respiratory System *
150 million Packages
All Other Indication Areas 0.95
billion euros (without VAT)
All Other Indication Areas
97 million Packages
Muscular and Skeletal Systems
0.33 billion euros (without VAT)
Muscular and Skeletal System
26 million Packages
Dermatology ***
0.55 billion euros (without VAT)
Dermatology ***
66 million Packages
Nervous System 0.63 billion
euros (without VAT)
Nervous System
106 million Packages
MEDICAL CANNABIS
Doctors have been allowed, since March 10, 2017, to prescribe medical cannabis in individual cases as part
of their therapy. All pharmacies are allowed to create and dispense related medications on prescription.
Cannabis can be prescribed in various forms including the plants’ flowers or as an isolated main ingredient
Dronabinol, also known as “THC”. The doctor determines the form and dosage, and pharmacists provide their
patients with the appropriate directions when dispensing the prescribed medication. When authorisation has
been granted, health insurance funds cover the costs of the medication prescribed by doctors.
Cannabis Prescriptions for SHI Insured (Total Units Dispensed)
incl. only that dispended in public pharmacies
Source: German Institute for Drug Use Evaluation (DAPI)
Preparations Containing Cannabis
and Unprocessed Cannabis Flowers
Pre-packaged Pharmaceuticals
Containing Cannabis
0
100,000
200,000
300,000
400,000
2020201920182017
44,224
35,821
80,045
144,941
54,593
199,534
224,549
62,400
286,949
284,442
68,379
352,821
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 6564
SPECIFIC COVERAGE AREAS SPECIFIC COVERAGE AREAS
Sales Revenue
Sales Volume
incl. only that dispended in public pharmacies
Source: Insight Health GmbH & Co. KG
NON-PRESCRIPTION PHARMACEUTICALS: SPECIAL TREATMENT SERVICES AND THERAPIES
Extra-ordinary types of therapies covered by the Medicinal Products Act (AMG) include herbal, homeopathic
and anthroposophical medications. These non-prescription medications (incl. healthcare products) are popular
and in high demand in pharmacies.
2018 2019 2020
Herbal Medicines 991 991 856
Homeopathic Medicines 378 368 325
Anthroposophical Medicines 91 93 86
2018 2019 2020
Herbal Medicines 101 98 80
Homeopathic Medicines 35 32 27
Anthroposophical Medicines 9 9 8
in million euros (without VAT)
in millions of packages
GREEN PRESCRIPTIONS
A green prescription is a way for a patient’s doctor to recommend a non-prescription medication. The patients
must pay for the medication themselves in the pharmacy. However, the prescription contains a notification that
it may be submitted to many health insurance funds for reimbursement as part of their coverage programme.
On all accounts, the green prescription serves patients as a reminder of the doctor’s recommendation, active
ingredient and dosage form.
Non-prescription Medicines
with a Green Prescription
TOP 10 Pharmaceutical Groups:
Expectorant without Anti-infective Component (R05C)
Topical Nasal Congestion Remedies (R01A)
Pain Relievers (N02B)
Sore Throat Medication (R02A)
Antithrombotic Agent (B01C) *
Constipation Remedy (A06A)
Microorganisms for Diarrhoea (A07F)
Cough and Cold Remedies (R05F)
Dermatological Antimycotics (D01A)
Systemic Antihistamines (R06A)
45.4
23.8
6.5
3.4
2.4
2.3
2.1
1.6
1.5
1.5
1.2
1.4
* Platelet aggregation inhibitors
Source: IQVIA Commercial GmbH & Co. OHG (IMS Diagnosis Monitor)
Prescriptions 2019 in millions
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 6766
SPECIFIC COVERAGE AREAS SPECIFIC COVERAGE AREAS
DISPENSING OF CONTRACEPTIVES
Emergency contraception (“the morning after pill”) has been available without prescription in German pharmacies
since March 15, 2015. Lawmakers wanted to make this form of contraceptive more readily available to women.
Accordingly, sales figures have risen (as self-medication) while there has been a significant fall in the number of
doctor’s prescriptions. As is the case with other contraceptives, women have the legal right, until they turn 22
years of age, to financial reimbursement by the statutory health funds. In order to claim this, though, the medica-
tion must be prescribed by a doctor (pink prescription).
31,000
0 200,000 400,000 600,000 800,000 1,000,000
2015
2016
2017
2018
2019
2020
770,000
820,000
53,000 23,000
27,000
732,000
665,00065,000
49,000
467,000146,000
835,000
808,000
757,000
662,000
19,00046,000
0 5,000,000 10,000,000 15,000,000 20,000,000
2015
2016
2017
2018
2019
2020
11,304,000
11,823,000
12,511,000
13,341,000
3,124,000
3,344,000
3,629,000
3,900,000
14,690,000
14,330,000
13,689,000
15,453,000
16,457,000
17,590,000
261,000
286,000
317,000
349,000
10,199,000 3,896,000
9,230,000 4,255,000
235,000
204,000
877,000
19,00038,000
800,000 848,000
17,000
Source: Insight Health GmbH & Co. KG
With Private Prescription With SHI Prescription Without Prescription
31,000
0 200,000 400,000 600,000 800,000 1,000,000
2015
2016
2017
2018
2019
2020
770,000
820,000
53,000 23,000
27,000
732,000
665,00065,000
49,000
467,000146,000
835,000
808,000
757,000
662,000
19,00046,000
0 5,000,000 10,000,000 15,000,000 20,000,000
2015
2016
2017
2018
2019
2020
11,304,000
11,823,000
12,511,000
13,341,000
3,124,000
3,344,000
3,629,000
3,900,000
14,690,000
14,330,000
13,689,000
15,453,000
16,457,000
17,590,000
261,000
286,000
317,000
349,000
10,199,000 3,896,000
9,230,000 4,255,000
235,000
204,000
877,000
19,00038,000
800,000 848,000
17,000
Sales of Contraceptives in Community PharmaciesDispensed Packages (without Emergency Contraceptives)
Sales of Emergency Contraceptives in Community PharmaciesDispensed Packages
SUBSTITUTION THERAPY
Medical substitution therapy is used to improve and stabilise the physical condition of opioid-addicted patients.
The manufacture and dispensing of substituting agents are bound by regulatory requirements and are carried
out by about 2,300 public pharmacies. At the doctor’s request, it can be prescribed that the narcotic should be
administered directly in front of pharmacy staff (so-called visual proof administration). This is a voluntary service
performed by the pharmacies.
* Source: Substitutionsregister 2020 (Substitution Registry)
** Survey of the German Pharmacists’ Association (DAV) in 2018. The number of 2,300 involved pharmacies is an informed estimate.
Source: Federal Institute for Drugs and Medical Devices (BfArM), German Pharmacists’ Association (DAV), National Association of Statutory Health Insurance Funds
(GKV-Spitzenverband)
Substitution Therapy 2020 *
Substitution Treatment in Statutory Health Insurance
Methadone (36.6 %)
1 to 10 Patients (56.6 %)
11 to 30 Patients (20.9 %)
Buprenorphine
(23.4 %)
31 to 100
Patients
(15.4 %)
Morphine
(1.8 %)
Diamorphine (1.2 %)Dihydrocodeine (0.1 %)
Codeine (0.1 %)
more than 100
Patients
(7.0 %)
Levomethadone
(36.8 %)
Substituting Agents 2020: 2.27 million
Prescriptions
Substituting Pharmacies:
2,300 **
2018 2019 2020
Prescriptions in millions 2.39 2.35 2.27
Sales Revenue in millions of euros 86.4 87.4 90.0
Number of Listings
Patients 81,300
Doctors 2,545
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 6968
SPECIFIC COVERAGE AREAS SPECIFIC COVERAGE AREAS
PROVISION OF MEDICAL AIDS AND BANDAGES
Pharmacies are, alongside healthcare supply stores, allowed to supply SHI insured with therapeutic or medical
aids. This usually requires the pharmacy’s participation in a supply agreement between the health insurance fund
and the pharmacists’ association. A requirement for participation is a so-called pre-qualification which confirms
all the necessary conditions for the sale of particular types of aids in advance. Approximately 18,000 pharmacies
have at least one product-group specific pre-qualification. Another important function of pharmacies is the public
supply of bandages and wound dressings.
SHI Medical Aid Sales * in Community Pharmacies 2020 in million euros
Application Aids (e. g., insulin pens) 285
Incontinence Aids (e. g., urine bags) 120
Aids for Compression Therapy (e. g., compression stockings) 91
Consumable Aids for Caregiver Use (e. g., gloves and face masks) 70
Measuring Instruments: Bodily Function and Condition (e. g., Lancets and Blood Pressure
Devices) 48
Inhalation and Respiratory Therapy Devices (e. g., nebulisers) 35
Extraction Units (e. g., breast pumps) 22
Vision Aids (e. g., eye pads) 18
Bandages 8
Stoma Articles 6
Orthoses / Splints 5
Other Product Groups 25
Total733 million euros
(incl. VAT)
SHI – Medical Dressings * in Public Pharmacies 2020 in million euros
Modern wound treatment (e. g., hydropolymer dressings) 418
Compresses 121
Bindings 93
Plasters 58
Klebemull Adhesive 23
Bandages 15
Swabs 5
Wadding 5
Other Product groups 19
Total757 million euros
(incl. VAT)* Individual prescriptions and consultation room supplies at pharmacy retail prices
Source: German Institute for Drug Use Evaluation (DAPI)
VACCINES
The Statutory Health Insurance (SHI) spends over one billion euros per year (incl. VAT) on vaccines. These are
generally prescribed on a pink prescription slip by doctors for use during consultation hours. Flu epidemics
and recommendations from the standing vaccine commission account for seasonal or annual fluctuation. The
large rise in the volume of vaccines in 2020 is attributed to the population’s greater willingness to be vaccinated
against influenza, pneumococci or the varicella zoster virus.
* Incl. combination vaccines with diphtheria, tetanus etc.
** Incl. combination vaccines with mumps, rubella, chickenpox
Figures reflect only vaccines dispensed by community pharmacies.
Source: German Institute for Drug Use Evaluation (DAPI)
Sales Volume
in millions of Doses
Sales Revenue
in millions of euros
2018 2019 2020 2018 2019 2020
Influenza (the Flu) 13.4 14.0 19.3 163 173 240
Pertussis (Whooping Cough) * 7.6 7.9 7.5 341 348 320
Pneumococcus 3.5 3.6 5.1 189 191 257
TBE (tick-borne encephalitis) 4.1 4.9 4.3 148 180 154
Measles ** 2.0 2.2 2.8 133 123 162
Varicella Zoster (Chickenpox, Shingles) 0.7 1.4 2.6 32 98 231
HPV (Human Papilloma Virus) 0.7 1.3 1.3 111 203 194
Rotavirus 1.3 1.3 1.2 62 61 59
Meningococcus 0.9 1.0 0.9 35 41 42
Hepatitis 0.9 0.8 0.7 50 48 37
Other 1.3 1.3 1.1 20 20 15
Total 36.4 39.7 46.8 1,284 1,486 1,711
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 7170
SPECIFIC COVERAGE AREAS SPECIFIC COVERAGE AREAS
There are regional as well as seasonal differences found in vaccination numbers. The higher figures found in
the former East German states are mainly a result of the higher amount of influenza vaccination coverage.
Individual states in both the east and west see a higher number of measles vaccinations. The high number of
TBE (tick-borne encephalitis) vaccinations in southern Germany can be explained by the spread of the disease
carriers there in the summer months.
* incl. combination vaccines with mumps, rubella, chickenpox
Figures reflect only vaccines dispensed by community pharmacies.
Source: German Institute for Drug Use Evaluation (DAPI)
614
582
498
636
577
598
610
626
617
602715
845
876
715752
763
624
218
241
192
295
251
256
260
256
267
251324
453
384
305
377
385
217
39
36
34
35
38
42
37
48
39
3829
30
44
4530
30
43
101
55
30
47
16
19
36
16
27
2188
54
117
2529
21
112
Doses of Vaccine Issued at the Expense of SHI per 1,000 SHI Insured
Measles Vaccine *National
average:
36
TBE Vaccine National
average:
57
Vaccine Doses Total National
average:
620
Influenza Vaccine National
average:
263
PHARMACIES BY SALES REVENUE CATEGORIES
Average sales for a pharmacy in Germany amount to roughly 2.78 million euros annually (without VAT). There
are, however, large differences found when comparing individual pharmacies. About 60 percent of pharmacies
do not reach the average sales amount whereas some individual, large pharmacies greatly exceed it.
Percentage of Pharmacies
Sales Revenue in million euros (without VAT)
Reporting Year 2020
Source: Treuhand Hannover GmbH (Treuhand Data Panel)
0
3
6
9
12
15
> 5
.00
< 5
.00
< 4
.75
< 4
.50
< 4
.25
< 4
.00
< 3
.75
< 3
.50
< 3
.25
< 3
.00
< 2
.75
< 2
.50
< 2
.25
< 2
.00
< 1
.75
< 1
.50
< 1
.25
< 1
.00
< 0
.75
1.6
2.8
5.3
7.0
8.6
9.5
8.9
8.9
7.7
7.2
5.8
5.0
4.2
2.8 3.
1
6.9
1.9
1.4
1.3
Average Sales Revenue:
2.78 million euros
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 7372
OPERATING RESULTSSPECIFIC COVERAGE AREAS
BETRIEBSWIRTSCHAFTLICHE DATEN
OPERATING RESULTS OF THE AVERAGE PHARMACY
Three-quarters of a pharmacy’s average annual revenue of 2.78 million euros is spent on the cost of goods
and sales operations. Payroll and other expenses must be deducted from the remaining gross revenue. Profit
before taxes in 2020 averaged 168,000 euros; a number affected by unusual corona virus-related circum-
stances. The remaining amount does not translate directly into a gross income because pharmacy owners,
as self-employed freelancers, not only deduct taxes from this amount but also make investments and cover
their own retirement plans fully.
2018 2019 2020
Net Sales Revenue * in Thousands of euros 2,381 2,587 2,776
− Cost of Goods and Sales 1,815 1,991 2,152
= Gross Revenue 567 596 624
− Staff / Payroll 256 272 280
− Other Tax-Deductible Expenses 173 181 188
= Fiscal Operating Result (pre-tax) ** 144 148 168
of which Partial Operating Result for the SHI *** 83 84 85
of which Subsidies from Night-time and Emergency Service Fund 6 6 8
of which Subsidies for Delivery Services 0 0 4
Note: In 2020, a large pharmacists’ data processing centre was forced to file for bankruptcy. This led to a large number
of pharmacies suffering large, sometimes six-figure, payment defaults. The outstanding claims do not affect the taxable
operating results for this year. Until the final determination of the insolvency rates, these may be accounted for as a value
adjustment in the profit and loss calculations.
* Without sales tax and SHI markdowns
** Incl. subsidies from the night-time and emergency service fund
*** Cost allocation was performed using the 50–50 sales / revenue method.
Source: Treuhand Hannover GmbH (Treuhand Data Panel)
DEVELOPMENT OF PHARMACY REMUNERATION
In 2004, the pharmacy fee was set at 8.10 euros per prescription-only pharmaceutical. In 2013, it was raised,
for the first time in ten years, to 8.35 euros. There is an additional 3 percent mark-up on the pharmacy purchase
price as well as a charge of 0.21 euros to support the night-time and emergency services fund. The effective
pharmacists’ remuneration is reduced by the pharmacy markdown for pharmaceuticals dispensed at the expense
of SHI. This markdown is currently set at 1.77 euros (incl. VAT). Material costs (e. g., energy costs) and personnel
costs (e. g., negotiated standard wages) have risen significantly more than remuneration.
Index (2004 = 100)
* Pharmacy remuneration per prescription-only package as per section 1 AMPreisV (Drug Price Ordinance) in accordance with section 130 SGB V
** Prognosis
Source: Federal Ministry of Health (BMG), Federal Statistical Office (Destatis), ADEXA, ABDA statistics
90
100
110
120
130
140
150
160
170
180
190
2021**20192017201520132011200920072005
SHI Revenues185.3
Gross Domestic Product (nominal)151.6
Negotiated (standard) Wages in Pharmacies 137.3
In�ation Rate (CPI) 126.5
Pharmacy Remuneration*118.5
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 7574
OPERATING RESULTS OPERATING RESULTS
0 20 40 60 80 100
83.7 %86.4 %
90.0 %83.6 %
72.1 %74.0 %
79.4 %74.6 %
67.8 %70.7 %
72.2 %72.2 %
38.0 %47.3 %
35.8 %43.4 %
23.7 %17.8 %
34.8 %34.8 %
29.2 %24.3 %
35.6 %34.4 %
24.0 %17.9 %
26.6 %25.4 %
27.6 %
23.2 %19.5 %
25.6 %45.0 %
1.3 %2.8 %
5.0 %3.6 %
Planning Security (i. e., Stable
Legal Frameworks such as
Retention of the Drug Price
Ordinance (AMPreisV)
Stable / Improved Commercial
Framework Conditions
Reduction of Bureaucracy
Recruitment and Fostering of
Trainees / Apprentices
Introduction of “Medication
Management” and Other Remun-
erated Pharmaceutical Services
Improved Cooperation with
Insurers and Healthcare Funds
Improved cooperation with
doctors
Fighting the corona pandemic
with vaccines and therapeutics
More Flexibility and Leeway
Regarding Patient Care / Supply
Other than the aforementioned
Source: Apothekenklima-Index 2020 (marpinion GmbH)
2020
2019
2018
2017
Pharmacy Owners’ Assessment of the Most Important Health Policy Challenges in the Next Two to Three Years
FUTURE EXPECTATIONS OF PHARMACIES
Alongside the retrospective assessment of the operating results, future expectations are also decisive for the
evaluation of the overall situation of pharmacies. The industry climate has clouded over in recent years, partly
because of unresolved regulatory issues.
Source: Apothekenklima-Index 2020 (marpinion GmbH)
Economic expectations of owners for their own business in the next two to three years
0 5 10 15 20 25 30 35 40
3.3 %
2.0 %
1.8 %
1.8 %
22.6 %
19.4 %
17.0 %
15.2 %
33.2 %
32.3 %
33.0 %
33.4 %
32.1 %
32.8 %
36.6 %
37.2 %
8.8 %
13.4 %
11.6 %
12.4 %
Significantly Worse
Significantly Better
Somewhat Better
Unchanged
Somewhat Worse
2020
2019
2018
2017
Despite the relatively stable average business results of pharmacies, the expectations of pharmacy owners
have gradually deteriorated in recent years. This is partly due to pharmacy remuneration developing below the
inflation rate for a prolonged period. The worsened outlook applies both to expectations for their own businesses
as well as to those of the industry as a whole. One major reason for this is the lack of planning security.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 7776
OPERATING RESULTS OPERATING RESULTS
Owners’ Economic Expectations for the “Pharmacy” Industry as a Whole in the Next Two to Three Years
0 10 20 30 40 50
0.2 %
0.5 %
0.2 %
0.2 %
9.5 %
5.9 %
4.6 %
7.0 %
25.6 %
22.6 %
15.4 %
18.8 %
44.7 %
45.7 %
48.6 %
47.6 %
19.7 %
25.5 %
31.2 %
26.4 %
Source: Apothekenklima-Index 2020 (marpinion GmbH)
2020
2019
2018
2017
PHARMACY OPERATION AND INVESTMENT
Numerous conditions must be met to operate a community pharmacy. These are listed in the German
Pharmacies Act (ApoG) and in the Ordinance on the Operation of Pharmacies (ApBetrO). They require exten-
sive investments. Many pharmacies far exceed the minimum requirements in terms of quality management,
patient-friendliness and suitability for everyday use. However, this requires still more extensive investments.
Source: ABDA – Federal Union of German Associations of Pharmacists
Operating License » licensed pharmacist
» personal supervision
» sole responsibility
Operational Spaces » at least 110 square metres of floor space
» offices, laboratory, storage, night-time service room
Pharmaceuticals » prescription and pharmacy-only medicines as special goods
» pre-packaged products, formulations and narcotic pain relievers
» supply for at least one week of average requirements
Quality Management » pharmaceutical personnel including PTA, pharmaceutical engineers, pharmacists
» mandatory QMS system for processes in the pharmacy
» guidelines of the Federal Chamber of Pharmacists and certification
» (chamber certificate, TÜV etc.) as orientation
Standby Duty » proper supply of medicines to the population
» obligation to be permanently on duty with a scheduled exemption
by the chambers of pharmacists
» posting of information about the nearest pharmacy on duty at every pharmacy
Significantly Worse
Significantly Better
Somewhat Better
Unchanged
Somewhat worse
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 7978
OPERATING RESULTS OPERATING RESULTS
Source: Apothekenklima-Index 2020 (marpinion GmbH)
Investment Planning of Pharmacies
0 10 20 30 40 50
44.5 %
45.1 %
43.2 %
50.0 %
27.0 %
25.2 %
30.4 %
32.4 %
25.3 %
25.1 %
24.0 %
13.7 %
13.9 %
20.2 %
16.0 %
14.4 %
7.6 %
5.5 %
6.4 %
5.6 %
No, no investments
are planned.
Yes, the improvement /
expansion of IT
resources.
Yes, the renovation /
modification of
pharmacy spaces or
technical facilities.
Yes, other investments.
Yes, opening or
takeover of a
subsidiary pharmacy.
2020
2019
2018
2017
Source: Apothekenklima-Index 2020 (marpinion GmbH)
Owners’ Assessment of how Many Interested Parties Could Be Expected in the Event of Selling their Pharmacy
0 10 20 30 40 50
13.6 %
16.1 %
19.8 %
19.0 %
21.0 %
19.4 %
25.0 %
26.8 %
46.3 %
44.4 %
43.4 %
42.2 %
20.8 %
18.4 %
11.8 %
12.0 %
No interested parties
One interested party
2–4 interested parties
5 and more
interested parties
2020
2019
2018
2017
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 8180
OPERATING RESULTS OPERATING RESULTS
Supplementary,
pharmacy-typical
products
5.03 billion euros
Pharmacy Sales Revenue 2020 (without VAT) 56.71 billion euros = 100 %
MEASURED IN SALES FIGURES
8.9 %
Pharmaceuticals
51.68 billion euros
Volume of pharmaceuticals covered by SHI,
private insurance and other
48.20 billion euros
Self-medication
3.49 billion euros
not prescribed
3.20 billion euros
prescribed
1.03 billion
euros
Prescription-only pharmaceuticals
47.17 billion euros
Pharmacy-only
pharmaceuticals
(non-prescription)
4.23 billion euros
Unrestricted
OTC pharma-
ceuticals
0.29 billion
euros
83.2 % 7.5 %
1.8 %
85.0 % 6.2 %
5.6 %
0.5 %
91.1 %
SALES STRUCTURE AND DISPENSED PACKAGES
Dispensed pharmaceuticals account for 91 percent of revenue in pharmacies with supplementary products
commonly found in pharmacies accounting for the remainder. Roughly 83 percent of sales resulted from
prescription-only pharmaceuticals prescribed by a doctor or dentist.
Note: Mail order sales are not taken into account.
Source: Insight Health GmbH & Co. KG, ABDA statistics
MEASURED IN NUMBER OF PACKAGES
Note: Mail order sales are not taken into account.
Source: Insight Health GmbH & Co. KG, ABDA statistics
Volume of pharmaceuticals covered by SHI,
private insurance and other
849 million packages
Self-medication
447 million packages
65.5 % 34.5 %
not prescribed
407 million
packages
prescribed
100 million
packages
7.7 % 31.4 %
Prescription-only pharmaceuticals
749 million packages
Pharmacy-only
pharmaceuticals
(non-prescription)
507 million packages
Unrestricted OTC
pharmaceuticals
40 million packages
57.8 % 39.1 % 3.1 %
Pharmaceuticals 20201,296 million packages = 100 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 8382
OPERATING RESULTS OPERATING RESULTS
in billions euros 2018 2019 2020
Pharmacy Sales Revenue (without VAT) 50.70 54.10 56.71
Prescription-only Pharmaceuticals 41.03 44.23 47.17
Pharmacy-only Pharmaceuticals (Non-prescription) 4.59 4.64 4.23
Prescribed 1.14 1.14 1.03
not Prescribed 3.46 3.50 3.20
Unrestricted OTC Pharmaceuticals 0.27 0.27 0.29
Volume of Pharmaceuticals Covered by SHI, Private Insurance and Other 42.16 45.37 48.20
Self-medication 3.72 3.77 3.49
Supplementary, Pharmacy-typical Products 4.82 4.96 5.03
in millions packages 2018 2019 2020
Pharmaceuticals 1,363 1,376 1,296
Prescription-only Pharmaceuticals 739 760 749
Pharmacy-only Pharmaceuticals (Non-prescription) 584 577 507
Prescribed 121 118 100
not Prescribed 463 458 407
Unrestricted OTC Pharmaceuticals 40 39 40
Volume of Pharmaceuticals Covered by SHI, Private Insurance and Other 861 878 849
Self-medication 503 497 447
Note: Mail order sales are not taken into account.
Source: Insight Health GmbH & Co. KG, ABDA statistics
Sales Revenue and Volume
SUPPLEMENTARY PRODUCTS COMMONLY FOUND IN PHARMACIES
The supplementary pharmacy-typical range of products is made up of all non-pharmaceuticals dispensed and
sold in the pharmacy. This includes certain therapeutic aids, dietary supplements, vitamins and minerals or
blood sugar test strips as well as cosmetics and sunscreen. They account for 8,9 percent of the total revenue.
* when not classified as a pharmaceutical
Source: Insight Health GmbH & Co. KG
0.99 billion euros
0.63
billi
on e
uros
0.79 billion euros
0.69 billion euros
0.96
bill
ion
euro
s
euro
s
0.32
billi
on 0.18 billion euros
0.13 billion euros
0.08 billion euros
euros0.26 billionMedical-technical Aids and Supplies
Eye-related Products *
Gastrointestinal *
Foodstuffs Commonly Sold in Pharmacies
(e. g., Cough Drops and Teas)
Other
Nutritional Supplements
* (e. g., Vitamins and
Minerals)
Diet Aids and
Dietetics
Diagnostics and Measurement
Devices (e. g., Blood Sugar Test Strips)
Bandaging and Plasters
Personal Hygiene and Body Care *
(e. g., Skin Products, Cosmetics,
Sunscreen and Disinfectant)
Total: 5.03 billion euros
Sales Revenue 2020 (without VAT)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 8584
OPERATING RESULTS OPERATING RESULTS
31 %
69 %
31 %
69 %
18 %
82 %
Other EU Countries
Czech Republic
Hungary
Bulgaria
Poland
Croatia
Greece
Spain
Italy
Romania 2
2
2
1
4
7
5
9
18
15
9
6
4
6
22
11
5
27 29
25
19
14
11
7
7
6
6
31
Other countries
Jordan
Ukraine
North Macedonia
Tunisia
Albania
Bosnia and Herzegovina
Egypt
Syria 165
3
4
8
10
58
5
35
24
17
3
6
46 70
6 14
9
319154
93
34
22
20
12
11
10
116
Source: Federal Chamber of Pharmacists (BAK) Source: Federal Chamber of Pharmacists (BAK)
PROFESSIONAL LANGUAGE PROFICIENCY EXAM FOR FOREIGN PHARMACISTS
There is also labour migration in the field of pharmaceutical supplies. Pharmacists with a mother tongue other
than German who apply for approbation in Germany are required to provide proof of German language skills
specific to and necessary for their profession. This is done using three-part proficiency exams based on the
Common European Framework of Reference of Languages (CEFR). In almost all federal states, the chamber
of pharmacists has been assigned this responsibility by their state authorities.
Number of Examinations and Success Rates
Number of Exam Candidates, Gender Ratios and Countries of Origin 2020
Passed on the First Attempt
Non-EU States
European Union (EU, EEA, Switzerland)
Passed on Subsequent Attempts
Men
Women
337
455
792 total from 65 countries
2018903 Professional
Language Proficiency
Exams
31 %
69 %
31 %
69 %
18 %
82 %
31 %
69 %
31 %
69 %
18 %
82 %
20191,060 Professional
Language Proficiency
Exams
2020936 Professional
Language Proficiency
Exams
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 8786
PHARMACIES AND EUROPE PHARMACIES AND EUROPE
APOTHEKEN UND EUROPA
PHARMACY-RELATED LEGAL STIPULATIONS IN EUROPE
The organisational structures of the multiple healthcare systems within the European Union vary. Accordingly,
the regulative demands and laws concerning the supply and provision of pharmaceuticals also differ from
country to country. Only a minority of states have allowed mail order sales of prescription-only medicines;
in some countries, pharmacies can be owned by third parties (through non-pharmacists, corporations).
Source: Pharmaceutical Group of the European Union (PGEU) Source: Pharmaceutical Group of the European Union (PGEU)
Ban of mail order trade with Prescripion-only Pharmaceuticals
Ban on Third-Party Ownership
Yes
No
No information
Yes
No
No information
Country Rx Mail order Trade Ban Ban on Third-party Ownership
Belgium ✓ ×
Bulgaria ✓ ×
Denmark × ✓
Germany × ✓
Estonia × ✓
Finland × ✓
France ✓ ✓
Greece ✓ ×
Ireland ✓ ×
Italy ✓ ×
Croatia ✓ ×
Latvia N / A N / A
Lithuania N / A N / A
Luxembourg N / A ✓
Malta × ×
Netherlands × ×
Austria ✓ ✓
Poland ✓ ✓
Portugal ✓ ×
Romania ✓ ×
Sweden × ×
Slovakia ✓ ×
Slovenia ✓ ✓
Spain ✓ ✓
Czech Republic ✓ ×
Hungary ✓ ✓
Cyprus ✓ ✓
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 8988
PHARMACIES AND EUROPE PHARMACIES AND EUROPE
VALUE-ADDED TAX ON PHARMACEUTICALS
Value-added tax (VAT) on pharmaceuticals varies greatly among the 27 member states of the European Union.
Germany has one of the highest VAT rates on pharmaceuticals – behind Denmark and Bulgaria. In contrast Malta,
Ireland and Sweden have all made certain pharmaceuticals exempt from the tax.
The European Commission’s publication for 2021 was not available by the editorial deadline.
* The VAT rate was temporarily reduced to 16 % in the second half of 2020
Source: European Commission (EC)
Tax Rate for
Pharmaceuticals
in 2020
General VAT tax
rate in 2020
Denmark 25.0 25.0
Bulgaria 20.0 20.0
Germany * 19.0 19.0
Latvia 12.0 21.0
Finland 10.0 24.0
Italy 10.0 22.0
Czech Republic 10.0 21.0
Austria 10.0 20.0
Slovakia 10.0 20.0
Slovenia 9.5 22.0
Netherlands 9.0 21.0
Estonia 9.0 20.0
Romania 9.0 19.0
Poland 8.0 23.0
Greece 6.0 24.0
Portugal 6.0 23.0
Belgium 6.0 21.0
Hungary 5.0 27.0
Croatia pharmaceuticals covered by the SHI;
non-prescription pharmaceuticals
5.0
25.0
25.0
Lithuania reimbursable pharmaceuticals;
non-reimbursable pharmaceuticals
5.0
21.0
21.0
Cyprus 5.0 19.0
Spain 4.0 21.0
Luxembourg 3.0 17.0
France reimbursable pharmaceuticals;
non-reimbursable pharmaceuticals
2.1
10.0
20.0
Sweden prescription-only pharmaceuticals:
non-prescription pharmaceuticals
0.0
25.0
25.0
Ireland pharmaceuticals for oral use;
pharmaceuticals for non-oral use
0.0
23.0
23.0
Malta 0.0 18.0
PHARMACY DENSITY IN EUROPE
With 23 pharmacies per 100,000 inhabitants, Germany is in the bottom third of the European comparison
field. The 27 member states of the European Union have an average pharmacy density of 32 pharmacies per
100,000 inhabitants.
* Last available year
** France métropolitaine (excluding overseas territories)
Source: ABDA statistics, Pharmaceutical Group of the European Union (PGEU), national pharmaceutical associations, European Commission (EC)
Greece 88
3,282
840
9Denmark
12Netherlands
14Sweden
15Finland
15Luxembourg
16Austria
16Slovenia
23Germany
23Hungary
24Czech Republic
28Croatia
28Portugal
32France **
36Poland
37Slovakia
38Estonia
38Ireland
43Latvia
42Belgium
46Bulgaria
47Lithuania
49Malta
62Cyprus
32Italy
9,500
Number of Pharmacies *
Pharmacies per 100,000 Residents
22,102
524
221
4,841
8,620
1,317
13,497
ca. 143,000
1,994
498
1,894
2,304
2,547
1,181
2,923
20,736
19,331
819
97
1,397
340
18,753
506
2,000
1,433
47Spain
44Romania
32EU average
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 9190
PHARMACIES AND EUROPE PHARMACIES AND EUROPE
COMPARISON OF COUNTRIES: VACCINATION IN PHARMACIES
Worldwide, pharmacists are allowed to vaccinate against influenza in pharmacies in at least 20 countries, including
France, Great Britain and the USA. The aim is to increase the vaccination rate and to ensure basic services in
regions with weak healthcare infrastructure. In Germany, pilot projects for influenza vaccination in pharmacies
have been permitted since 1 March 2020.
Countries where Pharmacists May Vaccinate Against Influenza in Community Pharmacies
Vaccination Permit
Pilot Project
Note: In Switzerland, the vaccination permit is valid in 21 of the 26 cantons.
Source: Pharmaceutical Group of the European Union (PGEU), International Pharmaceutical Federation (FIP), ABDA
Non-European
Countries with
Vaccination Permits
Argentina
Australia
Brazil
Costa Rica
Hong Kong, China
Israel
Canada
Kenya
Lebanon
New Zealand
Paraguay
Philippines
South Africa
USA
Publisher
ABDA – Federal Union of German
Associations of Pharmacists
Heidestrasse 7
10557 Berlin, Germany
www.abda.de
Design
Cyrano Kommunikation GmbH
Hohenzollernring 49 – 51
48145 Muenster, Germany
LEGAL NOTICE
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 9392
PHARMACIES AND EUROPE