Bureaucratic procedures overshadowing tradition lead to ongoing pharmacy fatalities
In the heart of Künzelsau, a town of approximately 16,000 inhabitants, the Johannes-Apotheke, a pharmacy that has been a part of the community for over a century, has closed its doors for the last time. The owner, Claudia Franz, expressed difficulty and emotion on the last day of operation, as many customers found it hard to believe that the cherished pharmacy was closing.
The closure was due to rising costs and increasing bureaucracy, creating an unsustainable burden for the small pharmacy. Small pharmacies in Germany, like the Johannes-Apotheke, are struggling with stringent regulatory demands, such as the EU's Falsified Medicines Directive (FMD), which requires costly technology investments for medication verification at the point of dispense. Additionally, these small pharmacies face economic pressures from unfavorable reimbursement rates from pharmacy benefit managers (PBMs), escalating labor costs, and competition from larger chains that benefit from centralized procurement and automation.
The FMD mandates unique identifiers and anti-tampering devices on all prescription packs, and compliance requires significant investment in systems to verify these at dispensing. This system integration across national levels in the EU is complex and expensive, creating a substantial administrative burden on smaller pharmacies, which may lack the resources for seamless technological adoption. Failures in these systems can block legitimate sales, further impacting revenue and patient access.
Moreover, small pharmacies cannot easily achieve the cost savings gained by large chains through robotics-enabled centralized dispensing or better contracts with payers, placing them at a competitive disadvantage. This combination of rising operational costs, bureaucratic complexity, and market pressures drives smaller community pharmacies towards closure. This trend has been observed globally and leads to concerns about reduced patient access and medication nonadherence when pharmacies close, as patients lose convenient local access to essential medicines.
Rouven Steeb, vice president of the Baden-Württemberg state pharmacy association, expects the decline of pharmacies to double by the end of the year. Heinz Kolmarr, another longtime customer, was sad but plans to find another pharmacy instead of switching to online medication delivery. However, Claudia Franz warns that the fewer pharmacies there are, the more the online drug delivery trade benefits.
Eleonore Rudolph, a regular customer, rejects digital medication purchases, stating the need to see the medication and get advice. For many Künzelsau residents, the Johannes-Apotheke was more than just a place to buy medicine, it was a piece of home. Longtime customer Rosemarie Kopp found the closure unexpected and visibly moved.
Pharmacies in Germany are dependent on fixed remuneration set by the state, which has not been adjusted for a decade despite significantly increased costs. The fixed remuneration burdens pharmacies with costs such as personnel, energy, and rent, leaving no room for price adjustments. There are currently around 2,100 pharmacy locations nationwide, but in Baden-Württemberg, 57 pharmacies have closed in the past half-year, while only six new ones have opened.
In many EU countries, the delivery of prescription drugs to customers is strictly regulated or even prohibited, but in Germany, it is much more loosely regulated and permitted under certain conditions. As more small pharmacies close, the online drug delivery trade may become a more attractive option for both customers and businesses. However, the loss of these community pharmacies could have significant implications for patient care and access to essential medicines.
- The challenging regulatory demands, such as complying with the EU's Falsified Medicines Directive (FMD) and the resulting high costs of medication verification systems, are major concerns for small pharmacies like the Johannes-Apotheke, causing them to struggle.
- Small pharmacies, including the Johannes-Apotheke in Künzelsau, are facing difficulties due to increasing bureaucracy, steep operational costs, and market pressures, potentially leading to a decline in patient access to essential medicines and medicine nonadherence.
