A CORE SET OF INDICATORS TO
CHARACTERISE AND ASSESS THE

DISTRIBUTION CHAIN IN THE
PHARMACEUTICAL SECTOR

Valérie Paris – ...
Information regularly published on
pharmaceutical distribution
•

OECD: a few questions in previous Product Market Regulat...
Objectives of the presentation
Propose a core set of indicators (qualitative and
quantitative) for a possible data collect...
Regulation of wholesalers and market
structure
Regulation

• Regulation of ownership and licensing;
• Regulation of vertic...
Wholesale remuneration scheme – out-patient sector 2010

AT
BE
BG
CZ
DE
DK
EE
EL
ES
FI
FR
HU
IE
IT
LT
LU
LV
MT
NL
PL

Pric...
Regulation of retail distribution and
number of retailers
Regulation
- Types of retailers allowed to distribute medicines ...
Pharmacy remuneration scheme – out-patient sector 2010
C.

Scope of medicines

Type

AT
BE
BG
CZ
DE

Price control at
phar...
Outcomes: Assessing distribution costs

Manufacturer’s selling price
+ Mark-ups added on at various points of the supply c...
Outcomes: Distribution costs
Some data are also available
on mark-ups observed
on essential medicines
in M&LIC from ad-hoc...
Outcomes: Assessing availability of
medicines
• Density of POM dispensaries, geographical distribution and/or
distance to ...
Outcomes: Quality of supply
• No simple indicator to measure quality (of services and products)

• Density of pharmacists ...
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Competition and Pharmaceuticals - Valérie Paris - 2014 OECD Global Forum on Competition

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This presentation by Valérie Paris was made at the 2014 Global Forum on Competition (27-28 February) during the session on competition issues in the distribution of pharmaceuticals. Find out more at http://www.oecd.org/competition/globalforum

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  • Objective of the presentation:
  • Competition and Pharmaceuticals - Valérie Paris - 2014 OECD Global Forum on Competition

    1. 1. A CORE SET OF INDICATORS TO CHARACTERISE AND ASSESS THE DISTRIBUTION CHAIN IN THE PHARMACEUTICAL SECTOR Valérie Paris – OECD Health Division Global Forum on Competition 28 February 2014, OECD, Paris
    2. 2. Information regularly published on pharmaceutical distribution • OECD: a few questions in previous Product Market Regulation survey; # of pharmacists in OECD Health Statistics • WHO – European Health for all database: # of pharmacists and pharmacists graduated – WHO pharma country profiles data and reports: # pharmacies and pharmacists; accreditation of pharmacies ; inspection and quality controls for distributors, implementation of good distribution practices, pricing policy, distribution mark-ups and taxes; public sector procurement and distribution; private sector distribution • PHIS information system (European countries): – Density of POM dispensaries; type of price regulation at manufacturer, wholesale and pharmacy levels, taxes on pharmaceuticals and reference prices systems – PPRI and PHIS Country profiles: regulation of wholesalers and retail distributors; # of wholesales and retailers; regulation of mark-ups 2
    3. 3. Objectives of the presentation Propose a core set of indicators (qualitative and quantitative) for a possible data collection in order to: • Describe the regulation and characteristics of the distribution of pharmaceuticals in countries • Assess the effectiveness of a country’s distribution chain Taking account availability of data for a maximum of countries 3
    4. 4. Regulation of wholesalers and market structure Regulation • Regulation of ownership and licensing; • Regulation of vertical integration of retailers; • Public service obligations: range of products (full- vs shortliners), delivery delays; • Regulation of mark-ups; • Regulation of discounts to pharmacies. Market structure • Number of wholesalers by type • Market concentration. 4
    5. 5. Wholesale remuneration scheme – out-patient sector 2010 AT BE BG CZ DE DK EE EL ES FI FR HU IE IT LT LU LV MT NL PL Price control at wholesale level Yes Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes No Yes Scope of medicines Type All medicines All medicines POM Reimbursable POM, reimbursable OTC All medicines All medicines All medicines Reimbursable All Reimbursable Reimbursable Reimbursable All medicines All medicines All medicines Reimbursable Regressive mark-up/margin Regressive mark-up/margin Regressive mark-up/margin Regressive mark-up/margin Regressive mark-up/margin Regressive mark-up/margin Linear mark-up/margin Regressive mark-up/margin Regressive mark-up/margin Regressive mark-up/margin Linear mark-up/margin Linear mark-up/margin Regressive mark-up/margin Different6 Regressive mark-up/margin Linear mark-up/margin Linear mark-up/margin Note: The table is incomplete, Source: PHIS database, available at https://phis.goeg.at 5
    6. 6. Regulation of retail distribution and number of retailers Regulation - Types of retailers allowed to distribute medicines (POM and OTC): pharmacies, dispensing doctors, other outlets, internet retailers - Regulation of ownership for pharmacies (Is ownership reserved to pharmacists? Can a pharmacist own several pharmacies?) - Regulation of establishment of new pharmacies? (Quotas per population; Distance between pharmacies; other) - Service obligations for pharmacies (Regulation of opening hours; range of products, provision delays) - Regulation of mark-ups and/or retail prices. Market characteristics - Number and density of retail POM dispensaries (by type) 6
    7. 7. Pharmacy remuneration scheme – out-patient sector 2010 C. Scope of medicines Type AT BE BG CZ DE Price control at pharmacy level Yes Yes Yes Yes Yes All medicines All medicines POM Reimbursable POM, reimbursable OTC Regressive mark-up/margin Regressive mark-up/margin Regressive mark-up/margin Regressive mark-up/margin Different EL FR HU IE IT LT LU LV MT NL PL PT RO SE Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes All medicines Reimbursable All medicines Reimbursable Reimbursable Reimbursable All medicines All medicines All medicines POM Reimbursable POM, reimbursable OTC POM POM Linear mark-up/margin Regressive mark-up/margin Regressive mark-up/margin Linear mark-up/margin Linear mark-up/margin Regressive mark-up/margin Different Regressive mark-up/margin Linear mark-up/margin Fees Regressive mark-up/margin Linear mark-up/margin Regressive mark-up/margin Regressive mark-up/margin12 Note: The table is incomplete, Source: PHIS database, available at https://phis.goeg.at 7
    8. 8. Outcomes: Assessing distribution costs Manufacturer’s selling price + Mark-ups added on at various points of the supply chain + National and regional taxes + VAT - Discounts and rebates +Fixed pharmacy fee, dispensing fee or prescription fee = retail price 8
    9. 9. Outcomes: Distribution costs Some data are also available on mark-ups observed on essential medicines in M&LIC from ad-hoc surveys or studies by WHO-HAI)
    10. 10. Outcomes: Assessing availability of medicines • Density of POM dispensaries, geographical distribution and/or distance to the closest dispensary; • Occurrence of shortages in supply - Monitoring of product shortages is sometimes available at national level • Actual availability more difficult to measure, especially in M&LIC (WHO-HAI conduct surveys in outlets) 10
    11. 11. Outcomes: Quality of supply • No simple indicator to measure quality (of services and products) • Density of pharmacists or health professionals with a minimum training in pharmacy can be used as a proxy for the quality of service (POM) • The existence of policies of on inspections and control of distribution facilities and/or products (collected in WHO country profiles) are indicators of process • Data on counterfeit medicines are scarce (but in expansion) 11

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