german pharmacies figuresdatafacts2012

2

01 Pharmacy image .......................................................................... 3

02 Pharmacy services ....................................................................... 4

03 Emergency service and formulations ........................................... 5

04 Numbers of pharmacies ............................................................... 6

05 Pharmacies in the German states ................................................ 7

06 Trends in the number of jobs in community pharmacies .........8 – 9

07 Pharmacists and pharmacy students ........................................ 10

08 Pharmacy and trainee position ................................................... 11

09 Pharmacy density in Europe ...................................................... 12

10 Pharmacy remuneration by comparison .................................... 13

11 SHI expenditure on pharmaceuticals (excl. co-payments) ........ 14

12 Distribution of the value added .................................................. 15

13 Allocation of total SHI expenditure .......................................16 – 17

14 Distribution miscellaneous costs ................................................ 18

15 Vaccine sales .............................................................................. 19

16 Statutory pharmacy and manufacturer rebates ......................... 20

17 Rebated pharmaceuticals .......................................................... 21

18 Co-payments for pharmaceuticals ............................................. 22

19 Co-pay exemptions .................................................................... 23

20 Prescribed pharmaceuticals (SHI) ............................................. 24

21 Pharmaceutical expenditure per person .................................... 25

22 Distribution of pharmacies according to turnover .................26–27

23 Structure of pharmacy sales .................................................28–29

24 Structure of complementary product range ............................... 30

25 Drug-related problems (DRP) concerning self-medication ........ 31

26 VAT on pharmaceuticals in the EU ........................................32–33

Contents

3

82 %

86 %

87 %

93 %

72 %

of Germans feel that pharmacies providegood-quality service, and consider them to be some of the best service providers in Germany4

of Germans judge the night and emergency service as an important part of their health care3

of Germans have a high degree of trust in pharmacists2

of Germans consider owner-run pharmacies as indispensable in urgent cases 1

of Germans go to the pharmacy first when they have minor health issues5

is the mark Germans give to owner-run pharmacies concerning healthcare of their children5

1.8

Sources (representative surveys)1 Institut für Handelsforschung, Köln 20122 Reader's Digest 20113 Forsa 20134 Allensbach 20085 IFAK-Institut 20115 infas 2009

01Pharmacy image

4

Services 2012

4 million patient contacts per day 250,000 home deliveries per day 500,000 emergency services per year 15 million extemporaneously prepared formulations,

which are covered by the statutory health insurance 2,500 training courses offered by the Chambers of Pharmacists 129,000 participants of those training courses

02 Pharmacy services

Packaging defect

(Suspected) adverse drug reactions (side effects; including suspected misuse or abuse of drugs)

Quality product defects

Mechanical failures (product defect)

Mislabelling (product defect)

Other product defects

8,500 Reports of suspected drug safety concerns to the Drug Commission of German Pharmacists (AMK)

26 %

4 %

24 %

26 %

12 %

8 %

5

Night and emergency service

1,400 pharmacies per night 20,000 patients per night and emergency service 7 million packs provided outside the regular opening hours Especially important for children (and their parents): above-

average percentage of SHI* pharmaceuticals dispensed during night and emergency service is prescribed by paediatricians.

1 million requests via the internet and apps along with telephone calls and text messages to the mobile pharmacy emergency hotline 22 8 33

1.8 million online queries per year via the official web portal of German pharmacists www.aponet.de

Formulations

15 million extemporaneously prepared formulations per year, which are covered by the statutory health insurance

21 percent of which are methadone, 14 percent cytostatic and 6 percent parenteral preparations

1 million extemporaneously prepared formulations per year exclu-sively for children and covered by the statutory health insurance

Emergency service and formulations 03

* SHI – Statutory Health Insurance

6

Figures as at year-end

04 Numbers of pharmacies

2004 2005 2006 2007 2008 2009 2010 2011 2012

21,39221,476

21,551 21,570 21,602 21,54821,441

21,238

20,921

Number of pharmacies (incl. subsidiaries)

Subsidiaries

Pharmacies opened

Pharmacies closed

2004 2005 2006 2007 2008 2009 2010 2011 2012

6321,228

1,7962,356

2,8513,224 3,478 3,661 3,853

343326 346 370 360 298

263221

184

2004 2005 2006 2007 2008 2009 2010 2011 2012

2004 2005 2006 2007 2008 2009 2010 2011 2012

256 242 271351 328 352 370

424501

7

Figures as at year-end; * Pharmacies with operating licence in accordancewith § 2 of the Apothekengesetz (pharmacy regulations)

German State

Public pharmacies

in 2012

Independent pharmacies*

Subsidiaries

Baden-Württemberg 2,670 2,168 502

Bavaria 3,347 2,733 614

Berlin 861 709 152

Brandenburg 573 450 123

Bremen 155 121 34

Hamburg 436 353 83

Hesse 1,569 1,283 286

Mecklenburg-West Pomerania 409 333 76

Lower Saxony 2,041 1,661 380

North Rhine 2,425 2,001 424

Westphalia-Lippe 2,127 1,717 410

Rhineland-Palatinate 1,084 918 166

Saarland 323 282 41

Saxony 999 791 208

Saxony-Anhalt 617 496 121

Schleswig-Holstein 712 596 116

Thuringia 573 456 177

Total 20,921 17,068 3,853

Pharmacies in the German states 05

98

Year-end 2004 2005 2006 2007 2008 2009 2010 2011 2012

Pharmacists 46,014 46,276 46,953 47,766 48,030 48,002 48,695 48,690 48,422

Of which female (%) 65.5 64.8 66.0 66.6 68.5 69.2 68.7 69.9 70.2

Pre-registration traineepharmacists

1,431 1,534 1,518 1,506 1,327 1,287 1,367 1,442 1,462

Pharmaceutical engineers 9,602 9,266 8,292 8,413 8,196 8,056 7,701 7,570 7,193

Pharmaceutical technicalassistants (PTA)

43,946 46,431 48,656 49,874 51,907 53,734 55,345 56,987 58,368

Pharmaceutical commercialemployees (PCE) / other

35,812 36,454 38,355 36,026 36,020 35,769 34,719 33,915 33,269

Total jobs 136,805 139,961 143,774 143,585 145,480 146,848 147,827 148,604 148,714

06 Trends in the numberof jobs in communitypharmacies

10

07 Pharmacists and pharmacy students

Pharmacists in: 2011 2012Percentage

of women

Community pharmacies 48,690 48,422 70.2

Of which managers 17,577 17,068 46.2

Hospital pharmacies 1,966 2,034 65.0

Industry, administration,organisation, science 8,635 9,283 58.4

Pharmaceutical industry 4,602 5,079 57.5

Scientific institutions 280 280 64.6

Armed Forces 224 221 32.1

Authorities and associations 835 875 61.1

Universities 1,314 1,336 54.4

Educational institutions 480 490 76.3

Others 900 1,002 61.1

Total employedpharmacists 59,291 59,739 68.2

Pharmacists

Pharmacy students

2011/2012 13,603

2010/2011 12,719

2009/2010 12,485

2008/2009 12,052

2007/2008 11,721

11

Pharmacy trainee positions

PCEs in training

Pre-registration trainee pharmacists

PTA trainees

08

Total number of trainee positions

4,244

2,451

1,462

8,157

12

People per pharmacy*

09 Pharmacy density in Europe

Denmark 17,700

Slovenia 6,600

Luxembourg 5,500

United Kingdom 4,600

Czech Republic 4,000

Estonia 2,800

Romania 3,100

Hungary 4,000

Germany 3,900

Portugal 3,700

Italy 3,400

EU-average 3,200

Slovakia 2,800

Latvia 2,700

Lithuania 2,200

Spain 2,200

Belgium 2,100

Malta 2,000

Greece 1,000

Bulgaria 1,800

Cyprus 1,900

Netherlands 8,300

Sweden 7,600

Austria 6,500

France 2.800

Croatia** 4,100

Ireland 2,600

Finland 6,600

Poland 3,400

* Germany: ABDA-Statistik 2012; all other countries: last available year according to ZAEU, SFK, IPU, ÖAK, AFP, SPA** Accession to the EU 1st July 2013

13

Pharmacy remuneration by comparison 10

Total SHI income

Gross domestic product

Standard wages (ADEXA)

Inflation rate

Total gross profit per prescribed unit

Index (2004 = 100) * Provisional, based on projection

110.7

116.4

123.3

137.6

118.0

125

95

110

100

2004 2005 2006 2007 2008 2009 2010 2011 2013*2012

14

in EUR bn

Total amount spent by SHI on pharmaceuticals in 2012

11 SHI expenditure on pharma ceuticals (excl. co-payments)

Pharmaceutical industry and purchased materials and services (such as raw materials)

Pharmaceutical wholesalers

VAT (exchequer)

Pharmacies

4.21 (=15.2 %)

4.43 (=16.0 %)

1.03 (=3.7 %)

18.04(=65.1 %)

27.71 (=100 %)

15

Every EUR 100 spent by SHI on pharmaceuticals is allocated as follows:

* Taking into account the statutory pharmacy rebate of EUR 1.75

Distribution of the value added 12

2012

2011

2010*

2009*

2008

2007

Pharma-cies

Whole-salers

Industry Exchequer (VAT)

0 % 20 % 40 % 60 % 80 % 100 %

15.2 3.7 65.1 16.0

15.4 3.6 65.0 16.0

15.6 4.0 64.4 16.0

15.7 3.9 64.4 16.0

15.5 4.0 64.5 16.0

15.9 4.1 64.0 16.0

1716

13 Allocation of totalSHI expenditure

* Provisional** Taking into account the statutory pharmacy rebate of EUR 1.75*** From pharmacies

Of w

hich

is a

lloca

ted

to

pha

rmac

ies

bas

ed o

n th

e D

rug

Pric

e O

rdin

ance

(Arz

neim

ittel

pre

isve

rord

nung

)

Pha

rmac

eutic

als*

**

Total SHI expenditure (in EUR bn) M

isc.

co

sts

Ad

min

istr

ativ

e ex

pen

ditu

re

Rem

edie

s an

d th

erap

eutic

aid

s

Den

ture

s

Den

tists

Do

cto

rs

Of

wh

ich

(%

)

Ho

spita

ls

20065.2 16.834.01.8

148.0915.0 5.6 5.5 16.1 2.7

20045.4 16.633.92.6

140.185.915.3 5.8 14.5 2.5

2010**4.7 18.033.31.8

175.9915.1 5.6 5.4 16.1 2.5

2011

2012*

4.7 18.433.61.8179.61

15.1 5.9 5.3 15.2 2.3

4.7 18.733.71.7184.52

15.1 5.9 5.2 15.0 2.3

20075.1 17.533.01.8

154.0215.0 5.6 5.3 16.6 2.6

20085.0 32.71.8

160.9415.0 5.7 5.1 18.2 16.6 2.6

2009**4.8 32.71.8

171.0815.1 5.6 5.2 18.2 16.6 2.6

20055.2 16.334.01.7

143.9215.0 5.8 5.7 16.4 2.8

18

14 Distribution ofmiscellaneous costs

Sick pay 5.0

Transportation expenses 2.2

Home care 2.1

Pharmaceuticals from others 1.5

Ambulant & inpatient treatment, rehab 1.3

Early diagnosis measures 1.1

Dialysis in doctors` practices 1.0

Social services 0.9

Integrated care 0.8

Pregnancy, maternity 0.6

Services abroad 0.5

Others 1.7

Total 18.7

in %

19

In 2007, vaccinations were included in the SHI catalogue of required services.

* Provisional

Vaccine sales

in EUR m (incl. VAT)

Of which tick-borne meningoencephalitis

Of which flu

Of which pneumococcus

Of which human papillomavirus (HPV)

15

2012*

131 187 139 97

2011

139 230 146 77

2010

125 275 141 57

2009

171 335 149 90

2008

266 285 153 216

2007

300 241 170 133

2006

140 182 84

1,176

1,257

1,021

932

1,033

1,349

799

20

16 Statutory pharmacy and manufacturer rebates

* Provisional, taking into account the statutory pharmacy rebate of EUR 1.75

Pharmacy rebate

Manufacturer rebates (excl. rebate contracts)

Wholesale rebate (only prescriptions)

in EUR m

2010* 2011 2012

1,211

2,312

1,032

1,477

2,285

1,208

147

21

18,400 Number of rebate contracts

144 Involved health insurance companies

161 Involved pharmaceutical manufacturers

29,200 Number of rebated pharmaceuticals (Central Pharmaceutical Number)

42 % Share of rebated pharmaceuticals subject to no or reduced co-payments

354 m Rebated packs of generic pharmaceuticals

13.3 mNumber of data sets that need to be pro-cessed by Pharmacy IT

Rebatedpharmaceuticals

Figures as at year-end 2012

17

22

18 Co-payments for pharmaceuticals

Co-payments in EUR m

Average charge per unit in EUR

1,862

20122007

1,626

2008

1,674

2009

1,696

2010

1,767

2011

1,833

2.60

2012

2.30

2007

2.30

2008

2.30

2009

2.40

2010

2.50

2011

23

Co-pay exemptions

Number of patients who exceed the annual prescription charge limit of 1 % of their gross annual income (chronically ill patients):

2004 2011

5,969,8056,938,274

Number of patients who exceed the annual prescription char-ge limit of 2 % of their gross annual income:

2004 2011

508,359

673,557

Number of patients who are exempt from the prescription charge (hardship cases in accordance with § 62 SGB V):

2004 2011

7,446,6336,643,362

19

24

Note: modified method of counting medical devices

20 Prescribedpharmaceuticals (SHI)

Prescriptions per member

Pharmaceu-ticals per

prescription

Prescribed pharmaceu-

ticals per member

2012 8.73 x 1.59 = 13.88

2011 8.89 x 1.60 = 14.22

2010 8.84 x 1.62 = 14.32

2009 8.79 x 1.64 = 14.42

2008 8.81 x 1.64 = 14.45

2007 8.66 x 1.63 = 14.12

25

Pharmaceutical expenditure per person

Incl. VAT

21Pharmaceutical expenditure per person

Over-the-counterpharmaceuticalsEUR 52

Prescription phar-maceuticalsEUR 509

TotalEUR 561

2726

Pharmacy share according to turnover (%)

Turnover in EUR m (excl. VAT)

Distribution of pharmacies according to turnover22

7.0

<0.

75

9.6

<1.

00

13.6

15.1

<1.

25

<1.

50

12.0

<1.

75

11.2

<2.

00

1.4<

3.75

8.7

<2.

25

1.0<

4.00

5.1

<2.

50

0.7

<4.

25

4.9

<2.

75

0.5

<4.

50

3.3

<3.

00

0.3

<4.

75

2.2

<3.

25

0.4

<5.

00

1.6

>3.

50

1.4

>5.

00

2928

1) Supplymentary assortment2) Patient care products3) Unrestricted OTC pharmaceuticals

23 Structure ofpharmacy sales

Measured in sales value:

Pharmacy sales in 2012 (excl.VAT) EUR 42.6 bn = 100 %

Pharmaceuticals EUR 38.6 bn = 90.6 %

1)EUR2.3 bn= 5.4 %

2)EUR1.7bn = 4.0 %

Value of pharmaceuticals covered by SHI, private insurance or other

EUR 35.0 bn = 82.1 %

Self-medication

EUR 3.6 bn= 8.5 %

Prescriptionpharmaceuticals

EUR 34.1 bn =80.0 %

Pharmacy-only pharmaceuticals (non-prescription)

EUR 4.2 bn =9.9 %

3)EUR0.3 bn = 0.7 %

Not prescribed

EUR3.3 bn = 7.8 %

Pre-scribed

EUR0.9 bn= 2.1 %

Measured per units:

Prescriptions 2012 1,355 m units = 100 %

Prescription pharmaceuticals

722 m units =53.3 %

Prescribed

102 m units= 7.5 %

Not pre-scribed

486 m units= 35.9 %

Volume of pharmaceuticals covered by SHI,private insurance and other

824 m units = 60.8 %

Self-medication

531 m units = 39.2 %

1)

45 m = 3.3 %

Pharmacy-onlypharmaceuticals(non-prescription)

588 m units =43.4 %

Note: modified database for prescription pharmaceuticals, therefore not fully comparable with previous years.

1) Unrestricted OTC pharmaceuticals*

* Pharmaceuticals which may be sold outside pharmacies (e.g. by chemists)

30

Supplementaryassortment (2.3)

Patient careproducts (1.7)

Sales in EUR bn (excl. VAT)

24 Structure of complemen-tary product range

Medical products and therapeutic aids

Hygienic and cosmetic products

Vitamins and minerals

Other

0.3

(1.2)

1.4

0.8

1.4

4.0 Total

(0.3)

31

Findings of the study: Nature and frequency of drug-related problems in daily community pharmacy practice in Germany.

Almost every 5th patient request for self-medication phar- maceuticals was associated with one or more drug-related problems (DRP).

72 % of DRP occured in conjunction with the four most common indications, i.e. pain, respiratory-, gastrointestinal- and skin disorders.

75 % of DRP were inappropriate self-medication, inapprop-riate product request, wrong dosage, and duration of drug use (including abuse) was too long.

If a patient had a medication record at the pharmacy, significantly more cases of wrong dosage and drug-drug interactions could be identified.

90 % of DRP could be resolved in pharmacies.

Source: Eickhoff C, Hämmerlein A, Griese N, Schulz, M.: Nature and frequency of drug-related problems in self-medication (over-the counter drugs) in daily community pharmacy practice in Germany. Pharmacoepidemiol. Drug Saf. 2012; 21 (3); 254-260

Drug-related problems (DRP) concerningself-medication

25

3332

26 VAT on pharmaceuticals in the EU*

General VAT rate

General VAT rate

Tax rate for pharmaceuticals

Tax rate for pharmaceuticals

Denmark 25.0 25.0

Germany 19.0 19.0

Bulgaria 20.0 20.0

Czech Republic 15.0 21.0

Latvia 12.0 21.0

Italy 10.0 21.0

Austria 10.0 20.0

Slovakia 10.0 20.0

Estonia 9.0 20.0

Slovenia 8.5 20.0

Poland 8.0 23.0

Belgien 6.0 21.0

Greece 6.5 23.0

Portugal 6.0 23.0

Netherlands 6.0 21.0

Romania9.0

24.0

24.0Prescription pharmaceuticals

Over-the-counter pharmaceuticals

Finland 10.0 24.0

Hungary 5.0 27.0

Cyprus 5.0 18.0

Spain 4.0 21.0

Luxembourg 3.0 15.0

Malta 0.0 18.0

Sweden0.0

25.0

25.0Prescription pharmaceuticals

Over-the-counter pharmaceuticals

Ireland0.0

23.0

23.0Oral medication

Non-oral medication

UK0.0

20.0

20.0National Health Servicepharmaceuticals

Over-the-counter pharmaceuticals

Croatia**5.0

25.0

25.0National Health Servicepharmaceuticals

Over-the-counter pharmaceuticals

Lithuania 5.0

21.0

21.0Refundable pharmaceuticals

Non-refundable pharmaceuticals

France 2.1

7.0

19.6Refundable pharmaceuticals

Non-refundable pharmaceuticals

* Tax rates as at 2013** Accession to the EU 1st July 2013

34

Notes

35

Legal disclosure:

Published by the ABDA – Federal Union of German Associations of PharmacistsJägerstr. 49/5010117 BerlinGermanywww.abda.de

Print:

Liskow Druck und Verlag GmbHwww.liskow.de

Sources:

ABDA-StatistikBundesministerium für GesundheitEuropäische KommissionForsa Gesellschaft für Sozialforschung und statistische Analyse mbHIFAK-InstitutIMS HEALTH GmbH & Co. OHGinfas Institut für angewandte Sozialwissenschaft GmbHInstitut für Demoskopie AllensbachInstitut für Handelsforschung, KölnIrish Pharmacy Union (IPU)Österreichische Apothekerkammer (ÖAK)Pro Generika e.V.Reader's Digest Stichting Farmaceutische Kengetallen (SFK)Statistisches BundesamtThe Nielsen Company GmbHVerein Deutsches Arzneiprüfungsinstitut e.V.Zentrum für Arzneimittelinformation und Pharmazeutische Praxis (ZAPP)Zusammenschluss der Apotheker in der Europäischen Union (ZAEU)