1. health and fitness
2. drugs

Ban of Advertising
of Community Pharmacies
in Poland
Piotr Bohater
International Affairs Coordinator
Polish Pharmaceutical Chamber
The self-government
of the pharmaceutical profession
is independent and
subordinated only to legislation,
especially to:
- the Law on Pharmaceutical Chambers
- the Pharmaceutical Law
There are about 27.000 members of the
pharmaceutical self-government in Poland
The Polish Pharmaceutical Chamber
and its organs have
their seat in the capital
city of Warsaw
Regional Pharmaceutical Chambers
The area of operation of each particular regional
pharmaceutical chamber and its seat is determined
by the Polish Pharmaceutical Chamber, taking into
account the basic administrative territorial division
of the state
20 Regional Pharmaceutical Chambers
- different magnitude of area of operation
- different number of members
Number of Pharmacies per Country
24000
23197
21558
22000
20000
18000
17206
16000
14000
12948
12000
11204
10000
8000
6000
5196
4445
France
Germany
Spain
Italy
UK
Croatia
Poland
Sweden
Belgium
Finland
2775
Bulgaria
Norway
2348
Czech Rep
Cyprus
Netherlands
875
Switzerland
802
Ireland
573
Austria
442
Denmark
0
278
322
978 1200 1394
86
Slovenia
2000
Slovakia
1580 1692 1825
Portugal
4000
Luxembourg
number of
pharmacies
20745
5
One of the most liberal pharmacy system
in Europe

ownership of the community pharmacy is not limited to pharmacists

there are neither demographic nor geographical criteria for
establishing a pharmacy

pharmacies cannot by owned by the pharmaceutical wholesalers
only theoretically

the rules that prohibit establishing big pharmacy chains (more than
1% of pharmacies in the province) are not enforced

there are maximum prices for the prescripion-only medicines

community pharmacy can resign from the patient’s co-payment

a great number of OTC medicines can be sold outside pharmacies

online sales of non-prescription medicines
Act on the Reimbursement of Medicines,
Food for Particular Nutritional Uses
and Medical Devices

The Polish Parliament on 12 May 2011 voted for the Act on the Reimbursement
of Medicines, Food for Particular Nutritional Uses and Medical Devices,
approving most amendments proposed by the Senate. The new law was signed
by the President on 25 May 2011.

Main provisions of the Reimbursement Act came into force on the 1st of January
2012.

The new bill governing the reimbursement of pharmaceuticals is a part of the
„health-care package”

The act led to a radical change in the rules on the Polish pharmaceutical market,
affecting pharmaceutical manufacturers, wholesale companies and community
pharmacies.
Functioning of the reimbursement system
in Poland until 1st of January 2012

The functioning of the reimbursement system was marked by cumulated
pathologies leading to irrational management of public funds.

Fierce competition between pharmacies, with infamous Drugs for a Penny and
Wholesale Prices.

Aggressive marketing, promotions, offering gifts for purchasing reimbursed
medicines led to the unnatural creation of demand which resulted in medically
unjustified expenditure, both on the part of the National Health Fund, and on the
part of patients themselves.

The Polish Pharmaceutical Chamber pointed out for many years that the
pathologies were very destructive for community pharmacies and the whole
pharmaceutical market.

On the basis of long term experience, it was legitimate to say that the Polish
reimbursement system required thorough changes.
Wholesale
prices
It could not be
cheaper
Medical
pharmacy
First
patients
will
receive
the money
Stop
overpaying!
Big
opening
Style Pharmacies –
queens of low
prices
The end of
expensive
medicines in
Głogów
Manufacturer
prices
Pharmacy of
cheap
medicines
Don’t let
milk you
dry
Buy here
the
cheapest
26th of June 2010, Sofia
12
Cheap
medicines
for
everyone
Do not overpay!!!
Buy cheap
medicines in
your town
The Ban of Bonus and Loyalty Systems

The Reimbursement act introduced the ban of bonus systems, lotteries,
offering gifts, loyalty systems for purchasing of reimbursed medicinal
products.
A MAJOR STEP FORWARD IN RESTORING
THE RIGHT PLACE OF POLISH PHARMACIES
IN THE HEALTH CARE SYSTEM

After many years of liberalisation of pharmaceutical distribution the
Polish government decided to stop the negative trend because
practical experiences proved that it was unfavourable for both the public
interest and for the state’s complex medication policy.

The Polish parliament made a major step in this direction by
enacting Article 94a of the Pharmaceutical Law that has introduced
the ban of advertising of community pharmacies in Poland.
Fixed prices and margins

One of the most important provision introduced by the Reimbursement
Act

Introduction of fixed manufacturer prices, wholesale margins and retail
margins for reimbursed medicines

Prices are set during the negotiation process between the Ministry of
Health and a pharmaceutical manufacturer

Introduction of limit groups based on criteria such as similar indications
and similar effectiveness. The base of the reimbursement limit will be the
highest among the lowest wholesale prices, which cover at least 15% of
monthly turnover in terms of value in a given category.

Retail margin calculated only to the reimbursement limit that is, in most
cases, much lower than the wholesale price
Obligation to complying with the price
and co-payment

Pharmacies are obliged to comply with the price and patient’s
co-payment established for medicines included on the official
reimbursement list.

Penalties are imposed on pharmacies not complying with the prices
and patients co-payments.

Measures that ban any bonus systems, lotteries, discounts, gifts,
loyalty systems etc. offered to patients for purchase of reimbursed
medicinal products.
Ban of Advertising
of Community Pharmacies
The provisions on the prohibition of advertising of community pharmacies
are simple and clear. In accordance to the Pharmaceutical Law
Article 94a:
"1. It is forbidden to advertise community pharmacies and
pharmaceutical dispensaries and their activities. The information
about the location and opening hours of the community pharmacy
and pharmaceutical dispensary is not advertising.
1a. Advertising of non-pharmacy turnover units and their activities
concerning medicinal products or medical products is prohibited”
Ban of Advertising
Standard for Liberal Professions in Poland

There are much the same restrictions concerning other liberal
professions in Poland:

medical doctors, dentists, veterinarians,
midwives,
lawyers or legal advisers.



That means the ban of advertising of community pharmacies constitutes
a standard for liberal professions in Poland.
Supervision over the Ban of Advertising
of Community Pharmacies

Supervision over the ban of advertising of community pharmacies in
Poland hold Voivodeship Pharmaceutical Inspectors
according to the Article 94a of the Pharmaceutical Law.

In case of breaking the law with regard to the ban of advertising of
community pharmacies the Voivodeship Pharmaceutical inspector
orders to stop the advertising immediately and may fine the owner
of the community pharmacy up to 50,000 zł (12,000 Euro).

The owner of the community pharmacy may appeal to the Main
Pharmaceutical Inspector and then to the Administrative Court in
Warsaw.

But the order to stop the advertising immediately will be in force until the
decision of the Main Pharmaceutical Inspector and possibly the ruling of
the Administrative Court in Warsaw.
Ban of Advertising
of Community Pharmacies

It is one of the the most important guarantee of proper functioning
of pharmacies as public health practitioners and pharmacists as
representatives of public health profession.

Particularly that there are neither ownership nor establishment
(demographic and/or geographic) criteria for opening new
community pharmacies in Poland.

Therefore, when any company owned by non-pharmacists may own and
run community pharmacies in Poland, introducing the ban of advertising
of community pharmacies has been the only way to stop very
aggressive marketing campaigns performed by many chain
pharmacies that were contrary to pharmaceutical deontological
code.
Lobbying Campaigns Against
the Ban of Advertising
of Community Pharmacies

Non-pharmaceutical business associations operating on the Polish
pharmacy market have been continuing lobbying campaign against the
ban of advertising of community pharmacies for many months.

They have attacked members of the Polish Pharmaceutical Council and
have been putting the Polish government under pressure.

But Polish pharmacists strongly support the position of the Polish
Pharmaceutical Chamber of no change in the rules prohibiting
advertising of pharmacies.

The letter on these matter signed by nearly five thousand Polish
pharmacists was sent to the Ministry of Health.
The Polish government refused to change
the Article 94a

The Polish government has rejected proposals to make any
change of the Article 94a of the Pharmaceutical Law because after
two years evidences proved that the effects of the ban are very
positive for patients and the National Health Fund.

The Polish Pharmaceutical Association representing the
pharmaceutical profession and many pharmacists working as scientists
at pharmaceutical faculties at ten medical universities in Poland has
supported the position of the Polish Pharmaceutical Chamber and
the Polish government concerning the ban of advertising of
community pharmacies.
Complaint of the Polish Confederation Lewiatan
to the European Commission

The Polish Confederation Lewiatan (the business association)
representing owners of biggest pharmacy chains in Poland lodged a
complaint against Article 94a of the Pharmaceutical Law that
introduced the ban of advertising of community pharmacies in Poland to
the European Commission in October 2013.

We do not know the detailed text of the complaint but we know that
Lewiatan has referenced:

Article 3 and 4 of The Treaty of European Union,

Article 34, 49 and 101 of The Treaty on the Functioning of the European
Union and

The Title VIII of The Directive 2001/83/EC of the European Parliament
and of the Council
The Role of Pharmacists in the Health Care System

Experiences of most European countries show explicitly that the main
direction of development of pharmacies in Europe should be desire
to advance pharmacy profession and community pharmacy
services.

Pharmaceutical care focused on patient performed by committed health
care professionals creating multidisciplinary team benefits patients
and health care systems much more than marketing strategies
with the aim to achieve only business goals.

Medicines should not be treated like ordinary articles of commerce
and community pharmacies should not be treated like “shops with
medicines” because in this case it would not be possible to perform the
complex pharmaceutical care that should be an important element of
the state’s medication policy.
Thank you for your attention
Piotr Bohater
International Affairs Coordinator
Polish Pharmaceutical Chamber