A quantitative classification of OTC medicines regulations in 30 European countries: dispensing restrictions, distribution, pharmacy ownership, and pricing systems

Informa UK Limited - Tập 16 - Trang 1-11 - 2023
Eduardo Daniel López Vila1, Caroline Buts1, Marc Jegers1
1Department of Applied Economics, Vrije Universiteit Brussel, Brussels, Belgium

Tóm tắt

This paper reviews the regulations of over-the-counter (OTC) medicines in 30 European countries with the goal of identifying the regulatory trends and clusters as of May 2022. To that end, we reviewed the regulation that directly or indirectly might have an impact on OTC medicines. The data were gathered from the national legislation, reports from international organizations, and the existent literature. The 12 regulatory items obtained were classified into four categories: price, pharmacy ownership, distribution modes, and dispensing restrictions. In addition, these items were also employed in the cluster analysis. Pharmacy ownership is mainly private, and in the majority of countries, OTC medicines are not subject to any pricing system. Almost every country studied allows online selling of OTC medicines, and 16 countries allow non-pharmacy retail to sell OTC medicines as well. The dispensing restrictions applicable in pharmacy retail are similar in the countries studied: they rely on the staff, OTC medicines are placed behind the counter and the doses dispensed tend to be restricted. Concerning non-pharmacy retail, additional dispensing restrictions might be imposed, such as the establishment of buyers’ minimum age, the requirement of a pharmacist to supervise the operations, a regulation on the location in the store, and further restrictions on the package sizes, strength, or pharmaceutical form. The cluster analysis resulted in an initial division between countries that widely allow the sale of OTC medicines in non-pharmacy retail and countries, where pharmacy retail has an OTC monopoly. Based on the regulations, 7 subsequent groups were identified evidencing wide regulatory heterogeneity within the countries studied. Our findings point out that OTC medicines are in general not subject to pricing systems, selling is allowed online, and ownership of pharmacies is mostly private. However, regarding dispensing restrictions, pharmacy chains, and establishment restrictions of pharmacies, we found heterogeneity that is also visible in our cluster analysis, since we identified 7 clusters.

Tài liệu tham khảo

Yfantopoulos JN, Chantzaras A. Drug policy in Greece. Value Health Reg Issues. 2018. https://doi.org/10.1016/j.vhri.2018.06.006. Wiśniewski M, Religioni U, Merks P. Community pharmacies in Poland—the journey from a deregulated to a strictly regulated market. Int J Environ Res Public Health. 2020. https://doi.org/10.3390/ijerph17238751. World Health Organization (WHO). Regional Office for Europe. The legal and regulatory framework for community pharmacies in the WHO European Region. World Health Organization. Regional Office for Europe. 2019. https://apps.who.int/iris/handle/10665/326394. Accessed 12 Dec 2021. Martins SF, Van Mil JW, Da Costa FA. The organizational framework of community pharmacies in Europe. Int J Clin Pharm. 2015. https://doi.org/10.1007/s11096-015-0140-1. Vogler S. Liberalization in the pharmacy sector. OECD Global Forum on Distribution. 2014. https://jasmin.goeg.at/id/eprint/258. Accessed 12 Dec 2021. Oleszkiewicz P, Krysinski J, Religioni U, Merks P. Access to medicines via non-pharmacy outlets in European countries—a review of regulations and the influence on the self-medication phenomenon. Healthcare. 2021. https://doi.org/10.3390/healthcare9020123. Vogler S, Arts D, Habl C. Community pharmacy in Europe. Lessons from deregulation–case studies. 2006. https://jasmin.goeg.at/id/eprint/241. Accessed 20 Dec 2021. Lluch M, Kanavos P. Impact of regulation of Community Pharmacies on efficiency, access and equity. Evidence from the UK and Spain. Health Policy. 2010. https://doi.org/10.1016/j.healthpol.2009.11.002. Vogler S, Habimana K, Arts D. Does deregulation in community pharmacy impact accessibility of medicines, quality of pharmacy services and costs? Evidence from nine European countries. Health Policy. 2014. https://doi.org/10.1016/j.healthpol.2014.06.001. Moura A, Barros PP. Entry and price competition in the over-the-counter drug market after deregulation: evidence from Portugal. Health Econ. 2020. https://doi.org/10.1002/hec.4109. Anell A. Deregulating the pharmacy market: the case of Iceland and Norway. Health Policy. 2005. https://doi.org/10.1016/j.healthpol.2005.01.020. Vogler S. Medicine Price surveys, analyses and comparisons: evidence and methodology guidance. 1st ed. Cambridge: Academic Press; 2018. Stargardt T, Schreyögg J, Busse R. Pricing behaviour of pharmacies after market deregulation for OTC drugs: the case of Germany. Health Policy. 2007. https://doi.org/10.1016/j.healthpol.2007.04.006. Andersson F, Hatziandreu E. The costs and benefits of switching a drug from prescription-only to over-the-counter status. PharmacoEcon. 1992. https://doi.org/10.2165/00019053-199202050-00006. Morgan OW, Griffiths C, Majeed A. Interrupted time-series analysis of regulations to reduce paracetamol (acetaminophen) poisoning. PLoS Med. 2007. https://doi.org/10.1371/journal.pmed.0040105. Morthorst BR, Erlangsen A, Nordentoft M, Hawton K, Hoegberg LCG, Dalhoff KP. Availability of paracetamol sold over the counter in Europe: a descriptive cross-sectional international survey of pack size restriction. Basic Clin Pharmacol Toxicol. 2018. https://doi.org/10.1111/bcpt.12959. Hopkins AG, Spiller HA, Kistamgari S, Zhu M, Michaels NL, Funk AR, Smith GA. Suicide-related over-the-counter analgesic exposures reported to United States poison control centers, 2000–2018. Pharmacoepidemiol Drug Saf. 2020. https://doi.org/10.1002/pds.4997. Leopold C, Vogler S, Mantel-Teeuwisse AK, de Joncheere K, Leufkens HG, Laing R. Differences in external price referencing in Europe—a descriptive overview. Health Policy. 2012. https://doi.org/10.1016/j.healthpol.2011.09.008. Sandulovici R, Mircioiu C, Rais C, Atkinson J. Pharmacy practice and education in Romania. Pharmacy. 2018. https://doi.org/10.3390/pharmacy6010005. Gallone EL, Enri LR, Pignata I, Baratta F, Brusa P. The 2017 deregulation of pharmacies in Italy: introducing non-pharmacist ownership. Health Policy. 2020. https://doi.org/10.1016/j.healthpol.2020.08.013. Tamasauskas D, Sakalauskas V, Kriksciuniene D. Evaluation framework of hierarchical clustering methods for binary data. In: 12th International Conference on Hybrid Intelligent Systems (HIS). (2012). SPF Economie. Médicaments en vente libre ou médicaments OTC (Over The Counter) | SPF Economie. https://economie.fgov.be/fr/themes/ventes/politique-des-prix/prix-reglementes/medicaments-usage-humain/medicaments-originaux/medicaments-en-vente-libre-ou. Accessed 10 Jan 2022. Oikeusministeriö. Valtioneuvoston asetus lääketaksasta 713/2013 - Ajantasainen lainsäädäntö - Finlex. https://www.finlex.fi/fi/laki/ajantasa/2013/20130713. Accessed 15 May 2022. Dimova A, Rohova M, Atanasova E, Kawalec P, Czok K. Drug policy in Bulgaria. Value Health Reg Issues. 2017. https://doi.org/10.1016/j.vhri.2017.08.001. Silins J, Szkultecka-Dębek M. Drug policy in Latvia. Value Health Reg Issues. 2017. https://doi.org/10.1016/j.vhri.2017.08.006. Barbarisi I, Bruno G, Diglio A, Elizalde J, Piccolo C. A spatial analysis to evaluate the impact of deregulation policies in the pharmacy sector: evidence from the case of Navarre. Health Policy. 2019. https://doi.org/10.1016/j.healthpol.2019.08.010. Journal Officiel du Grand-Duché de Luxembourg. Règlement grand-ducal du 27 mai 1997 relatif à l’octroi des concessions de pharmacie. - Legilux. https://legilux.public.lu/eli/etat/leg/rgd/1997/05/27/n1/jo. Accessed 12 Feb 2022. Vogler S, Arts D, Sandberger K. Impact of pharmacy deregulation and regulation in European countries. 2012. https://jasmin.goeg.at/id/eprint/227. Accessed 20 Dec 2021. Government Gazette. ΦΕΚ 1445/Β/23.06.2016 – Ρυθμίσεις επαγγέλματος φαρμακοποιού – Ίδρυση φαρμακείου. https://www.sfee.gr/fek-1445v23-06-2016-rithmisis-epangelmatos-farmakopiou-idrisi-farmakiou/. Accessed 23 Feb 2022. Bratkowska K, Religioni U, Krysiński J, Merks P. Quality of pharmaceutical services in independent pharmacies and pharmacy chains in Poland from the patient perspective. Patient Prefer Adherence. 2020. https://doi.org/10.2147/PPA.S284014. Briesacher B, Corey R. Patient satisfaction with pharmaceutical services at independent and chain pharmacies. Am J Health Syst Pharm. 1997. https://doi.org/10.1093/ajhp/54.5.531. Jacobs S, Hassell K, Ashcroft D, Johnson S, O’Connor E. Workplace stress in community pharmacies in England: associations with individual, organizational and job characteristics. J Health Serv Res Policy. 2014. https://doi.org/10.1177/1355819613500043. Mott DA, Doucette WR, Gaither CA, Pedersen CA, Schommer JC. Pharmacists’ attitudes toward worklife: results from a national survey of pharmacists. J Am Pharm Assoc. 2004. https://doi.org/10.1331/154434504323063968.