Prying Open European Pharmacies
MILAN — It does not look like a scene of revolution in one tiny corner of a vast Carrefour hypermart here: a couple of perplexed customers scanning five open shelves stacked with aspirin, ibuprofen消炎鎮痛, antiseptic抗菌 cream and cough medicine.
But for the first time in many European countries, nonprescription drugs are being sold over the counter at outlets other than pharmacies.
“I’m glad we can shop for medicine this way, it’s cheaper and convenient,” said Giovanni D’Ambrosio as he surveyed the offerings for seasickness in preparation for a holiday in Sardinia. “But I’m not sure what I should use,” he said, about to seek advice a pharmacist.
For centuries, European drugstores have been part of a closed guild system governed by laws that required even the simplest medications, like vitamins and mouthwash, to be dispensed by pharmacists.
But with billions of euros in revenue at stake, several big competitors are trying to break that stranglehold on simple drug sales. Large chains, including Carrefour and Auchan, want to offer rows of health products, and pharmacy groups like Boots and A. S. Watson, of Hong Kong, are seeking to create British-style networks in countries that have long protected the influential pharmacy guild.
“In the U.S. or the U.K., you can pop into a grocery store to buy nonprescription drugs,” said James Dudley, a consultant on the industry in London. “But that’s an option that doesn’t exist in most of Europe.”
Efforts to pry open the market to competition are being resisted by many politicians, who view it as an experiment, perhaps a dangerous one. “Everyone is after this because it’s big money,” said Mr. Dudley, noting that Europeans spend 40 billion euros ($56.4 billion) annually on nonprescription drugs.
But for consumers, the trend toward greater competition means cheaper and more readily available treatments for simple ailments. In France, Spain and Italy, the share of nonprescription medications sold outside pharmacies last year was less than 5 percent. And with sales restricted to pharmacies, Europeans have often paid startlingly high prices for basic remedies.
Consider ibuprofen, a common analgesic sold under many brand names. A 100-pill bottle of Advil in the United States can cost as little as $9. Twelve pills of Moment, the brand name here, cost 6 euros ($8.45) at a pharmacy.
The guild system, whose roots reach back before the Renaissance, spins a web of protections over the pharmacists and pharmacies in the largest European cities and the smallest towns. Many countries will allow only pharmacists to own a drugstore, and each pharmacist may own only one. In lands like Italy and Spain, the number of pharmacies is limited by law — only one in a small town — and they are passed on to children like property.
Pharmacists, and even some health ministries, insist that such controls are needed. “The system is justified for the protection of public health” and “to preserve the professional independence of pharmacists,” Patrick Brasseu, a spokesman for the French health ministry, said.
They argue that even limited change will put high-quality pharmacies out of business and pose a potential threat to consumers like Mr. D’Ambrosio, who are so used to receiving advice from pharmacists that they may not know how to choose wisely for themselves.
“Commercial chains respond to the market, not to professional needs,” said Giorgio Siri, president of Federfarma, the Italian industry trade group. “The transformation of an efficient decentralized system of 17,000 independent professionals into a system of a few huge groups that can control the market and limit citizens’ choices will have a negative effect.”
Pharmacists supply health advice across much of Europe. In Italy, for example, the local pharmacist checks blood pressure. Some items, like emergency contraceptive pills, require prescriptions in the United States but can be dispensed without one in Europe because the pharmacist can advise patients before a sale.
But in an age when simple nonprescription drugs are sold even at gas stations and airport shops in Britain and the United States, governments in the Netherlands, Italy, Norway, Denmark, Portugal, Poland and the Czech Republic have begun to crack open the old system and are allowing the chains to move in, making these medications more widely available.
Two years ago, Norway changed its laws to allow nonprescription drugs to be sold outside pharmacies and opening the market to drugstore chains. Now, 98 percent of the country’s pharmacies are part of chains like Celesio, Boots and Phoenix. In Germany, a Dutch online drug retailer, Doc Morris, is seeking to purchase a pharmacy, challenging a German law that limits ownership to pharmacists.
A recent European Union consultation said the system “protects the monopoly held by existing pharmacists, to the detriment of consumers and competition.” The European Commission, the union’s executive arm, is challenging restrictive ownership laws in several countries.
Part of the divide in how nonprescription medicine is sold in North America and Continental Europe stems from a history of different health care systems. In the United States, where people often pay out of pocket for doctors’ visits and medicine, there have long been efforts to minimize office visits and to sell nonprescription drugs directly to consumers and in bulk to minimize costs.
In Europe, with its government health programs, office visits were free, as was medicine, including nonprescription drugs, if recommended by a doctor. So European patients have felt far less pressure to become knowledgeable consumers about medicine and to make some treatment decisions themselves.
As state systems became financially strained in recent years, that generosity has ebbed, and Europeans in many countries are now paying for basic medicine. That, in turn, has led to more consciousness about costs and a willingness by patients to educate themselves.
There are cultural issues, too — although they are being quickly overcome by consumers. The Italian customers here at the Carrefour in Assago, just outside Milan, scrupulous readers of food labels, tend to look at medication cartons from afar, knowing little about brand names and ingredients.
Massimo Caemi brought a friend to help him look for something for an infected finger. “Eccola!” — here it is — he said as the pharmacist-in-residence guided him to a shelf containing tubes of antibiotic ointment.
“I think it’s great and about time,” Mr. Caemi said after he learned to navigate the drug displays. “And it’s 20 percent cheaper than at the pharmacist’s.”