The health minister wants to strengthen rural pharmacies with a reform. Pharmacists affected believe the plans have not been thought through – and warn of incalculable consequences for patients.
Mike Beyer has already had two high-ranking visitors from politics this year. In March, the Chancellor visited his Sonnenapotheke in Teltow, as the small town south of Berlin is in Scholz's constituency. Beyer then invited the Federal Minister of Health himself. He wants to leave no stone unturned to improve the situation of pharmacies in this country. And for him, that means first and foremost: preventing the planned reform.
When he talks about the ideas from the Federal Ministry of Health, he seems angry and a little confused. During their conversation, he explained to Karl Lauterbach exactly what bothers him about the reform plans and why he believes that they would do more harm than improve the situation of pharmacies. But the minister was not convinced. Instead, he tweeted: Without our reform, pharmacies in rural areas will die out.
In fact, more than 500 pharmacies closed last year – for economic reasons. This year, even more will probably close. The planned pharmacy reform is intended to remedy this and, above all, to ensure supply in rural areas. But Beyer is certain: This is not the way to go.
Fixed amounts and percentage surcharges
Because he knows the situation of rural pharmacies very well. He runs two pharmacies in Teltow and has eight employees, including two pharmacists and two pharmaceutical engineers who trained in the GDR. The Corona period has brought heavy losses for him and most of his colleagues, he says. Most have not yet recovered from this low point. This is also due to the ever worsening conditions. Inflation also affects pharmacies, everything is getting more expensive. But the fees have always remained the same during this time. Anyone who has no reserves or still has to pay off loans is in a situation that threatens their existence.
The problem is the way pharmacies are financed. It is essentially based on three pillars: for each prescription drug sold there is a fixed amount of 8.35 euros, a surcharge of three percent and a flat rate of 21 cents for emergency and night services. From this a discount of currently 2 euros is deducted by the health insurance companies. At the moment, only those pharmacies that sell a lot of very expensive drugs can actually be run economically, because three percent of 1,000 euros is more than three percent of ten euros. So the more expensive drugs are sold, the higher the revenue. The fixed amount, the so-called fixed sum, has hardly increased in the past 20 years.
Pharmacists should be allowed to operate a network
This is where the federal government's reform comes in. It wants to reduce the percentage of remuneration to two percent and increase the fixed amount. The idea behind this is that smaller pharmacies and rural pharmacies would sell less expensive medicines, such as cancer drugs, than pharmacies in large cities. They would benefit from the change in remuneration.
But that is exactly what is wrong, says Mike Beyer. He asked the minister on the basis of what data his ministry wanted to introduce this regulation. After all, there are seriously ill people who need expensive medicines everywhere. And no one drives to a big city pharmacy to get their medicine. So rural pharmacies could also suffer losses if the percentage revenue is reduced but the fixed amount is not increased sufficiently.
The basic problem with the reform is that it actually only intends to redistribute funds and does not plan to increase pharmacists' fees, criticizes Beyer.
Pharmacist Mike Beyer knows the problems his profession faces, especially in rural areas.
Measures against Skilled labor shortage
But another aspect of the reform could have really bad consequences, warns the pharmacist. Minister Lauterbach calls it a reduction in bureaucracy and help against a shortage of skilled workers. The new regulation aims to make it easier to set up new pharmacies, as this is very heavily regulated in Germany. Up to now, only licensed pharmacists have been allowed to set up. They can operate a maximum of three branches, and they cannot be too far apart – the keyword is owner-managed pharmacy. In addition, there must always be at least one licensed pharmacist on site.
Since there is also a shortage of skilled workers in the pharmaceutical sector, the reform is intended to help here. The plan is for pharmacists to now be allowed to operate a kind of pharmacy network. In addition to their main pharmacy and the branches, two additional branch pharmacies should be possible. These can also be located further away from each other. The new pharmacies are not subject to the previously applicable minimum opening hours, so they do not have to offer emergency services.
Above all, however, a pharmacist does not have to be on site all the time. After the reform, pharmacies could be managed by pharmaceutical technical assistants (PTAs). A pharmacist only has to be present for eight hours a week. That's the theory.
Some things may only be done by qualified professionals
But pharmacist Beyer says that this has not been thought through. These newly established pharmacies cannot replace real pharmacies in the area, because certain services can only be provided by licensed pharmacists. The classic example is the dispensing of medicines that are covered by the Narcotics Act – painkillers for cancer patients and in palliative care, for example. This must be possible at any time. But if an authorized person is only rarely on site, patients would have to wait unnecessarily long, Beyer fears. Other advisory services or the production of certain fresh medicines are also tied to the presence of a trained specialist. In most cases, this is a pharmacist. Telemedicine cannot replace this.
The planned branch pharmacies would only be a type of drug sales outlet. Of course, they would initially be more economical to run because more expensive specialist staff would be saved. But the consequences for the industry and the patients are incalculable. There is a risk that specialists will be laid off precisely because they are more expensive.
And the competition would also increase the economic pressure on owner-operated pharmacies. They might also have to cut staff. Some might have to close completely. The hope of making more care available in rural areas this way cannot be fulfilled.
Burden of emergency care
Pharmacist Beyer points out that conditions in rural areas are actually more difficult than in big cities. This is mainly because pharmacies are obliged to offer service around the clock. There are emergency associations for this purpose, which organize night and holiday services. However, since there are naturally fewer members in such associations in rural areas, each individual pharmacy has such emergency services much more often. This is also where part of the Pharmacy Reform Act comes in. It is planned to increase the emergency flat rate that is paid on every prescription drug sold: from 21 cents to 28 cents. Each pharmacy is to receive at least 550 euros extra for each emergency service. Since pharmacies in rural areas offer emergency services more often, they automatically receive more.
In principle, this is a step in the right direction, says Beyer, but here too the major shortcomings of the reform are painfully apparent. The funds for this increase are not to be added to the system, but rather taken from somewhere else. The planned 50 million euros will be cut from the financing of pharmaceutical services. These include consulting services and, for example, measuring patients' blood pressure.
Redistribution instead of adequate financing is not a solution to the problems facing pharmacies in this country. Mike Beyer's demand to the minister is to stabilize the system that makes local care possible – and then reward it so that pharmacies can survive. That is a reform that really helps.
