new 2010 edition · 1998 –2009 26 16. self-medication -the importance of otc medicines to...

OTC Distribution in Europe is a study of the factors driving change and presenting challenges and opportunities to manufacturers. It includes analysis and discussion of European and national statutory and regulatory developments; healthcare supply chain economics; evolving formal and informal channel structures; distribution channel competitors’ market shares, linkages and groupings.

This is the seventh edition of James Dudley's highly regarded 18 country consultancy report - OTC Distribution in Europe

the largest and most up to date strategic analysis of the supply network serving the non-prescription pharmaceuticals and OTC Self

460 pages and 200 graphs, tables & figures

OTC Distribution in Europediscussion and opinions regarding the historic, present and future challenges and opportunities for the European non

together with consumer healthcaand distributor market shares

is a study of the factors driving change and presenting challenges and opportunities to manufacturers. It includes analysis and discussion of European and national statutory and regulatory developments; healthcare supply chain

nd informal channel structures; distribution channel competitors’ market shares, linkages and

OTC Distribution in Europe is an exploration of changes in manufacturer, retail customer and consumer and patient needs and the unfolding strategies required by healthcare companies to adapt and lead Europe’s selfmarkets. The 2010 study provides insights and understanding of inter-channel rivalries between pharmacy and the mass market operatorthe need for retail pharmacy chains or voluntary groups to force the pace of innovationneeded to challenge emerging competing channels including supermarkets, mail order pharmacies and the Internet.

This is the seventh edition of James Dudley's highly regarded 18 country OTC Distribution in Europe. This expanded 2010 edition is

the largest and most up to date strategic analysis of the supply network serving the prescription pharmaceuticals and OTC Self-medication in Europe with over

460 pages and 200 graphs, tables & figures

New 2010 Edition

OTC Distribution in Europe is an in-depth strategic 18 country study

It defines and explores the main themes of change running through the European region and shows how they will influence the channel strategies for manufacturers’ of nonprescription and OTC self-medication as well associated consumer healthcare products. It provides a wealth of knowledge covering 18 European markets together with insights into an increasingly competitive and comarketing channel structure from a highlyrespected strategy consultant

James W. Dudley

n in Europe provides up-to-date statistics, analysis, insights, discussion and opinions regarding the historic, present and future challenges and opportunities for the European non-prescription and OTC self medication market

together with consumer healthcare and pharmaceutical market sizes trends, pricing and distributor market shares

is an exploration of changes in manufacturer, retail customer and consumer and patient needs and the unfolding strategies required by healthcare companies to adapt and lead Europe’s self-medication markets. The 2010 study provides insights and

channel rivalries between pharmacy and the mass market operators and the need for retail pharmacy chains or voluntary groups to force the pace of innovation. This is

challenge emerging competing channels including supermarkets, mail order

This is the seventh edition of James Dudley's highly regarded 18 country . This expanded 2010 edition is

the largest and most up to date strategic analysis of the supply network serving the medication in Europe with over

New 2010 Edition

OTC Distribution in Europe is an depth strategic 18 country study

It defines and explores the main themes of change running through the European region and shows how they will influence the channel strategies for manufacturers’ of non-

medication as well associated consumer healthcare products. It provides a wealth of knowledge covering 18 European markets together with insights into an increasingly competitive and complex marketing channel structure from a highly

James W. Dudley

date statistics, analysis, insights, discussion and opinions regarding the historic, present and future challenges and

prescription and OTC self medication market re and pharmaceutical market sizes trends, pricing

Driving the Recovery

Executive Summary

In 2010 European consumers are expected to purchase nearly $37.5 billion worth of non-prescription OTC medicines for self-medication representing around 36% of world demand. Accounting for 16% of retail pharmaceutical business in the region non-prescription self-medication is an important business category for both manufacturers and retailers.

Yet a number of major factors are coming into play which will influence the competitive environment for the consumer healthcare industry. Among these are the restructuring of the pharmaceutical supply chain, continued deregulation of retail channels, the growing importance of retail pharmacy groupings and mass market chains and the expansion of products licensed for sale in non-pharmacy outlets. These factors together will have a major impact on how manufacturers plan their strategies over the next few years.

“Change that will reshape the structure of the supply chain, focus buyer power and as a consequence present suppliers with new strategic challenges. The aim of this seventh study into

OTC Distribution in Europe is to explore change and to provide thoughts on how to anticipate unfolding threats and opportunities”.

OTC Medicine Manufacturers will have to find strategic responses at both national and international levels to a number of critical issues some of which include: -

Future processes of deregulation of the pharmacy supply chain in the light of revised actions from the European Commission and the judgements by the European Court of Justice affecting pharmacy ownership in Germany, France, Spain, Austria and Sweden

Continuing concentration of pharmaceutical wholesaler’s buying power and vertical integration into retailing and logistics across European borders

The expansion of a Europe-wide retail pharmacy footprint of ‘virtual’ and wholly owned chains connected to a handful of key wholesalers

Recovery prospects for the non-prescription sector in Western Europe and its future in Eastern States in the light of healthcare reforms and the maturity of some core categories leading to changes to industry structures with an increasing shift to brand driven consumer marketing cultures

The ambitions of mass market grocery and chain discount drugstore operators to enter the lucrative consumer health market through GSL brands and pharmacy and OTC unit in-plants

The expansion of international retailers from Central and Eastern Europe into the European consumer health and beauty markets The spread of pharmacy chains and the introduction of general sale lists(GSL) to the Nordic Region

The continuing legacy of reforms in Europe’s largest market, Germany, especially the impact on consumer confidence and perceptions of non-prescription medicines following the abolition of reimbursement for and resale price maintenance on OTC medicines, legalization of mail order and Internet marketing of pharmaceuticals and the benefits and costs of partial deregulation of pharmacy ownership – especially in terms of increased pharmacy numbers, improved profitability and the surge in affiliations to voluntary or virtual pharmacy chains.

OTC Distribution in Europe - 2010 TOC___________________________________________________________________

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James Dudley International Ltd All Rights Reserved Page 1-1

OTC Distribution in EuropeThe 2010 Edition

Driving the Recovery18 Country European Market Study

Table of Contents

Chapter 1Distribution of OTC Medicines in Europe – Introduction, Market

Definitions and Summary of Key Issues

1. Forward to the 2010 Study of the Distribution of OTC Medicines in Europe 1

2. The European Non-prescription OTC Self-Medication Market 2010 5

3. Estimates of the Market Size for OTC Medicines of the 18 European Markets for the 2009 OTC Distribution in Europe Study 7

Graph 1: Development of Sales of the Total Non-prescription Bound and OTC Self-medication market for 18 major European Markets € millions at Consumer Purchase Prices 2006 – 2009 (estimates) 7Graph 2: Year on Year Sales Gains and Losses OTC Self-medication Sales compared to Semi-ethical Prescriptions – Europe 2006 - 2009 9

3.1 Impact of De-reimbursement of Non-prescription medicines and OTC Self-medication Market Demand in Europe 9

Graph 3: Analysis of Value Sales of Non-prescription Medicines following Major De-reimbursement in Germany 2004 – Germany Compared to France 2003 to 2009 (2003 = 100) 10

4. Share of Sales by Market 2009 – Total Pharmaceuticals, OTC Medicines and Semi-Ethical products in Europe 11

Table 1 12Non-prescription Medicines % € Share Europe by Country 12Total Retail Pharmaceutical, Non-prescription and OTC Self-medication Markets 2009 est.

12Table 2 13Country % € Share of Non-prescription Medicines’ Country Markets taken by Prescription Sales 2006 compared to 2009 – Main European Markets 13

5. Barriers to Growth for the Non-prescription and OTC Self-medication Markets in Europe 13

6. Major Categories of OTC Self-medication Medicines in Europe’s Main Markets14Graph 4: Growth of the European Self-Medication Market by Therapeutic Category 2006 – 2009

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7. Non-prescription Pharmaceuticals and OTC Self-medication Medicines Country Market Growth - Europe 2006 - 2009 15

Table 3 16Europe’s Main Non-prescription and OTC Medicines Markets 16

TOC OTC Distribution in Europe - 2010______________________________________________________________________________

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Page 1-2 All Rights Reserved James Dudley International Ltd

Total Non-prescription and OTC Self-medication Business 16% € Growth 2006 – 2009 16

8. Non-prescription Pharmaceuticals and OTC Self-medication Medicines Leading Manufacturers’ Market Shares and Growth - Europe 2008 17

Table 4 17Europe’s Leading Non-prescription Medicines Manufacturers’ % Market Share 2008 17

Graph 4: Growth of Top Ten Leading Non-prescription Medicine Suppliers in Europe 2008 17

9. Regulatory Controls on Distributing and Merchandising of OTC Medicines in Europe 18

10. Non-prescription Medicines and OTC Self-medication in Europe – Changing Distribution Channel Environments 18

Graph 5: Key Markets - Europe 2009 Share of OTC Self-Medication Turnover through Non-pharmacy Channels (excluding prescriptions) 19

11. Analysis of Pharmacies in Europe 20Table 5 21Europe - Number of Pharmacies by Country and Population served per Pharmacy 2009 21

12. Growth of Retail Pharmacies in Europe 22Table 6 22Growth in Retail Pharmacy Numbers by European State 222006 - 2009 22

13. Regulatory Restraints on the Growth of Pharmacy Numbers in Europe 23

13.1 Restrictions on Pharmacy Numbers in Europe 23Table 7 24Regulations Controlling Pharmacy Numbers in Europe by State 24

14. The Role of the Retail Pharmacies in Europe 25

15. Economic Pressures on Pharmacies in Europe 25

15.1. Pressures from the Social Healthcare System 26Table 8 26Self-Medication in Europe - Average Pharmacy Margins 261998 – 2009 26

16. Self-medication - The Importance of OTC Medicines to Pharmacies in Europe27

Table 9 28Pharmacies - Average Annual Consumer Purchases of Non-prescription and OTC Self-medication Products by European State 2009 28Consumer – Purchase Prices (€000s) 28Table 10 29Retail Pharmacies in Main European States - % Sources of Business Turnover 2009 29

17. Promoting Self-medication in Europe - Restrictions on Merchandising of OTC Medicines in Pharmacies in Different European States 29

Table 11 30Constraints on Merchandising 30OTC Self-medication Medicines in Pharmacies by European State 30

18. Retail Price Maintenance of OTC Self-medication Medicines in Europe 30


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Table 13 31Self-medication – Status of Retail Price Maintenance on OTC Medicines in European States

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19. Analysis of Trends in the Ownership of Pharmacies in Europe 32Graph 6: 18 Key Markets - 2009 % Share of Number of European Pharmacies by Ownership Classification 33

Table 14 35Retail Pharmacies in Private and Public Chains in Europe – 2008/9 35

20. Location of Pharmacies in Multiples in Europe 35Graph 7: 18 Key Markets – Location of Chain Pharmacies by State in Europe 2009 36

20.2 European Court of Justice Ruling resulting from DocMorris Case Challenging German Ownership of Pharmacies Laws 2009 and its impact on EU Pharmacy Law 37

Table 15 38Ownership Regulations for Pharmacies in Europe as at 2009 38(18 Country Study) 38

21. Pharmacist owned Small Scale Retail Multiples in Europe 38

22. The Growth of Large Retail Pharmacy Chains in Europe 39Table 16 40Europe’s Leading Retail Pharmacy Chains 2008/2009 40

23. Growth of organised of Voluntary Groupings (Virtual chains) of Independent Pharmacies in Europe 42

24. Why do Clusters of Independent Pharmacies form into Voluntary Groupings, Virtual Chains and Symbol Groups in Europe? 42

Table 17 43% of Pharmacies in Virtual Retail Pharmacy Chains – 18 European Markets 2008/2009 43

Graph 8: 18 Key Markets – Location of Pharmacies in Virtual Chains and Symbol Groups by State in Europe 2009 44

Table 18 45Emerging Virtual Pharmacy Groupings in Europe 2009 45

24.1 The Difference between Voluntary Trading Organisations and Franchises –European ‘Virtual’ Pharmacy Chains 47

25. Innovation, Buyer Power and Branding - the Reasons for Retail Pharmacy Groups in Europe 48

26. Supermarket Chains - a growing Force in Pharmacy Retailing in Europe 49Table 19 50Growth of Pharmacies in Main Supermarket Groups in the UK 2006 - 2009 50

27. The potential Impact of Retail Pharmacy Multiple Groupings on the OTC Self-medication and Consumer Healthcare Companies in Europe 51

28. Threats and Challenges from Mail order and Internet Pharmacies in Europe52

29. Consumer Sources of Information about their Health 54Graph 9: Respondents’ Descriptions of their Level of Interest in their Personal Health and Wellbeing – France, Germany, Italy, Spain and UK 2009 54


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Graph 10: Respondents’ Health Conditions Suffered – France, Germany, Italy, Spain and UK 2009 55

Table 20 55% Minor Ailments and Conditions Treated with OTC Medication in France, Germany, Italy, Spain, Sweden, Switzerland and the UK Compared to the USA 55Table 21 56Sources of Information Consumers believe to be Important 565 European Countries – 2004 56

30. Summary Conclusions and Outline Future Agenda for Non-prescription Medicines and OTC Self-medication in Europe 56

30.1 The Future for Leading Pharmaceutical Wholesalers Retail Groupings in Europe57

30.2 New Model for the Major Pharmacy Distributors in Europe 58

30.3 Growth of General Sale (GSL) OTC Self-medication Medicines across Europe 58

30.4 Ambitions of Mass Market Retail Chains to acquire Pharmacies in Europe 59

Chapter 2 Pharmaceutical Wholesalers Strategies for Managing Change

in Europe

1. The Role of Wholesalers within the Pharmaceutical Supply Chain in Europe 1Figure 1: Pharmaceutical Supply Chain in Europe 1

2.1 Services offered by European Pharmaceutical Wholesalers 4Figure 2: Summary of Services Provided by Pharmaceutical Wholesalers 5

The basic offer 5

Marketing and training support 5

Additional support services 6

Financial services 6

2. Unfolding Company Strategies across the European Pharmaceutical Wholesaling Industry 7

3. Transformation from Wholesalers to Integrated Channel Managers - Driving Change for Europe’s Pharmaceutical Distribution Industry 9

4. Innovation, Diversification, Vertical Integration and Competitor Strategies of Major European Pharmaceutical Wholesalers 9

Table 1 10Europe’s Leading Pharmaceutical Distributors’ Activities along the Supply Chain 2009 10

5. Impact on Pharmaceutical Distributors Strategies of Changes to Third party Pharmacy Ownership Rules in Europe 11


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6. Expansion of major Pharmaceutical Wholesalers across borders in Europe and into the Global market Place 11

Graph 1: International Pharmaceutical Wholesalers’ and Channel Managers’ Turnover in Europe in 2008/9 (est. Euros Billions) 12Graph 2: Estimated % Market Share of Leading International Pharmaceutical Distributors in Europe based on Wholesale/Logistics Turnover 2008/9 – 18 European Market Study 13

Table 2 14Major Pharmaceutical Wholesaler’s’ and Channel Managers’ National and Consolidated % Market Share 2009 1418 European Market Study 14(Based on reported sales as a % of national wholesale sales) 14Table 3 16Leading International Pharmaceutical Wholesalers 16Rank Position by Country Market 2008/9 16

6.1 Reasons for Mergers and Acquisitions in the European Pharmaceutical Wholesale Industry 16

7. Role of Major Pharmaceutical Distributors in the Development of Multiple Retail Pharmacy Chains, Mail order and Internet retailing in Europe 18

Graph 3: Split of European Pharmaceutical Wholesalers’ Turnover between Wholesaling/Logistics and Retail Pharmacy Sales 2009 (est.) 19

Table 4 20Leading Pharmaceutical Distributor Retail Developments in Europe 2009 20

Apteek - Estonia 20Selmos Valstine - Norway 20

8. European Pharmacy Chains wholly owned by Pharmaceutical Wholesaler Groups – Alliance Boots, Celesio, Phoenix and Mediq (OPG) 20

8.1 Alliance Boots Retail Europe 21

8.2 Celesio Retail Europe 21

8.3 Phoenix Retail Europe 21

8.4 Mediq Retail Europe 21

9. Creation and Expansion of Voluntary Groupings of Pharmacies in Europe –Symbol Groups, Franchise Concepts and Virtual Chains 22

9.1 Mail Order Pharmacies 22

10. Conclusions - New Business Models for the European Pharmaceutical Supply Chain - a Response to changing Manufacturer, Pharmacy and Patient Needs 23


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Chapter 3Profiles of Companies Driving the European Pharmaceutical

Supply Chain1. Summary of Celesio’s Business in Europe 1

Table 1 2Celesio Consolidated Sales & Profits (€000) 2007 – 2008 2

1.1 Celesio - Sources of Business Growth 2000 - 2008 2Table 2 3Celesio Source of Business and EBIT 2000 – 2008 3Table 3 3Celesio Group Turnover by Market and Main Activity - (€ Millions) 2008 3

Celesio Refocused Business Strategy 1999 – 2008 4

1.2 Celesio – New Business Organization 2009 4Figure 1: 5Celesio Organizational Structure as at January 2009 5

1.2 Celesio’s Pharmaceutical Wholesaling Market Share by Country 6Table 4 7Celesio’s Market Share by European Pharmaceutical Wholesale Market 2008 7

1.3 Celesio Pharmacy Retailing – Consumer and Patients’ Solutions 7Table 5 8Celesio European Retail Pharmacy Estate 2008 Compared to 2003 8

1.4 Celesio Pharmacy Retailing – Outline Performance in Seven European States 8Table 6 9Celesio Seven European Markets - Average Turnover per Retail Pharmacy 2008 Compared to 2003 (€Millions) 9

1.5 Celesio Mail Order Internet Pharmacy Retailing 9

UK – Lloydspharmacy Business 10

Celesio Pharmacies in Italy 10

Celesio Pharmacies Czech Republic 10

Celesio Pharmacies Norway 11

Celesio Pharmacies Netherlands 11

Celesio Pharmacies Belgium 11

Celesio Retail Pharmacy Chain Developments in Sweden 11

Celesio Pharmacies Ireland 12

Celesio in Germany 12

1.6 Celesio – ‘Manufacturer Solutions – Pre-wholesaling Services and Contract Sales Forces 12

Celesio Contract Sales Operations in Europe 13

Celesio Homecare UK 13


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1.5. Celesio – The Future 13

Alliance Boots 15

2. Summary of Alliance Boots Business 15

Alliance Boots Retail Divisions – UK 15Table 7 16Alliance Boots Pharmacy Chains and Number of Outlets in the UK 2009 16

Boots the Chemist Trading Profile UK 16

2.3 Boots the Chemist Internet Services in the UK 17

Alliance Boots Non-pharmacy Retail Activities in the UK 17

Alliance Boots International Retail Division 17

2.1 Alliance Boots Group Source of Revenue and Trading Profit 19Table 8 19Revenues and Profits Alliance Boots Pharmaceutical wholly owned and Associate Businesses 2008 19

Alliance Boots Minority owned Companies and Strategic Partnerships 19

Alliance Boots Associates - Andreae-Noris Zahn AG (ANZAG) and Galenica A.G. 19

Hedef Alliance Holding A.S. 20

Alliance Healthcare Portugal 20

Guangzhou Pharmaceuticals Corporation - China 20

Unidrug Distribution Group (UDG) - UK 20

Unifarma Distribuzione S.r.I. - Italy 20Table 9 21Alliance Boots Main Associate Companies 2009 21

2.2 Alliance Boots emerging Global Pharmaceutical Wholesaler and Distributor 21Table 10 22Alliance Boots Pharmaceutical Wholesale Market Share by European Country 2008/9 22

2.3 Alliance Boots Development of an International Brand of Generic Pharmaceuticals - Almus 23

2.4 Alliance Boots Pharmaceutical Retailing 24Table 11 24Alliance Boots European Retail Pharmacy Estate 2009 compared to 2006 24

2.4. The Future for Alliance Boots – Emerging Global Player 25

Phoenix 27

3. Summary of Phoenix Business in Europe 27

CERP Lorraine 28Table 12 29Phoenix Pharmaceutical Wholesaling Market Shares - Europe, 29% € Share 2008/9 29


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3.1 Phoenix Tamro – Wholesale Pharmaceutical Distribution and Retail Pharmacy Chains in the Nordic and Baltic States region 29

3.2 Phoenix Pre-wholesaling in Europe 30

3.3 Phoenix in Pharmacy Retailing in Europe 30Table 13 31Phoenix Associated Groupings of Independent Pharmacies 2009 31

MIDAS 31

MVDA/Linda 31

Numark 31

Escura Apotheek in the Netherlands, Midas in Germany, SPEM in Italy and VMI in Denmark 31

Apteeks 1, Seimos Vaistine and Aptieka 1 (renamed from Tamro Aptieku) 32

3.2 The Future for Phoenix Group in European Pharmaceutical Distribution 32

4. Summary of Sanacorp – CERP Rouen Merger 34Graph 1: Millennium Combined Pharmaceutical Wholesale Market Share Resulting from the Merger of CERP Rouen France and Sanacorp Germany 2009 34

4.2 Conclusions Millennium (CERP Rouen and Sanacorp Merger) 35

Mediq N.V. (previously named) OPG Groep N.V Netherlands 36

5. Summary of Mediq Business in Europe 36

5.1 Mediq N.V. (OPG Groep) Sources of Business 36Table 14 36Mediq N.V. Business Units and Sales Share 2009 36

Mediq Pharmacy – Retail and Wholesale Pharmacy Operations in the Netherlands, Belgium and Poland 37

Mediq Direct 37

Mediq Institutional 37

5.2 Mediq NV Business Strategy 2007 to 2009 37

5.3 The Future Mediq (OPG Groep) Netherlands 38

A.S. Watson Group 39

6. A.S. Watson Group Expansion of Pharmacy and Drugstores into Europe 39

6.1 A.S Watson in the Netherlands 39

6.2 A.S Watson in Germany, Poland, Hungary and the Czech Republic 40

6.3 A.S Watson in the Baltic Region 40

6.4 A.S Watson in the UK 41

6.5 A.S Watson in the Ukraine 41

6.6 A.S Watson in Russia 41 6.7 A.S Watson Global Buying Policy 42


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Chapter 4New Channels for Consumer Access to Healthcare in Europe

1. Development of Internet Pharmacies in Europe – 2010 Report 1

1. 1 The Internet as a new Challenge in Pharmacy Retailing in Europe 3

1.2 Internet Pharmacy Development in Europe – The German Experience 4

1.3 Internet Applications to the Delivery of Primary Care Services in Europe 4

2. Business to Business Internet Applications in Pharmaceutical Distribution in Europe 6

2.1 Alliance Boots Internet Portal – dot Info in Europe 7

2.2 Celesio - Internet based Solutions for Pharmacies in Europe 7

3. Business to Consumer (B2C) Internet Pharmacy Retailing Applications in Europe 8

3.1 Internet Pharmacy Retailing Models in Europe Compared 8

3.2 ‘Pureplay’ Online Pharmacies in Europe 8

3.3 DocMorris Building a New Retail Pharmacy Brand in Europe 9

3.4 The Emergence of Healthcare Portals linked to ‘Clicks and Bricks’ Pharmacies in Europe 10

4. Opportunities for Business to Consumer e-Commerce for Pharmaceutical Companies in Europe 11

Table 1 12Patients and Medical Professionals - Trust in Sponsored Healthcare Web sites Europe 12Table 2 13Online Commerce in Pharmaceuticals - Regulatory Status in Europe 13States Permitting Online Commerce – Revised 2009 13

5. Development of Internet Pharmacies in individual European States14

5.1 Development of Internet Pharmacies in France 14

5.2 Development of Internet Pharmacies in Germany 15

5.3 Development of Internet Pharmacies in Italy 15

5.4 Development of Internet Pharmacies the Netherlands 16

5.5 Internet Pharmacies in Poland 17

5.6 Development of Internet Pharmacies in Switzerland 17

5.7 Consumers Access to Internet Pharmacies in the UK 18

5.8 Development of Internet Pharmacies in Sweden 19

5.9 Development of Internet Pharmacies in Denmark 19


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5.10 Development of Internet Pharmacies in Finland and Norway 20

5.11 Development of Internet Pharmacies in Austria 20

5.12 Development of Internet Pharmacies in Belgium 21

5.13 Development of Internet Pharmacies in Spain 21

6. Development of Internet Pharmacies in Czech Republic, Hungary, Slovakia and Slovenia 22

6.1 Internet Pharmacies in Czech Republic 22

6.2 Internet Pharmacies Hungary 22

6.3 Internet Pharmacies Slovakia 22

6.4 Internet Pharmacies Slovenia 23

7. Evolution of the Legal Status of Mail Order and Internet Pharmacies for Medicines in Europe 23

8. The Future for Mail order and Internet Marketing of Non-prescription Medicines and OTC Self-medication in Europe _____________________ 24

Chapter 5OTC Distribution in Belgium

1. The Non-prescription and OTC Self-Medication Market in Belgium 2009 1Graph 1: Belgium Total Self-medication Market 2005 - 2009 1

2. Share of the Belgian Self-medication Market by Category 2009 1Table 1 2Belgium – Self-Medication Market Category Share and Growth 22005 - 2009(est.) 2

3. Changing Structure of the Belgian Self-medication Market 2Table 2 3Leading OTC Self-medication Brands in Belgium 3

4. Professional or Semi-ethical Pharmaceutical Brands 3

5. Consumer OTC Self-medication Brands in Belgium 3

6. Classification of Medicines in Belgium 4

7. Reimbursement of Non-prescription Medicines in Belgium 4

8. Statutory Control of Prices on OTC Medicines in Belgium – New Cost Control Measures 2009 5

9. The Changing Business Environment for Non-prescription medicines in Belgium5

10. Regulatory Environment for Pharmaceutical Distribution in Belgium 6


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11. Structure of Distribution Channels for Self-Medication in Belgium 7Figure 1: Outline Structure of OTC Pharmaceutical Distribution in Belgium 7

12. Trends in the Retail Pharmacy Sector in Belgium 7Graph 2: Pharmacy Development Belgium 1997 - 2008 8

13. Retail Pharmacy Groupings in Belgium 8Table 3 8Types of Pharmacy – Belgium 2008 8

14. Pharmacy Co-operatives in Belgium 9Table 4 10Leading Cooperative Retail Pharmacy Groups – Belgium by Number of Pharmacies 2009 10

15. Retail Pharmacy Co-operatives’ Strategies in Belgium 10

16. Celesio and Mediq (OPG) Retail Pharmacy Chains in Belgium 11

17. Independent Pharmacies in Belgium 11

18. Pharmacy Analysis of Turnover and Economics in Belgium 11

19. Trade Margins and VAT Manufacturer to Retail Pharmacy Price for Prescription and OTC Medicines in Belgium 12

20. Internet Pharmacies in Belgium 12

21. Restructuring of Pharmaceutical Wholesalers in Belgium 12Table 5 13Belgian Pharmaceutical Wholesalers’ Market Shares 2008 13

22. The Future for OTC Medicine Distribution in Belgium 14

Chapter 6OTC Distribution in France

1. The Self-Medication Market in France 2009 1Graph 1: France Total Self-medication Market 2005 – 2009 1

2. Prescribing Medicines not requiring a Prescription remains big Business in France 2

Table 1 2France - on Non-prescription Pharmaceutical and Self-Medication Markets 2Growth indices 2003 – 2009 est. (2003 = 100) 2

3. Share of the France Non-prescription Medicines and Self-medication Market by Therapeutic Category 2009 2

Table 2 3France – Self-Medication Market Category Share and Growth 32005 – 2009 est. 3

4. Medicine Classifications in the French Prescription Pharmaceutical and Non-prescription OTC Medicines Markets 3

4.1 Classification of Medicines in France 3


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4.2 Legal Definition of Non-prescription Medicines in France 3

5. Pharmacy Monopoly - Ownership Regulations in France Challenged by European Commission 4

6. Advertising Regulations for Non-prescription and OTC Medicines in France 4

7. Use of Trademarks for Medicinal Products in France 5

8. OTC Medicines Linkages to the Prescription Pharmaceuticals Sector in France 5

9. French Pharmaceutical Distribution - Price Control and Reimbursement Systems 5

10. Price Control - Prescription Medicines in France 6

11. Reimbursement Bands for Non-prescription Medicines in France 6

12. Scrutiny of the List of Pharmaceutical Products for Reimbursement in France6

13. Generic Substitution Targets for Prescription Medicines imposed on French Pharmacies 7

14. Structure of Distribution for Self-Medication in France 8

15. Types of Non-prescription or OTC Medicine Brand in France 8

16. The Retail Pharmacy Channel in France 9Figure 1: Outline Structure of OTC Pharmaceutical Distribution in France 9

17. Pharmacy Distribution by Region in France 10Table 3 10Number of Retail Pharmacies by Metropolitan Region in France 2009 10

18. Pharmacy – Virtual Chains and Buying Groups in France 11Table 4 11Leading Voluntary Groupings and Virtual Chains of Pharmacies in France 2009 11

19. Sources of Business Turnover and Economics of French Pharmacies 13

20. Consumer Attitudes towards Pharmacists in France 13Table 5 14Healthcare - Sources of Information French Consumers believe to be Important 14Table 6 14Self-medication - % of French Consumers Suffering Common Ailments Treating with an OTC Medicine 14

21. Potential for Internet Pharmacies in France 15

22. Prices and Margins of Non-prescription and OTC Medicines in France 16Table 7 16France – Price Build-up Reimbursed Pharmaceutical Products 2009 16

23. Non-Pharmacy Distribution in France of Consumer Healthcare Products in France 16

24. Pharmaceutical Wholesalers in France 17Table 8 17


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France - Pharmaceutical Wholesalers’ Share of Market and Distribution 2008/2009 17

Celesio France 18

Alliance Healthcare (Alliance Boots) France 18

CERP (Coopérative d'Exploitation et de Répartition) 19

Phoenix 19

Phoenix France 19

25. France – The Future for OTC Medicines ______________________________ 20

Chapter 7OTC Distribution in Germany

1. The Self-Medication Market in Germany 2009 1Graph 1: Germany Total Non-prescription and OTC Self-medication Market 2005 – 2009 €000 at Consumer Prices 1

Table 1 2Germany – Impact of Act on the Modernization of Statutory Health Insurance (GMG) on Non-prescription Pharmaceutical and Self-Medication Markets 2Growth indices 2003 – 2009 est. (2003 = 100) 2

2. Share of the German OTC Self-medication Market by Category 2009 2Table 2 3Germany – Self-Medication Market Share and Growth by Therapeutic Category 32005 – 2009 est. 3

3. The Structure of the German Non-prescription Bound Medicines and OTC Self-medication Market 3

3.1 Changing Structure of the German Non-prescription and OTC Self-medication Medicines Market 3

4. The Regulatory Environment for OTC Self-medication Consumer Medicines in Germany 5

4.1 Self-Medication Definition in Germany 5

5. New Healthcare Reforms impacting on the Non-prescription OTC Self-medication Medicines Sector in Germany 5

6. The Changing Regulatory Environment for the Distribution of Pharmaceutical Products in Germany 7

7. Prices and Margins of Non-prescription Pharmaceutical Products in Germany 7Table 3 8Average Wholesaler and Pharmacy Margins in Germany 8

8. Distribution Channels for OTC (non-prescription) Self-medication Medicines in Germany 8

Graph 2: Share of the German Non-prescription Medicines Market by Outlet Type – Pharmacy, Internet Pharmacy, Drugstore, Supermarket and Health Food Outlet (Reformhaus) 2008 9


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8.1. The Changing Structure of the Retail Pharmacy Sector in Germany 10Figure 1: Outline Structure of Non-prescription Pharmaceutical Distribution through Retail Pharmacies in Germany 10Graph 3: Growth of Pharmacies in Germany 1995 to 2008 11

Table 4 12Pharmacy Groupings – Analysis of Retail Pharmacy Numbers and Branch Ownership in Germany by Region 2008 compared to 2005 12

8.2 Pharmacy Turnover Analysis Germany 12Table 5 13Analysis of Pharmacy Turnover in Germany by Pharmacy Category 132008 compared to 2003 and 2005 13

8.3 Economic Impact on Pharmacy Retailing resulting from the 2004 Act to Modernise the Statutory Health Insurance System in Germany 13

Graph4: German Retail Pharmacies – Euro Turnover Analysis 2008 compared to 2005 14

9. Development of Retail Pharmacy Chains in Germany 14Table 6 15The Principal Virtual Pharmacy Chains (Voluntary Pharmacy Groupings) and Wholesaler owned Franchise Concepts in Germany 2008 15

9.1 Wholesaler Sponsored Virtual Pharmacy Chains in Germany 16

9.2 Independent Apotheken Kooperation Groups in Germany 16

9.3 Weaknesses of Virtual Pharmacy Chains in Germany 16

9.4 Franchise Concept Pharmacy Chains in Germany 16

9.5 DocMorris - A Major Breakthrough in Pharmacy Franchise Concepts in Germany16

9.6 Growth of Private Label Brands in Pharmacy Groups in Germany 17

10. Internet and Mail Order Distribution Channels for OTC Medicines in Germany 17

Table 7 19Examples of Internet Online Pharmacies in Germany 19

11. Retail Competition from Internet and Mail Order Pharmacies in Germany19

11.1 OTC Self-medication - Challenges for Internet and Mail Order Pharmacy Distribution in Germany 20

12. Pharmaceutical Wholesalers Germany 20Table 8 21Analysis - Concentration of German Pharmaceutical Wholesalers 1981 – 2009 21Table 9 22Analysis - German Pharmaceutical Wholesalers’ % Market Shares in 2008 compared to 1995 22

12.1 Pharmaceutical Wholesaler Strategies – Key Themes in a Changing Business Environment in Germany 22

13. Pharmaceutical Wholesalers Customer Strategies in Germany 24


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Graph 5: Trends - German Pharmaceutical Wholesaler % Margins – Prescription Only Medicines 2001 – 2008 25

14. Free sale or General Sale List (GSL) OTC Self-medication Medicines through Non-Pharmacy Channels in Germany 25

14.1 Drugstores in Germany 26

14.2 Independent Drugstores in Germany 26

14.3 Multiple Drugstore Retailers in Germany 26

14.4 Health food Shops in Germany 26

15. Consumer Uses, Acquisition of Information, Sources Purchase and Attitudes to OTC Self-medication in Germany 27

Table 10 28% Ailments and Conditions Treated with OTC Medication in Germany Compared to the USA and other Major Nationalities 28Table 11 29% Population Suffering Conditions Compared to % Treating with OTC Self-medication Remedies in Germany 29Table 12 30% Main Sources of Information for Population Treating Minor Health Conditions in Germany 30

15.1 OTC Self-medication Users Most Frequent Source of Purchase in Germany 30Graph 6: OTC Self-medication Users Most Frequent Source of Purchase in Germany 31

16. Conclusions – Themes of Change Driving the Restructuring of the OTC Self-medication and non-prescription Market in Germany 31

16.1 Vertical Integration within the Pharmaceutical Supply Chain - Continuing leadership by Pharmaceutical Wholesalers in Germany 33

Chapter 8OTC Distribution in Italy

1. Introduction – The Non-prescription Pharmaceutical and OTC Self-medication Market in Italy 1

Graph 1: Italy Total Non-prescription and Self-medication Market 2005 – 2009 1

2. Share of the Italian OTC Self-medication Market by Category 2009 2Table 1 2Italy – Self-Medication Market Share and Growth by Therapeutic Category 22005 – 2009 est. 2

3. Classification of Medicines in Italy - Prescription only, Non-prescription and OTC Medicines 2

3.1 Medicine Classification and the Structure of the Italian Non-prescription and OTC Self-medication Market 2

3.2 Definition of Non-prescription OTC Medicines in Italy 3


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3.3 Reimbursement of Pharmaceutical Products not requiring a Prescription (non-prescription medicines) in Italy 3

3.4 Non-prescription Status does not automatically mean OTC (farmaco di automedicazion) Status in Italy 4

4. Structure of the Non-prescription OTC Medicines Market in Italy 4Table 2 5Structure of the Italian Non-prescription Bound and OTC Medicines Market 5

5. Price Controls - Non-prescription and OTC Self-medication Medicines in Italy 5

6. Changes to the Regulatory Environment for Pharmaceutical Distribution Italy 5

6.1 Self-service Merchandising of OTC Medicines in Italy 6

7. Partial Deregulation of Retail OTC Medicine Supply through Non-pharmacy Channels in Italy 7

8. Regulations Covering Wholesaling of Pharmaceuticals in Italy 8

9. Prices and Margins of Non-prescription Pharmaceuticals in Italy 9

10. The Importance of Pharmacies in the Retail Distribution of Non-prescription Pharmaceuticals in Italy 9

11. Growth and Distribution of Retail Pharmacies in Italy 10Table 3 11Growth in Number of Public and Private Pharmacies and Populations served compared by Region in Italy 2006 – 2008 11

11.1 Community Pharmacy Density by Region in Italy 11Table 4 12Pharmacy Density compared to Population Density by Region in Italy 2008 12

12. Retail Pharmacy Chains in Italy 12Table 5 13Retail Pharmacy Chains in Italy 2008 13

13. Analysis of Italian Pharmacy Turnover by Merchandise Category 14Graph 2: Italy – Estimates of Pharmacy Turnover by Category 2008 14

13.4 Italian Pharmacists’ Attitudes to Self-Medication 15

14. Non-pharmacy Distribution of Non-prescription OTC Medicines for Self-medication in Italy 15

14.1 Non-pharmacy Retail Sales for Non-prescription OTC medicines in Italy16

Graph 3: Italy –Sales of Non-prescription OTC Self – medication through Mass Market Retail Channels 2006 – 2009 16

15. The Future for Parapharmacy Outlets (sanatoria), Supermarket based Non-pharmacy Channels and Pharmacy Distribution of OTC Medicines in Italy 16

16. Mail order and Internet Pharmacies in Italy 17

17. Consumer Uses and Attitudes to OTC Self-medication in Italy 18Table 6 18


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% Ailments and Conditions Treated with OTC Medication in Italy Compared to the USA and other Major Nationalities 18Table 7 19% Population Suffering Conditions Compared to % Treating with OTC Self-medication Remedies in Italy 19Table 8 20% Main Sources of Information for Population Treating Minor Health Conditions in Italy 20

18. Pharmaceutical Wholesalers Italy 20Table 9 21Leading Pharmaceutical Wholesalers Market Share in Italy 2008 21

18.1 Phoenix - Comifar Group Italy 21

18.2 Alliance Healthcare Italia (Alliance Boots) 22

18.3 Farmintesa 22

18.4 Unico 23

18.4 Celesio Italy 23

19. The Future for OTC Distribution in Italy 24

19.1 The Future for Pharmacy Ownership in Italy 24

19.2 The Future for Parapharmacy (sanatoria) and Non-pharmacy Distribution of OTC Medicines in Italy 24

19.3 Future Growth of Parapharmacy Retail Channels in Italy 25

19.4 The Future for Pharmaceutical Wholesalers in the Distribution of OTC Medicines in Italy 26

19.5 Pharmacists’ Attitudes to OTC Self-medication in Italy ____________________ 26

Chapter 9OTC Distribution in the Netherlands

1. The Non-prescription Medicines and OTC Self-Medication Market in the Netherlands 2009 1

Graph 1: The Netherlands Total Self-medication Market 2005 – 2009 1

2. Share of the Dutch OTC Self-medication Market by Category 2009 2Table 1 2The Netherlands – Self-Medication Market Share and Growth by Therapeutic Category 22005 – 2009 est. 2

3. Classification of Non-prescription Pharmaceutical Products in the Netherlands – New Three-class System includes General Sale List (GSL) and Pharmacy only Medicines. 2

3.1 Criteria for Non-prescription Medicines classified as AV - General Sale (GSL) in the Netherlands 3

4. Reimbursement of Non-prescription Medicines in the Netherlands 4


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5. Regulations to Abolish Price Fixing of OTC Medicines in the Netherlands 4

6. Structure of Distribution for Non-prescription Medicines and OTC Self-Medication in the Netherlands 4

6.1 Pharmacy and Non-pharmacy Retail Channels for Non-prescription Medicines and OTC Self-medication in the Netherlands 5

Graph 2: The Netherlands – Analysis % Retail Channel Category Share of OTC Self-medication by Pharmacy, Druggist and Supermarket 2008 6

Table 2 7Average Turnover of OTC Medicines by Retail Channel in the Netherlands 2008 compared to 2006 7

Sources: Neprofarm/IMS Consumer Health 2006/8/calc. James Dudley Management 7

7. Drugstores Retailing Non-prescription Medicines and OTC Self-medication in the Netherlands 7

7.1 Declining Drugstore Sector (Druggists) in the Netherlands 8Graph 3: Analysis - Growth of Pharmacies and Decline in Drugstores (Druggists) Numbers in the Netherlands 2001 – 2008 8

8. Self-medication - Private Label Brands of OTC (non-prescription) Medicines Sales through Drugstores in the Netherlands 9

9. Self-selection and Point of Purchase Merchandising for OTC Self-medication Medicines in Dutch Drugstores 9

10. Non-prescription Medicines and OTC Self-medication Sales through Grocery Outlets in the Netherlands 11

11. Retail Pharmacies - The Netherlands 11Table 3 12Main Pharmacy Chains in the Netherlands 2009 12

12. Consumer health on the net - OTC Self-medication – Mail Order Internet Pharmacies in the Netherlands 12

13. DocMorris international On-line Pharmacy Provider 13

14. Non-prescription Medicines and OTC Self-medication Channel Influences on Consumer Sources of Purchase and Choice of Brand for Self-medication in the Netherlands 13

15. Pharmaceutical Wholesalers in the Netherlands 14Table 4 14Market Shares of Pharmaceutical Wholesalers the Netherlands 2009 14

16.1 Dutch Pharmaceutical Wholesalers – Pharmacy Groupings Analysis 15Table 5 16Pharmaceutical Wholesaler Pharmacy Chains Development in the Netherlands 2003 -2008 16Table 6 16Pharmaceutical Wholesalers Virtual Pharmacy Chains and Franchised Outlets in the Netherlands 2009 16


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16. Wholesaler Private Label OTC (non-prescription) Medicine Brands in the Netherlands 17

17. Conclusions - The Future for OTC Self-medication Distribution in the Netherlands 17

Chapter 10OTC Distribution in Spain

1. Introduction – The Spanish OTC Medicines Market 1Graph 1: Spain Total Self-medication Market 2005 – 2009 1

2. Impact of Health Reforms on Reimbursement of Non-prescription Pharmaceuticals in Spain 2005 to 2009 1

Table 1 2Spain – Analysis of Self-Medication Market Share and Growth by Therapeutic Category 22005 – 2009 est. 2

3. Share of the Spanish OTC Self-medication Market by Category 20092

Table 2 2Spain – Self-Medication Market Share and Growth by Therapeutic Category 22005 – 2009 est. 2

Structure of the Spanish Non-prescription and OTC Medicines Market 3

4. The Regulatory Environment for Non-prescription and OTC Medicines in Spain3

Classification of Medicines in Spain 3

Registration of Non-prescription and OTC Medicines in Spain 4

5. Issues affecting the Prescription Sector for Products classified as Non-prescription Medicines in Spain 6

5.1 Reimbursement of Medicinal Products not requiring a Prescription in Spain

6

5.2 Pricing and Price Controls of Non-prescription and OTC Medicines in Spain6

6. Advertising of OTC Medicines in Spain 7

6.3 Regulation of Trade Names for Non-prescription and OTC Medicines in Spain 7

7. The Regulatory Environment for Pharmaceutical Distribution in Spain 8

8. Structure of Distribution for Non-prescription Medicines and OTC Self-Medication in Spain 8

9. Growth of Pharmacies in Spain 8Table 3 9


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Growth of Pharmacies in Spain 1986 to 2008 9

10. Regulatory Controls on the Number of Pharmacies in Spain 9

10.1 Analysis of Pharmacy Numbers Compared to Population Density by Region in Spain 9

Table 4 10Number of Pharmacies by Autonomous Community - Spain 10Table 5 11Analysis - Number of Pharmacies by Province Compared to Population Spain 2009 11

12. Analysis of Spanish Pharmacy Turnover 12Table 5 12% Share of Pharmacy Sales by Categories by Value - Spain 12

12.1 Pricing and Margins 12

13. Consumer Uses and Attitudes to OTC Self-medication in Spain 12Table 6 13% Ailments and Conditions Treated with OTC Medication in Spain Compared to the USA and other Major Nationalities 13Table 7 14% Spanish Population Suffering Conditions Compared to % Treating with OTC Self-medication Remedies 14Table 8 15% Main Sources of Information for Population Treating Minor Health Conditions in Spain

15

14. Pharmaceutical Wholesalers in Spain 15Table 9 16Spain – Pharmaceutical Wholesaler Coverage - Number of Depots by Region and Number of Pharmacies Served 16

14.1 Leading Pharmaceutical Wholesalers in Spain – Market Shares and Strategies 17Table 10 17Spain – Pharmaceutical Wholesalers’ Market Shares 2008 17

14.2 Cofares - Spain 17Table 11 18Cofares Group of Regional Companies – Spain 18

14.3 Alliance Boots Group - SA Farmacéutica Aragonesia (SAFA) 18

15. The Future for Pharmaceutical Wholesalers in Spain 19

16. The Future of OTC Distribution in Spain 19


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Chapter 11OTC Distribution in the UK

1. Introduction – The UK OTC Medicines Market 1

2. The Self-Medication Market in the UK 2009 1Graph 1: The UK Total Self-medication Market 2005 – 2009 2

Table 1 2The UK –Non-prescription Pharmaceutical and Self-Medication Markets 2Growth indices 2005 – 2009 est. (2005 = 100) 2

3. Share of the British OTC Self-medication Market by Category 2009 3Table 2 3The UK – Self-Medication Market Share and Growth by Therapeutic Category 32005 – 2009 est. 3

4. Structure of the Market Demand for Non-prescription and OTC Medicines in the UK 3

5. The Regulatory Environment for Non-prescription and OTC Medicines in the UK 4

5.1 Classifications of Medicines in the UK 4

5.2 Legal Definitions of Non-prescription Medicines and OTC Self- Medication in the UK 4

6. Consumer Uses and Attitudes to OTC Self-medication in the UK 5Table 3 6% Ailments and Conditions Treated with OTC Medication in UK Compared to the USA and other Major Nationalities 6Table 4 6% Population Suffering Conditions Compared to % Treating with OTC Self-medication Remedies in the UK 6

7. Structure of Distribution Channel Systems for Non-prescription Pharmaceuticals and OTC Medicines in the UK 7

8. Consumer Source of Purchase and Share of UK OTC Medicines Market by Outlet Type 8

Table 5 8Consumer Sources of Purchase for OTC Self-Medication by Channel in the UK 2006 8

9. The Retail Pharmacy Sector in the UK 9

9.1 New Role for Pharmacies in the UK – New Pharmacy Contract 9

9.2 Pharmacy Numbers compared to Population Density by Region in the UK 10Table 6 11Share of Pharmacies in the UK by Region 2009 11

10. Ownership of Pharmacies in the UK 12


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Graph 2: Retail Pharmacy Groupings in the UK - Chain Stores and Independent Pharmacies 2009 12

11. Independent Pharmacies in the UK 13

11.2 ‘Virtual’ Chains of Pharmacies (Symbol Groups) in the UK 13

Numark Phoenix (merged with Nucare) 13

11.3 Other Voluntary Pharmacy Groupings in the UK 14

12. Leading Pharmacy Chains in the UK 15Table 7 15Leading Pharmacy Chains and Number of Outlets in the UK 2009 15

12.1 Alliance Boots Pharmacy Chains in the UK 16Table 8 17Alliance Boots Pharmacy Chains and Number of Outlets in the UK 2009 17

Graph 3: Share of Boots Retail Turnover by Category 2008 19

Boots online in the UK 19

12.2 Celesio Lloydspharmacy in the UK 19

Lloydspharmacy online in the UK 20

12.3 Co-operative Group Pharmacy in the UK 20

12.4 L. Rowland (Phoenix) – Retail Pharmacy Chain in the UK 21

13. Independent and Regional Pharmacy Chains 21

The Day Lewis Group 21

14. Regional Independent Retail Pharmacy Multiples in the UK 21Table 9 22Leading Regional Independent Pharmacy Multiples in the UK 2009 22(Retail Pharmacy Chains with 30 to 100 branches) 22

15. Importance of Supermarket Chains and Discount Drugstores for OTC Self-medication Distribution in the UK 22

Table 10 23Number of Pharmacies Located in Leading Supermarket and Discount Drug Chains in the UK 2009 23

Graph 4: Leading Supermarket Groups % Share of the Grocery Market in the UK 2009 23

16. Internet as a Consumer Channel for Pharmaceuticals in the UK 24

17. Pharmaceutical Wholesaling in the UK 25Table 11 25Leading Pharmaceutical Wholesalers in the UK - 2008 25

18. Pharmaceutical Wholesaler Strategies in the UK - AAH Pharmaceuticals (Celesio), UniChem (Alliance UniChem) and Phoenix 25

18.1 AAH Pharmaceuticals (Celesio) 25

Wilkinson Healthcare 26

Enterprise 26


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Trident 26Table 12 26Celesio Wholesale Turnover € Millions 2008 in the UK 26

Turnover 26

18.2 Alliance Healthcare (UniChem Alliance Boots) 26

Alliance Healthcare 27

Cordia Healthcare 27Table 13 27Alliance Healthcare (UniChem) Turnover € Millions 2008 in the UK 27

18.3 Phoenix Healthcare Distribution UK 28

19. Conclusion Wholesaler Strategies in the UK 28

20. The Future for the Distribution of Non-prescription and OTC Medicines in the UK to 2013 29

20.1 Innovation to Compete for Consumer Access to Self-care will be driven by Retail Chains – both Pharmacy and Mass Market 30

20.2 New Models for Retailing Self-care Products and Services in the UK 30

21. OTC Manufacturers’ Strategies in the UK 32

21.1 Category Management for OTC Medicine Manufacturers in the UK 32

21.2 Category Management Criteria for OTC Medicines Manufacturers in the UK33

Chapter 12OTC Distribution in

Austria & Switzerland

1. The Self-Medication Market in Austria 2009 1Graph 1: Austria - Total Licensed Non-prescription Medicines and OTC Self-medication Market 2005 – 2009 1

2. Share of the Austrian OTC Self-medication Market by Category 2009 2Table 1 2Austria – Self-Medication Market Share and Growth by Therapeutic Category 22005 – 2009 est. 2

3. The Regulatory Environment for OTC (non-prescription) Medicines in Austria 2

3.1 Classification of Medicines in Austria 2

3.2 Registration of Non-prescription OTC Medicines in Austria 4

3.3 Regulations covering the Distribution of Non-prescription OTC Medicines in Austria 4

3.4 Regulations covering the Control of Retail Pharmacies in Austria 4


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3.5 Regulations covering Pricing of Non-prescription Medicines and OTC Self-medication in Austria 5

4. Reimbursement of Medicines in Austria including Non-prescription Pharmaceutical Products 5

5. Regulations covering the Advertising of OTC (non-prescription) Medicines in Austria 6

6. The Distribution Environment for Non-prescription Medicines OTC Self-medication in Austria 7

6.1 The Retail Pharmacy Environment for Non-prescription Medicines OTC Self-medication in Austria 7

Table 2 7Austria – Number of Retail Pharmacies, Pharmacy Branches and Dispensing Doctors by Federal State 2008 7

6.2 Analysis of Retail Pharmacy Turnover in Austria 8

7. Prices and Margins for Non-prescription Medicines and OTC Self-medication in Austria 8

8. Mail Order and Internet Pharmacies in Austria 8

9. Pharmaceutical Wholesalers in Austria 9

9.1 Ownership of Pharmaceutical Wholesalers in Austria 9

10. The Future for OTC Distribution in Austria 9

11. The Self-Medication Market in Switzerland 2009 11Graph 2: Switzerland Total Self-medication Market 2005 – 2009 11

Table 3 12Switzerland –Non-prescription Pharmaceutical and Self-Medication Markets 12Growth indices 2005 – 2009 est. (2005 = 100) 12

12. Share of the Swiss OTC Self-medication Market by Category 2009 12Table 4 12Switzerland – Self-Medication Market Share and Growth by Therapeutic Category 2005 –2009 est. 12

13. The Regulatory Environment for OTC Medicines in Switzerland 13

13.1 Classification of Medicines in Switzerland 13

13.2 Pharmaceutical Product Classifications in Switzerland 13

13.3 Registration of OTC Medicines in Switzerland 14

13.4 Regulations covering the Distribution Non-prescription Medicines OTC Self-medication in Switzerland 15

13.5 Regulations covering Retail Pharmacy or Drugstore Ownership in Switzerland 15

13.6 Pricing of Non-prescription Medicines OTC Self-medication in Switzerland 15

13.7 Regulations covering the Advertising of OTC (non-prescription) Medicines in Switzerland 16


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13.8 Regulations covering the Use of Trademarks of OTC (non-prescription) Medicines in Switzerland 16

14. Healthcare Reforms in Switzerland and their Impact on the Swiss OTC Pharmaceuticals Industry 17

15. The Distribution Environment for Non-prescription Medicines and OTC Self-medication in Switzerland 18

16. Non-prescription Medicines OTC Self-medication in Retail Pharmacies in Switzerland 18

16.1 Galenica Pharmacy Chain Switzerland 19

16.2 Other Pharmacy Groups 19

17. Sources of Pharmacy Turnover Switzerland 19

18. Mail Order and Internet Pharmacies in Switzerland - Self-medication on the Net - Swiss Pharmacies engaged in e-commerce 20

18.1 MediService - Swiss Distance Pharmacy Concept 20

18.2 Zur Rose Versandapotheke – Internet Pharmacy in Switzerland 21

19. Distribution of OTC (non-prescription) Medicines through Drugstores in Switzerland 21

Table 5 22Leading Drugstore Groupings in Switzerland - 2009 22

20. Prices and Margins of OTC Medicines in Switzerland 22

21. Swiss Pharmaceutical Wholesalers 23Table 6 23Leading Swiss Pharmaceutical Wholesalers 23

22. The Future for OTC Distribution in Switzerland 23

Chapter 13OTC Distribution in the Nordic Region

Sweden, Denmark, Finland and Norway

1. The Self-Medication Market in Sweden 2009 1Graph 1: Sweden - Total Self-medication Market 2005 – 2009 1

2. Share of the Swedish OTC Self-medication Market by Category 2009 2Table 1 2Sweden – Self-Medication Market Share and Growth by Therapeutic Category 22005 – 2009 est. 2

3. The Regulatory Environment for OTC Medicines in Sweden 2

3.1 Classification of Medicines in Sweden 2

3.2 Marketing Authorisation of Non-prescription Medicines and OTC Self-medication in Sweden 3


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3.3 Regulations covering the Distribution of OTC Medicines in Sweden 3

3.4 Pricing of Prescription and Non-prescription OTC Medicines in Sweden 4

4. Reimbursement of Non-prescription Medicines in Sweden 4Table 2 5Reimbursement Rates for Swedish Patients 5

4.1 The Pharmaceutical Benefits Board (LFN) Medicines Review Sweden 6

4.2 Advertising Regulations for Non-prescription and OTC Self-medication Medicines in Sweden 6

4.3 Use of Trademarks for OTC Self-medication Medicines in Sweden 7

5. Distribution Channels for Non-prescription OTC Self-medication Medicines in Sweden 7

5.1 Privatisation and Restructuring of Retail Pharmacy Channels in Sweden 7

5.2 Main Players building and acquiring Pharmacy Chains in Sweden 8

5.3 Self-service of OTC Medicines in Swedish Pharmacies 9

5.4 The Introduction of General Sale List of Non-prescription Medicines and OTC Self-medication for non Pharmacy Channels in Sweden 9

6. Changing Structure of Pharmaceutical Wholesalers in Sweden 9

7. Mail Order Internet and Distance Selling of Non-prescription Medicines and OTC Self-medication in Sweden 10

8. Introduction – The Danish Non-prescription Medicines and OTC Self-medication Market 11

Graph 2: Denmark – Development of the Total Non-prescription OTC Self-Medication Market at Consumer Prices euro-millions 2005 – 2009 11

9. Sales Split of Key Categories of OTC Medicines in Denmark 12Table 3 12Denmark Total OTC Self Medication Sales - Split by Major Category (Value) 2009 12

10. The Regulatory Environment for OTC Self Medication Medicines in Denmark 12

10.1 Classification of Medicines in Denmark 12

10.2 Registration of OTC Self-medication Medicines in Denmark 13

11. Regulations for the Distribution of Non-prescription Medicines and OTC Self-medication Consumer Medicines in Denmark 14

11.1 Regulations for the Distribution of Pharmacy Only Non-prescription Medicines and OTC Self-medication Consumer Medicines in Denmark 15

11.2 Regulations covering Internet and Distance Selling of OTC Medicines in Denmark15

12. Pricing Regulations for OTC Medicines in Denmark 15

13. Advertising Regulations for OTC Self-medication Consumer Medicines in Denmark 16


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13.1 Rules Applying to TV Advertising of OTC Medicines in Denmark 16

13.2 Rules Applying to Radio Advertising of OTC Medicines in Denmark 17

13.3 Rules Applying to Print Advertising of OTC Medicines in Denmark 17

14. Trade Margins / VAT for Pharmaceuticals in Denmark 17

15. Rules Covering Use of Trademarks for Pharmaceuticals in Denmark 17

16. The Distribution Environment for Non-prescription Medicines and OTC Self-medication Consumer Medicines in Denmark 18

Table 4 18Types of Outlet Distributing Non-prescription Medicines and OTC Self-medication in Denmark 18

16.1 Non-prescription Medicines and OTC Self-medication Consumer Sales through Retail Pharmacies in Denmark 18

16.2 Non-prescription Medicines and OTC Self-medication Sold through Non-Pharmacy Outlets in Denmark 19

16.3 Non-prescription Medicines and OTC Self-medication Consumer Medicines –Distance Selling through Mail order and Internet Pharmacies in Denmark 19

17. Restructuring of Pharmaceutical Wholesalers’ Network in Denmark 20

18. The Self-Medication Market in Finland 2009 21Graph 3: Finland - Total Self-medication Market 2005 – 2009 21

19. Share of the Finish Non-prescription Medicines and OTC Self-medication Market by Category 2009 21

Table 5 22Finland – Non-prescription Medicines and OTC Self-medication Market Share and Growth by Therapeutic Category 222005 – 2009 est. 22

20. The Regulatory Environment for OTC Medicines in Finland 22

20.1 Registration and Classification of Medicines in Finland 22

20.2 Registration of OTC Medicines in Finland 23

20.3 Patient Information Requirements in Finland for OTC Medicines 24

21. Regulations for the Distribution of OTC Medicines in Finland 24

22. Pricing Regulations for OTC Medicines in Finland 25

23. Advertising Regulations for OTC Self-medication Medicines in Finland 25

24. Trade Margins / VAT for OTC Medicines in Finland 26

25. Use of Trademarks for OTC Self-medication Consumer Medicines in Finland 27

26. Customer Information Channels for OTC Self-medication Consumer Medicines in Finland 27

27. The Distribution Environment for Non-prescription Medicines and OTC Self-medication Consumer Medicines in Finland 28


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27.1 Pharmacies in Finland 28

27.2 Self-medication – Distance Selling through Mail Order and Internet Pharmacies in Finland 28

28. Sources of Pharmacy Sales Turnover in Finland 29

29. Restructuring of the Pharmaceutical Wholesaler Network in Finland 29

30. Introduction - The Norwegian Non-prescription Medicines and OTC Self-medication Consumer Market 30

Graph 4: Norway – Development of the Pharmaceutical Non-prescription OTC Self-medicationMarket in Retail Pharmacy and Non-pharmacy Channels 2005 – 2009 - (Consumer Prices euro millions) 30

31. Sales Split of the Main OTC Self-medication Consumer Medicine Categories in Norway 30

Table 6 31Norway Total OTC Self-Medication Sales - % Split by Major Therapeutic Category (Value) 2008 31

32. The Regulatory Environment for OTC Medicines in Norway 31

32.1 Classification of Medicines in Norway 31

32. 2 Marketing Authorization of OTC Medicines in Norway 32

32.3 Regulations for the Distribution of OTC Medicines in Norway 32

32.4 Deregulation to allow Retail Pharmacy Chains in Norway 33

32.5 Pricing Regulations for Non-prescription Medicines and OTC Self-medication in Norway33

32.6 Advertising Regulations for OTC Medicines in Norway 34

33. Trade Margins and VAT for OTC Medicines in Norway 35

34. Rules Covering Use of Trademarks for Pharmaceuticals in Norway 35

35. Channels of Distribution for Non-prescription Medicines and OTC Self-medication in Norway 35

35.1 Pharmacy and Non-pharmacy Outlets for Non-prescription Medicines and OTC Self-medication in Norway 36

Table 7 36Retail Outlets Selling Non-prescription OTC Medicines for Self-medication in Norway 36

35.2 Development Retail Pharmacy Chains in Norway 36Table 8 36Market Shares Leading Retail Pharmacy Chains in Norway 2008 36

36. Grocery Distribution and other Non-pharmacy Retail Channels Distributing Non-prescription Medicines and OTC Self-medication in Norway 37

Table 9 37

37. History of Non-pharmacy Retail Distribution of General Sale List (GSL) OTC Medicines in Norway 37


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38. GSL OTC Self-medication - Non-pharmacy Retail Distribution in Norway 37Table 10 38Consumption of Leading OTC Medicines Purchased from Non-Pharmacy Channels in Norway 2008 38

38.1 Self-medication – Distance Selling through Mail order and Internet Pharmacies in Norway 38

39. Pharmaceutical Wholesalers in Norway 39

Chapter 14OTC Distribution in

Central & Eastern EuropePoland, Hungary, Czech Republic, Slovakia and Slovenia

1. The Non-prescription Medicines and OTC Self-medication Market in Poland 2009 1

Graph 1: Poland Total Non-prescription Medicines and OTC Self-medication Market at Consumer Prices €millions 2005 – 2009 2

2. Share of the Polish Non-prescription Medicines and OTC Self-medication Market by Category 2009 2

Table 1 2Poland – Non-prescription Medicines and OTC Self-medication Market Share and Growth by Therapeutic Category 22005 – 2009 est. 2

3. Non-pharmacy and Mass Market Channels for Non-prescription OTC Medicines and Supplements in Poland 3

4. The Regulatory Environment for Non-prescription and OTC Self-medication Medicines in Poland 3

4.1 Classification of Medicines in Poland 3

4.2 Marketing Authorization for Non-prescription and OTC Medicines in Poland 4

5. Regulations Governing Marketing and Distribution Channels for OTC Medicines in Poland 4

5.1 Pharmacy and Non-pharmacy Retail Channels for Non-prescription and OTC Medicines in Poland 4

5.2 Controls on Pricing and Margins of OTC Medicines in Poland 5

5.3 Advertising and Promotion of OTC Medicines in Poland 5

6. Changing Distribution Environment for Non-prescription OTC Self-medication Medicines in Poland 6

7. The Retail Pharmacy Environment for OTC Self-medication in Poland 6

7.1 Independent Retail Pharmacy Multiples in Poland 7Table 2 8The largest Independent Retail Pharmacy Chains in Poland 2009 8


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7.2 Retail Pharmacy Developments by Supermarket Chains in Poland 8

8. Mail Order and Internet Pharmacies targeting Patients and OTC Self-medication Consumers in Poland 9

8.1 “Clicks and Bricks” Second Generation online Pharmacy Concept in Poland 9

8.2 German online Pharmacies Targeting Poland Healthcare Consumers 10

9. Consumer Sources of Purchase Non-prescription OTC Medicines for Self-medication in Poland 10

Graph 2: Consumer Sources of Purchase – Medicines in Poland 10

10. Main Pharmaceutical Wholesalers Supplying Pharmacies in Poland 11Table 3 12Analysis Leading Polish Pharmaceutical Wholesalers 12Representing 85% Wholesaler Pharmacy Market Share 2008/9 12

10.1 Torfarm the Leading Pharmaceutical Wholesaler in Poland 12

10.2 Polska Grupa Farmaceutyczna (PGF) Second Largest Pharmaceutical Wholesaler in Poland 13

10.3 Farmacol a Leading Pharmaceutical Wholesaler in Poland 13

10.4 ACP Pharma Dutch Pharmaceutical Wholesaler in Poland 14

10.5 CF Cefarm - State Owned Pharmaceutical Wholesaler in Poland 15

CEFARM Pharmaceutical SA 15

10.6 Phoenix Pharma Polska 16

11. Role of Pharmaceutical Wholesalers in Poland 16

12. The Self-Medication Market in Hungary 2009 17Graph 3: Hungary Total Self-medication Market 2005 – 2009 17

13. Share of the Hungarian OTC Self-medication Market by Category 2009 17Table 4 18Hungary – Self-Medication Market Share and Growth by Therapeutic Category 182005 – 2009 est. 18

14. The Regulatory Environment for OTC Self-medication Medicines in Hungary18

14.1 Directives 18

14.2 Medicines’ Classification in Hungary 19

14.3 Marketing Authorization of Non-prescription Medicines and OTC Self-medication in Hungary 19

14.4 Regulations for Distribution of Non-prescription Medicines and OTC Self-medication in Hungary 20

14.5 Pricing of Non-prescription Medicines and OTC Self-medication in Hungary 20

14.6 Resale Price Maintenance Pharmaceutical Products in Hungary 20

14.7 Regulations on Advertising OTC Medicines in Hungary 21


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14.8 Trade Margins / VAT on Pharmacy Medicines in Hungary 22Table 5 22Average Wholesaler and Pharmacy Margins in Hungary 2009 22

14.9 Use of Trademarks for OTC Medicines in Hungary 22

15. The Distribution Environment for Non-prescription Medicines and OTC Self-medication in Hungary - Pharmaceutical Wholesalers in Hungary 22

Table 6 23Market Shares of the Main Pharmaceutical Wholesalers in Hungary 232008 23

15.1 Hungaropharma the Leading Pharmaceutical Wholesaler in Hungary 23

15.2 Gyöngy Patek - Strategic Retail Pharmacy Partnership in Hungary 23

15.3 Phoenix Wholesaling in Hungary 24

15.4 Medimpex - Gideon Richter and Egis Jointly owned Pharmaceutical Wholesaler in Hungary 24

16. Retail Pharmacies - Developments in Hungary 1990 - 2009 24

16.1 Growth of Retail Pharmacy Chains in Hungary 1990 - 2009 24

17. General Sales List (GSL) for OTC Self-medication Medicines in Hungary 25

18. The Self-Medication Market in the Czech Republic 2009 26Graph 4: Czech Republic - Total Self-medication Market 2005 – 2009 26

19. Share of the Czech OTC Self-medication Market by Category 2009 26Table 7 27Czech – Self-Medication Market Share and Growth by Therapeutic Category 272005 – 2009 est. 27

20. The Regulatory Environment for Non-prescription Medicines and OTC Self-medication in the Czech Republic 27

20.1 Medicine Classifications in the Czech Republic 27

20.2 Registration of Non-prescription Medicines and OTC Self- medication in the Czech Republic 28

21. Regulations Governing Marketing and Distribution Channels for OTC Medicines in the Czech Republic 30

21.1 Permitted Retail Channels for OTC (non-prescription) Self-medication Medicines in the Czech Republic 30

21.2 Pharmacy Ownership and Self-service Regulations for Non-prescription Medicines and OTC Self-medication in the Czech Republic 30

21.3 Pricing of Non-prescription Medicines and OTC Self-medication in the Czech Republic 30

21.4 Regulations on Advertising Non-prescription Medicines and OTC Self-medication in the Czech Republic 32

21.5 Controls on Advertising of Non-prescription Medicines and OTC Self-medication in the Czech Republic 33


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21.6 Patient Information Requirements for Non-prescription Medicines and OTC Self-medication in the Czech Republic 33

21.7 Use of Trademarks for Non-prescription Medicines and OTC Self-medication in the Czech Republic 33

22. The Distribution Environment for Non-prescription Medicines and OTC Self-medication in the Czech Republic 34

22.1 Pharmaceutical Wholesalers in the Czech Republic 34Table 8 34€ % Share Pharmaceutical Full Line Wholesalers in the Czech Republic 2008 34

Phoenix Lékárenský Wholesale in Czech Republic 34

Pharmos - Česká lékárnická 35

Alliance Healthcare Czech (Alliance Boots) 35

GEHE Pharma Praha (Celesio) Czech 35

23. Growth of Pharmacies in the Czech Republic 36Table 9 36Czech Republic Growth in Numbers of Retail Pharmacies 1990 - 2005 36

23.1 Leading Pharmacy Chains in the Czech Republic 36

Dr Max 36

Lloyds s.r.o. 37

Phoenix 37

23.2 Non-pharmacy Distribution in Czech Republic 37

23.3 Internet Pharmacies and Distance Selling of Pharmaceuticals in the Czech Republic 37

24. The Self-Medication Market in Slovakia 2009 38Graph 5: Slovak Republic - Total Self-medication Market 2005 – 2009 38

25. Share of the Slovakian OTC Self-medication Market by Category 2009 38Table 10 39Slovakia – Self-Medication Market Share and Growth by Therapeutic Category 392005 – 2009 est. 39

26. The Regulatory Environment for OTC Medicines in the Slovak Republic 39

26.1 Medicinal Classifications in the Slovak Republic 39

26.2 Marketing Authorization of OTC Medicines in the Slovak Republic 40

26.3 Regulations on the Distribution of OTC Medicines in the Slovak Republic 40

26.4 Pricing Regulations for OTC Medicines in the Slovak Republic 40

26.5 Reference Pricing System - Reimbursed Medicines in the Slovak Republic 41

26.6 Rules on Advertising OTC Medicines in the Slovak Republic 41

26.7 Advertising Controls on OTC Medicines in the Slovak Republic 42

26.8 Patient Information Requirements for OTC Medicines in Slovakia 42


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27. Trade Margins for Prescription Medicines / VAT for OTC Medicines in Slovakia 42

Table 11 42Slovak Republic – Prescription Pharmaceuticals’ Trade Margins and VAT 42

28. Use of Trade Marks for OTC Medicines in Slovakia 43

29. The Distribution Environment for Non-prescription and OTC Self-medication Medicines – Slovak Republic 43

29.1 Pharmaceutical Wholesalers in Slovakia 43

Phoenix Medical Supply 43

Unifarma Prievidza 43

30. Retail Pharmacies and Pharmacy Chains in Slovakia 44

31. The Self-Medication Market in Slovenia 2009 45Graph 6: Slovenia - Total Self-medication Market 2005 – 2009 45

32. Share of the Slovenia OTC Self-medication Market by Category 2009 45Table 12 46Slovenia – Self-Medication Market Share and Growth by Therapeutic Category 462005 – 2009 est. 46

33. The Regulatory Environment for Non-prescription Medicines and OTC Self-medication in Slovenia 46

33.1 Directives 46

33.2 Medicinal Classifications in Slovenia 46

33.3 Authorization of Non-prescription Medicines and OTC Self-medication in Slovenia 47

33.4 Regulations on the Distribution of OTC Medicines in Slovenia 48

33.5 Pricing Controls on Non-prescription Medicines and OTC Self-medication in Slovenia 48

33.6 Rules on Advertising Non-prescription Medicines and OTC Self-medication in Slovenia 48

33.7 Patient Information Requirements for OTC Medicines in Slovenia 48

34. Trade Margins / VAT for OTC Medicines in Slovenia 49Table 13 49Slovenia - Pharmaceutical Trade Margins and VAT 49

35. The Distribution Environment for Non-prescription Medicines and OTC Self-medication in Slovenia 49

35.1 Pharmacies in Slovenia 49

35.2 Internet Pharmacies and Distance Selling of Pharmaceutical Products in Slovenia 49

36. Pharmaceutical Wholesalers in Slovenia 50


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Chapter 15Conclusions of the Report

Driving the Recovery - OTC Distribution in Europe

1. Growth trends and outline Prognosis for Europe’s Non-prescription OTC Self-medication and Self-care Markets to 2013 1

Graph 1: Forecast of Sales of the Total Non-prescription Bound and OTC Self-medication market for 18 major Markets - € millions at Consumer Purchase Prices 2009- 2013 2

1.1 Growth Clusters by Country - European Non-prescription and OTC Self-medication Market 2

Graph 2: Europe – 18 Country Markets % Growth Estimates compared for Non-prescription Medicines to 2013 3

Europe -18 Country Study 4Prognosis and Key Issues for the Strategic Agenda by Country to 2013 4Table 1(continued) 5Europe -18 Country Study 5Prognosis and Key Issues for the Strategic Agenda by Country to 2013 5Table 1(continued) 6Europe -18 Country Study 6Prognosis and Key Issues for the Strategic Agenda by Country to 2013 6

2. Summary of the Main Factors Driving Change in Europe’s Non-prescription, Self-medication and Self-care Markets to 2013 6

2.1 The failure of the DocMorris case to change Europe’s Pharmacy Ownership rules6

2.2 New Pharmacy Retail Model in European States not Permitting Retail Pharmacy Multiples 7

2.3 The Rapid Growth of Large ‘Virtual’ Pharmacy Chains - in Germany, Switzerland, the Netherlands, Hungary and Poland 8

2.4 Abolition of the Retail Pharmacy State Monopoly in Sweden 9

3. Refocusing of Strategies and Restructuring of Major Pharmaceutical Distributors Across Europe 10

3.1 New Model for the Major Pharmacy Distributors in Europe 10

3.2 Growth of General Sale Listing (GSL) of selective OTC medicines for Self-medication across Europe – Influence of Major Mass Market Chains 10

3.3 Mass Market Retail Chains acquisition of Pharmacies Para-pharmacies and OTC Licenses in Europe 11

4. Competing in the Mass-Market - Implications for Brand Market Shares of OTC Self-medication Medicines in Europe 13

5. Unfolding development of Mail Order Internet Pharmacy in the European Union 14


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6. De-Reimbursement of Non-Prescription Medicines in Europe 15

7. Developments in Poland, Hungary, Czech Republic, Slovakia, Slovenia 15

8. The Changing Consumer Healthcare Market – Estimating the Speed of Change by Exploring Regulatory Freedoms in Europe’s Main Markets for OTC Self-medication Medicines 16

8.1 Main European States Ranked by Marketing Freedoms for OTC Medicines 17Table 2 17Europe’s Main OTC Medicines Markets Ranked by Marketing Freedoms 2009 compared to 2007 17

8.2 Main European States Ranked by Pharmacy Regulatory Freedoms 18Table 3 18Europe’s Main OTC Medicines Markets Ranked by Pharmacy Freedoms 2009 compared to 2007 18

8.3 Main European States OTC Medicines Markets Ranked by Total Regulatory Freedoms 18

Table 4 19Europe’s Main OTC Markets Ranked by Total Freedoms 2009 compared to 2007 19

9. The Key Challenges to Non-prescription and OTC Self-medication Medicines Manufacturers in Europe to 2013 19

Figure 1: Increasing Competitive Intensity in a Changing Multi channel Supply Chain –Impacts on Consumer Healthcare Brands in Europe 20

10. Conclusions – Driving Recovery in the European Consumer Healthcare Market 20

Lessons learned over the 18 years and seven editions of this Study 20

OTC Distribution in Europe - 2010 edition [Report] – Europe, OTC Medicines, Self-medication, Licensed medicines, Unlicensed medicines, Regulation, Distribution, Market Research, Trends, Forecasts, Pharmaceutical Wholesalers, Druggist and Drugstore chains, Consumer behaviour, Analysis, Regulatory, Rx to OTC, James W. Dudley

new 2010 edition · 1998 –2009 26 16. self-medication -the importance of otc medicines to...

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