E-drug: Siting policies for retail/community pharmacies (cont'd)
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Norway has a policy to ensure that pharmacy services are equally
distributed (as far as possible) to all parts of the country. As many
of you know, our country of 4.3 mill is long, stretching 2000 km
from south to north and sparsely populated particularly in the
northern and western areas. It is difficult to staff pharmacies in
these areas both for reasons of harsher living conditions and
because the demand for pharmacists is higher than availability.
Even though we now import quite a few from other Scandinavian
countries, we have vacancies even in big cities and particularly in
public service.
Pharmacies in Norway are either private (355) or public (27). The
public pharmacies are located in hospitals and owned by either a
county or the State but run by a pharmacist. Private pharmacies
are owned by pharmacists with an MSc in pharmacy.
Decisions on establishing, closing, merging, moving, changing
status are the responsibility of the Norwegian Board of Health
(NBH). A new pharmacy is established when considered desirable
or essential for the common good. Since 1984 a 5 year plan has
been put up listing places where it is assumed that a need for a
pharmacy exists, a move may be desirable, change of status is
considered desirable or the pharmacy should be closed when the
licence is available. The plan is a guideline only and for a new
licence to be advertised, the municipality has to apply if they want
a new pharmacy. After a hearing amongst interested parties (other
pharmacies in the area, professional associations, district medical
officer), and after having considered economic viability and
whether it is likely that someone will apply for the licence etc. the
NBH makes its decision. When a new licence is established or a
licence is available, it is advertised and interested pharmacists
must apply to the NBH. When you receive a licence, you have to
take over facilities and stock from the former owner. Sometimes,
if the facilities are not conforming to standards, the NBH may put
as a requirement that the new owner rebuilds or finds new
facilities. To cover his/her expenses, the State will guarantee for
a loan.
We have two types of pharmacies: a self-contained pharmacy
(255) or a subsidiary (78). The latter will be a subsidiary under a
self-contained pharmacy and will be run by a manager (a
pharmacist). In addition, pharmacies may also run small outlets in
other shops or in a specially assigned area. Outlets have been
established to ensure the population in small communities or in
places where communications are difficult access to OTC-drugs.
They vary considerable in turnover from NOK 1000 to NOK 1 mill
per year. At present we have about 1250.
When the NBH decides on the status (self-contained or
subsidiary), consideration is made mainly to economic viability.
Frequently, a new pharmacy will be established as a subsidiary for
the first few years. A pharmacy owner cannot refuse to run a
subsidiary if so decided by the NBH.
To close a pharmacy or to move it takes place when a licence is
available. I have to add here that pharmacy owners in Norway,
particularly in less popular areas move frequently, i.e. every 5
years which is the minimum period for a licence.
Hospital pharmacies may serve outpatients, employees and
sometimes even the population in the impact area.
Pharmacies have the sole right to sell drugs, both prescription
drugs and OTC drugs. Prescribers may not sell drugs unless so
licensed. Manufacturers or wholesalers may not own pharmacies.
All pharmacies have to pay a Government tax according to their
turnover of drugs. This fund is used for e.g. allocations to the
teaching institutions, pension fund, reimbursement of freight etc.
It is also used to support pharmacies in places where it is
impossible to run with a profit. In the past it ensured that all
pharmacy owners had a reasonable income, today the conditions
for receiving support is much stricter.
The NBH, which also has the Inspectorate, supervises the
pharmaceutical sector and ensures compliance with laws and
regulations. Minimum opening hours are set and any major
investment and/or renovation has to be approved. Profit margins
are also set in negotiations between the Government and the
professional associations. We have moved from a progressive
percentage profit, to a degressive profit and increased fixed fees
(e.g. a fee for prescriptions for narcotic and habit forming drugs as
they are more time-consuming to dispense). Overall profit margin
which used to be 25% is now probably around 15.
The law is currently under revision and some of the points
mentioned may be changed. Politicians, although wanting to
liberalise the pharmaceutical sector, are under pressure from
communities that fear the closing down of their pharmacy and from
the fear that more pharmacies may be established in popular
areas and with a lack of pharmacists this will drain the districts of
pharmacists.
Politicians also want to keep prices equal for all patients. We have
therefore a system ensuring that if drugs prescribed have to be
sent to the patient because of the long distance to the nearest
pharmacy, the patient will receive the drugs without having to pay
freight cost and the pharmacy will be reimbursed for the expense.
In conclusion, yes we still have a policy to ensure pharmacies are
established to give as many as possible access to pharmaceutical
services. Unfortunately, due to market liberalisation, we are now
struggling to keep the public health aspect.
Do come back to me if something is unclear/need further
explanation.
Best regards
Kirsten Myhr, MScPharm, MPH
Bygdoy Alle 58B
0265 Oslo
Norway
Tel: +47 22 56 05 85 (h)
Fax: +47 22 24 90 17 (w) Tel: +47 22 24 88 55 (w)
E-mail: myhr@online.no
or (w): kirsten.myhr@helsetilsynet.dep.telemax.no
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