European Pharmacists Forum Newsletter – English edition December 2019 Issue 57

EPF Newsletter

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Patients are embracing different ways of accessing healthcare and Ornella Barra says the time has come for pharmacists to look for new ways of doing things…

The evolution of pharmacy

“Sometimes we are hesitant to do something new because we think others will not like it. This can lead us in to the trap of not changing when we should, or not doing things that would actually be popular.

Many new technologies have emerged and matured over the past decade. We are now using mobile devices in almost all aspects of our life. Healthcare is no exception to this. People can order almost anything from their smartphone – so why not medicines? People can use video-calls to speak to almost anyone – so why not their local pharmacist?

Pharmacy must be willing and able to embrace this new tomorrow, as well as continuing to provide easy access and face-to-face discussions where and when people want them. Our patients are now expecting and welcoming new ways of doing things, and so must we.

All these new ways of working can help us at a time when all healthcare professions are facing workforce shortages. We need to focus on the things that will make the most difference to our patients and find better, quicker and easier ways of doing things. New technologies, digital and automation, will be part of this, but we also need a behavioural mindshift. Everyone in the pharmacy needs to step up and be able to work in different ways to provide new services and support each other.

This can also be a good thing for pharmacy teams. We have always been supportive of part-time roles, especially beneficial for the large female workforce, and now we see many people taking on “portfolio” careers, working in different roles at different times and in different places. These are great opportunities to demonstrate new ways of thinking and working smarter.

Technology also supports the provision of services beyond the pharmacy, with remote consultations and access to specialist knowledge possible from almost anywhere.

One of the biggest mindset changes will be about looking outside the pharmacy and getting involved in local networks for providing healthcare. Whether this comes through working with nearby pharmacies and doctors, developing connections with specialists at local hospitals, or even working with local public authorities, pharmacists will need to show how and why they should be part of the healthcare network.

What we do know is that pharmacy has a long history of changing and adapting. We are always evolving the way that we work, the products we sell and the services we provide. I am sure that we can and will continue to do this.”

Ornella Sponsored by

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Publication Director: Ornella Barra

Editorial Director: Laura Vergani

Editor: Rachel Heath

Contributors: Jonathan Buisson Tricia Kennerley

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EPF December 20192

United Kingdom

New pharmacy service starts as UK heads for winter election

Under the Community Pharmacist Consultation Service (CPCS), community pharmacies in England have started to deliver a new service that sees patients with minor conditions being referred to a pharmacist by doctors’ surgeries and the NHS 111 telephone service. The service is designed to reduce pressure, especially in the peak winter season. Surgeries will soon be able to refer patients directly to pharmacies in the next phase of the service. Community pharmacies have also administered more than 1.2 million flu vaccinations so far this year.

All eyes are on the health service and its performance as the UK heads towards its first December election in nearly a century. Although the election is nominally aimed at breaking the Brexit deadlock, politicians’ promises of more resource and staffing for the NHS are always a key focus in any UK election.

(Source: PSNC)

The Netherlands

Insurer joins “green care deal” for pharmaceuticals

Dutch health insurance company, CZ

has become the first to sign up to the

Netherland’s Association of Innovative

Medicines’ “green care deal”, aimed at

reducing harmful environmental emissions.

The healthcare sector is responsible for

about 5.9% of the country’s total CO2

emissions and manufacture and transport

of pharmaceutical products is responsible

for a fifth of this. The deal already has

a growing list of signatories. The deal

incentivises healthcare system stakeholders

to consider pharmaceutical manufacturers’

environmentally responsible behaviour,

rather than simply pricing, when procuring

medicines. It is likely that other insurers will

also sign up over the next year.

(Source: IHS)

Czech Republic

Review of medicine reimbursement considered

The Czech Health Minister has confirmed there will be a focus on widening the range of medicines that are eligible for reimbursement.

No other area of public healthcare is experiencing spending increases comparable to those seen for high-cost, innovative medicines. However, there has been little change since the last major reforms to the pharmaceutical pricing and reimbursement policy a decade ago. The trend for new, innovative drugs to be reimbursed outside the reimbursement system continues, and the review will also look at accelerating the administrative process for pricing and reimbursement.

Even with a comparatively well-sourced public healthcare sector, the Czech Republic is still facing similar problems to other European countries – an ageing population with high expectations of healthcare provision free at the point of service.

(Source: IHS)

Italy

Pharmacies hit by Venice flooding

Pharmacies in Venice battled to serve patients after severe weather left much of the historic city centre flooded and without electricity in mid-November. Strong winds pushed floodwaters to 1.87m, the second highest on record.

Floods damaged electricity supplies and the city’s computer network, as well as destroying medicines stocks of pharmacies in lower-lying areas. Damage across the city was extensive with gondolas and boats torn from moorings and some sinking. This initially prevented new supplies of medicines reaching pharmacies.

Andrea Bellon, President of Federfarma Venice, said that flooding was 50cm higher than the worst expectations. However, pharmacies were working hard to provide an emergency service from those premises that were able to open, so that medicine deliveries were maintained, even in the absence of electricity. Pharmacies were able to draw on support and insurance from Federfarma Nazionale to help them and their colleagues.

(Source: Fedifarma.it)

3EPF December 2019

AROUND EUROPE

Spain

Payment-by-results medicines in new clinical system

Valtermed, Spain’s new system for measuring therapeutic value, will inform future decisions on funding, pricing and therapeutic positioning, according to the Ministry of Health, Consumption and Welfare.

It is a unique data sharing system in which healthcare professionals will input and access data on clinical outcomes for all treated patients. Other healthcare bodies, including regional health authorities and hospital pharmacists will also have access to the analysis.

It is initially set to include seven medicines, all currently subject to payment-by-results reimbursement models, in order to prioritise drugs where there is clinical, financial or social uncertainty about their use.

(Source: IHS)

Turkey

Shortage of flu vaccines reported

Pharmacies have complained that they only received limited supplies of flu vaccines for the peak vaccination period this year.

Gamze Tascıer, a Turkish MP and pharmacist, said in a statement that “The Ministry promotes flu vaccination, but pharmacies are only receiving a few boxes of vaccines. This is dramatic and very sad in terms of revealing the state of health management in our country.”

The problem comes at a time when a shift in climate across Turkey has affected the influenza season, with cases now being seen in November and reaching peak levels in mid-January.

(Source: Medimagazine)

Germany

Insurer launches remote medical treatment pilot

One of Germany’s largest statutory health insurance funds, Techniker Krankenkasse (TK), is piloting a digitised remote medical consultation process which employees can use to have sick-leave certified and to dispense their prescriptions.

The project will start in December 2019 and up to 14,000 people could have access to the service through a video app. It is running in parallel with the role out of electronic prescriptions and TK is hoping to use its findings to inform ongoing rollout of digitisation in healthcare. Although there may be some opposition to the concept of a digitised process, the option may be attractive and could potentially free up doctors to deal with more complex patients.

(Source: IHS)

France

More restrictions on sales of OTC medicines

Displays of common over-the-counter (OTC) painkillers and anti-inflammatory medicines may soon be restricted. Proposals by the French National Agency for Medicines and Health Products Safety (ANSM) mean that they might have to be placed behind the counter in community pharmacies.

The plans are out for consultation at present, but are likely to come into force from January 2020. Consumer and patient organisations in France have broadly welcomed the policy for strengthening the advisory role of pharmacists, although this may impact negatively on sales of popular brands like Doliprane and Efferalgan (paracetamol) and Advil (ibuprofen).

(Source: IHS)

Portugal

Pharmacy programme wins international award

An initiative launched by the Associação Dignitude (Dignity Association), has received the International Pharmaceutical Federation (FIP) Pharmacy Practice Improvement Award for 2019.

The programme, called Abem, which began in 2016, allows both private and public bodies to identify people who are experiencing economic difficulties. Eligible patients only have to pay the standard national health service fee and can receive their medicines free from any of the 574 participating community pharmacies. The programme is funded by donations, including from pharmacies themselves, and has so far supported 7,000 patients.

(Source: FIP)

Romania

Multiple issues with drug shortages

Shortages have created major problems in Romania in the past two years, resulting in the implementation of drastic measures by the government to restore essential supplies. The Ministry of Health has also announced plans to introduce a suspension of export of 172 drugs over a six-month period.

The Romanian Association of International Drug Manufacture (ARPIM) has issued a warning of the risks associated with the renewal of a national drug pricing scheme. The Ministry of Health claims that renegotiated prices have been secured for many of the products covered by the scheme, which was due to expire in early November.

(Source: IHS)

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EPF December 2019 4

Javier Casas (Spain) opened the day with an overview of the Spanish healthcare market and explained that Spain is the first country in the world in terms of coverage for community pharmacy services. He went on to explain that medicine prices have suffered a 20% decrease in the past five years and are, on average 15% lower than medicine prices in the European Union. This has resulted in a decrease in pharmacy revenues, and some pharmacies were unable to survive.

He explained that pharmaceutical expenditure is 20 billion euros a year but that the most expensive medicines are dispensed in hospital pharmacies. He also noted that although online medicine sales do not represent large volumes, double digit growth has been recorded in this area which forces pharmacists to adapt and be more present in the new distribution channels and that the main concern is how to attract young customers away from buying online and into pharmacies. Javier Casas also confirmed that the entire pharmaceutical supply chain, not only wholesalers and pharmacists, is affected by price reductions.

Concha Almarza (Spain and Portugal) commented that over the past few years, the specialties segment has become the main growth driver in the pharmaceutical market, with 83% of medicines dispensed by hospital pharmacies being for outpatients.

She explained that innovation will be focussed on specialty medicines and that community pharmacies will evolve into a more complex model. She added that new technologies will become a contributing factor, and also that in light of the trend towards hospital pharmacies dispensing

more speciality medicines, community pharmacists must champion a new dispensing model.

Ramón Jordán (Spain) explained that the pain purpose of the Spanish model is to offer equal access to all medicines and underlined that pharmacists have a role in supporting and advising patients. He also referred to the fact that a pharmacist can only own one pharmacy, so in rural areas they can encounter a lot of financial difficulties.

Juan Guerra (SVP, Managing Director, International Wholesale, Walgreens Boots Alliance) announced that the company has developed Walgreens Find Care, a digital platform connecting patients to healthcare professionals and that it has set up a partnership with a company called Wing, to offer a delivery system using drones. He added that Walgreens Boots Alliance continues to expand, especially in China.

Mike Smith (England) highlighted the issues of the closure of 230 pharmacies over the past two years as well as issues surrounding medicine shortages.

Noel Wicks (Scotland) explained that the Scottish Government wants to free up pharmacists from certain administrative tasks, to enable them to make better use of their clinical expertise and that the Pharmacy First principle is aimed at ensuring that pharmacies are the first point of contact within the healthcare system.

Bruno Julia (France) shared that on 1 January, 2019, dispensing fees were introduced, meaning that fees now represent 72% of pharmacists’ remuneration.

He went on to explain that teleconsultations have been introduced in community pharmacies and that from 15 October, all pharmacists will be permitted to administer flu vaccines.

Philippe Gaertner (France) spoke of the creation of a working group on the issue of medicine shortages and added that the National Medicine Safety Agency is envisaging a ban on direct sales of paracetamol, ibuprofen and aspirin in the near future.

Walter Taeschner (Germany) explained that the situation in Germany has not fundamentally changed in the last twelve months, although he added that medicine shortages are becoming a public health issue, with community pharmacies reporting shortages of some 200 or 300 medicines.

Razvan Prisada (Romania) explained that pharmacy law is being reviewed to enable pharmacies to sell OTC products online.

Tricia Kennerley (Director, International Public Affairs, Walgreens Boots Alliance) invited working groups to discuss the financing model for pharmacies and pharmacists’ remuneration, to identify disruptors for margins or dispensing fees and to discuss dispensation of specialty medicines.

The working group also discussed the issue of shortages, mainly due to very low prices and estimated that continuous price cuts are a disruptor in many countries.

The 56th European Pharmacists Forum took place in Zaragoza, on 3 and 4 October, bringing together leading European pharmacists to discuss key issues affecting the pharmacy sector.

Highlights from the 56th EPF Seminar of 2019