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Posts Tagged ‘German pharmacies’

International Pharmacy: Independent Pharmacy Practice in Germany. By Our Student Pharmacist, Andrew P. Capozzi.

ApothekePharmacy practice differs in many ways worldwide, especially when comparing that of European countries to that of the United States.

In the US, approximately 34% of all community pharmacies are independently owned, meaning that they are locally- and pharmacist-owned rather than a member of a corporate chain, such as Kroger, CVS, Walmart, or Walgreens.

In contrast, in Germany, federal law requires that all community pharmacies, known as “Apotheken,” are independently owned and operated. However, with this regulation, a pharmacist is restricted to owning a maximum of three pharmacy locations.

With German pharmacies, most medications that are dispensed are by prescription, although several “over-the-counter” (OTC) medications are also available, but require a pharmacist to discuss with the patient their effects and safe use. In the United States, many OTCs such as Tylenol (acetaminophen) or Motrin (ibuprofen) can be purchased without requiring a pharmacist to counsel the patient on their use. These medications can also be found in grocery stores and gas stations, unlike in Germany where these products are only able to be found in pharmacies.

A major contrast between Germany and the United States is the healthcare systems that govern the care of citizens. In the United States, healthcare is regulated privately, with the exceptions of Medicare and Medicaid, whereas insurance is required for German citizens, up to a certain income, and provided as a guaranteed right of care. This statutory health insurance (SHI) system covers about 88% of the German population, accounting for approximately 73.3 million people. This difference highlights unique pricing and medication access differences between the two countries.

Pharmacy - Medication List

In Germany, the government regulates medication pricing through their national formulary of approved medications, guaranteeing that every prescription drug will cost the same in every pharmacy. With this regulation, every insured person will have the same access to medications, regardless of their locale or financial status. Further, under the public insurance plan, prescription medications are virtually free of charge for patients, costing a maximum of 10 euros (~$10.50) per medication; although, this is countered by federal taxation of all citizens to accommodate the healthcare system and its associated fees. Surprisingly, however, insurers are not required to cover birth control pills for women older than 22, which can cost about $67 a month out-of-pocket. In the United States, the Affordable Care Act allows American insurance plans to cover contraception as a form of preventative medicine with no cost sharing.

While pharmacy hours certainly vary in the United States, German pharmacies are generally open Monday through Friday from 9 AM to 6:30 PM and on Saturdays from 9 AM to 1 PM. Interestingly, pharmacies within a certain region alternate in providing after-hours services, posting the schedule of which pharmacy is on duty for the night at the entrance of each pharmacy as well as in the newspaper.

Although there may be several perceived advantages to German healthcare and pharmacy practice, the systems are not without their flaws. For example, a major challenge in Germany is the lack of cooperation and integration between healthcare providers and various sectors, especially as electronic health record (EHR) systems, which assist with documenting a patient’s medical information and health plans in one place, had not been established until around January 2021.

Until the beginning of 2022, paper-based prescribing had remained the standard for providers, with the transition to electronic prescribing options going live only this January. Additionally, telehealth infrastructure had not been largely formalized until January, as well, finally granting distance-based care options for patients outside of a physician’s office.

Apotheke im Mall

Biggest takeaway points:

  • German pharmacies must be owned by pharmacists.
  • Typically OTCs, such as analgesics and cold and cough medications, are pharmacy-only products.
  • By law, pharmacists must counsel on every medication, regardless if prescription or OTC.
  • Medication prices are set by the government since public insurance plans are provided to citizens.
  • Pharmacies in certain areas take turns offering 24-hour service to patients.
  • Electronic health record systems, telehealth services, and electronic prescribing are relatively new to the German healthcare system.

German Pharmacy

Resources:

City of Bonn. Pharmacies (Apotheke). Bonn: Medical Care. Published 2022. Accessed June 16, 2022. https://www.bonn.de/microsite/en/services/medical-care/pharmacies.php

Eickhoff C, Griese-Mammen N, Mueller U, Said A, Schulz M. Primary healthcare policy and vision for community pharmacy and pharmacists in Germany. Pharm Pract (Granada). 2021;19(1):2248. doi:10.18549/PharmPract.2021.1.2248

Michos L, Holmes E. National Community Pharmacists Association (NCPA) Digest 2021. Published online October 2021. https://ncpa.org/sites/default/files/2021-10/2021-Digest.pdf

Strumann C, Möller B, Steinhäuser J. Einschätzungen zum elektronischen Rezept – eine Querschnittstudie unter Apothekern in Deutschland. Gesundheitswesen. Published online June 23, 2021:a-1498-1816. doi:10.1055/a-1498-1816