The number of pharmacies in Germany has been declining for years. Especially small pharmacies with lower sales have had to fight. Professional associations sounded the alarm. But are these complaints justified?
Pharmacist Iris Zeien may be in luck: her pharmacy in Cologne won’t have to close if she stops by herself. She quickly found a successor in management—a former pharmacy intern with whom she had been associated for years. Today that is the exception. For years, other pharmacists have been looking for a successor—many simply can’t find it, also because the job is no longer as lucrative as it used to be.
The pharmacist has started looking for a successor because she is no longer happy with her job. At 62, she wants to retire early. “You can’t do all the extra bureaucratic tasks during normal working hours. I do all of this after get off work. It adds up to three hours a day,” says Zeien. It was a relief that she could now hand over that responsibility. Even though she’s actually been working with passion for 38 years.
Pharmacies close every 17 hours
The demise of pharmacies is definitely a trend: According to the Association of German Pharmacists’ Associations (ABDA), a pharmacy closes its doors every 17 hours in Germany. For the first time in decades, the total number of pharmacies fell below 18,000. In 2021, there will be 23 pharmacies per 100,000 inhabitants. This puts Germany in the middle of the pack in European comparisons. Countries such as Spain and Lithuania have more than twice as many pharmacies per 100,000 inhabitants as Greece and more than four times as many.
For some time now, pharmacies in Germany have had to deal with a lot of extra work due to bottlenecks in the supply of medicines. For example, if a doctor prescribes a drug that is currently unavailable, Zeien cannot simply sell another drug — even if it contains the same active ingredient. Instead, each time another drug is an option, it has to be discussed with the practice: “We currently have 300 products on the list, and we call the manufacturers every day to ask if they are available again. These are the ones we need Drugs that are commonly used are always in stock.”
time wasting bureaucracy
Jürgen Wasem, a health economist at the University of Duisburg-Essen, observes that bureaucracy is high, even if there are no delivery bottlenecks. He finds documentation annoying but necessary. Specifically regarding the discount agreements that health insurers negotiate with pharmaceutical companies. Pharmaceutical companies give discounts to health insurers if they ensure their patients receive only the drug and not similar products from competitors. According to Wasem, it’s up to pharmacies to justify this, as it means extra bureaucracy.
There could also be less bureaucracy elsewhere to ease the burden on pharmacies. To be able to dispense certain assistive products, such as incontinence products, pharmacies must demonstrate that they have the necessary equipment and expertise. “The fact that the certificate has to be renewed every three years is unnecessary in this form,” said health economist Wasem.
How do pharmacies make money?
ABDA president Gabriele Overwiening also expressed dissatisfaction with pharmacies’ financial situation, given the future viability of the industry. Only 2% of the expenditure of the statutory health insurance fund last year went directly to pharmacies. The amount that health insurers pay pharmacies for each drug a doctor prescribes — the prescription fee — hasn’t increased in years.
That assessment is actually correct, Wasem said. But what’s often not mentioned: Pharmacies don’t just make money from prescription fees. They also get three percent of the price of any prescription drug they sell. However, the amount paid by statutory health insurers to pharmacies has not declined in recent years. Figures from the Federal Ministry of Health even show an increase from almost 34 billion euros in 2018 to almost 43 billion euros in 2022.
higher wages Pharmaceutical Industry
For ABDA chairman Overwiening, this is still not enough for the future: “We need proper financing, we need our own decision-making power when launching drugs with the same active ingredient, and we need to reduce bureaucracy.”
It is also necessary to ensure that the industry finds new blood. According to the head of the association, there could be as many as 10,000 vacancies in pharmacy by 2029. There are too many positions that pharmacy graduates cannot fill. Because after finishing school, they flowed not only into pharmacy, but also into the pharmaceutical industry and health insurance companies – industries that can expect to pay significantly higher salaries.