On the one hand the owners, opposed to any intervention, on the other parapharmacies and corners of the large-scale distribution convinced that an intervention is necessary. Waiting for the decisive CDM.
Marco Malagutti – Wednesday, 04 February 2015 – Pharmacist33
The question is always the same and the answer becomes more uncertain every day. Will 2015 be the year of liberalisations? In anticipation of the d-day of February 20, the date scheduled for the Council of Ministers where the competition bill will be discussed, the rumors about what the contents should be continue to chase each other, with mixed results for the fate of pharmacies. The last item in chronological order would be desirable for the category and concerns an intervention by the Minister of Health Beatrice Lorenzin that would have given the Minister of Economic Development a halt Federico Guidi, asking to be involved in the decisions regarding pharmacies.
The interventions contained in the technical investigation, which have been being processed by the ministry for months, and at the time anticipated by the Pharmacist33, concern both the overcoming of the quota on the number of pharmacies present on the national territory, and the elimination of the 
limit of ownership of four pharmacies in the hands of a single subject, and the possibility of extending the sale of class C drugs to all establishments manned by a graduate pharmacist, such as large-scale distribution corners and parapharmacies.
Contents and indiscretions that have inevitably triggered reactions with the owners on the one hand, opposed to any intervention related to the number of pharmacies or the possibility of extending the sale of class C drugs outside the pharmacies and parapharmacies and large-scale distribution corners on the other, convinced that an intervention is necessary and that the current drug distribution system is highly discriminating for the category.
In the middle is the Ministry of Economic Development, which in turn is divided, at least in its statements, between those who pull the brakes and those who believe that increased competition is also necessary in the pharmacy sector. Now the intervention of the Ministry of Health, which asks not to be excluded from the decisions concerning pharmacies and which expresses a negative opinion on the liberalization package. The decisive Council of Ministers is approaching, while waiting for other twists and turns cannot be ruled out.
Medicines and pharmacies, here are all the reactions to Renzi's liberalizations in the pipeline
04 – 02 – 2015 – Alma Pantaleo – Ants
The date of February 20, the day on which the Prime Minister Matthew Renzi should present the competition bill, approaches. And for a few weeks now rumors have been circulating about the contents of the draft which have unleashed the first discontent of insiders and exponents of the sectors affected by the bill. The category of gods is also on a war footing pharmacists. But according to what Il Sole 24 Ore wrote yesterday, the part of the draft bill on drugs and pharmacies will in all probability not be included in the final version. We will see. However, here are details of the draft, analysis and reactions not only from insiders.
OPEN CONVERSATION BETWEEN FEDERFARMA AND THE GOVERNMENT
The National Federation of Italian Pharmacy Owners, Fedefarma, would have initiated a confrontation with the government. In a note published a fortnight ago on the site, it is explained that «The Minister of DevelopmentFederica Guidi, in the meeting with a delegation of Fedefarma established by the president, Annarosa Raccaby the national secretary Alfonso Misasiand by the president of the Sunifar, Alfredo Orlandi on the competition bill, it will take due account of the voice and considerations of the local pharmacies". We read further: «During the meeting, the representatives of the union reviewed the numbers of the sector and the effects of the liberalizations already launched by Bersani before and Mountains After. Then they focused on the proposals contained in the Antitrust Report of last July, expressing the support of Fedefarma to those on generics and the remuneration of pharmacies". The first statements on the topic by the president are then reported Racca: «The meeting lasted just under an hour and took place in a cordial atmosphere. We are satisfied with the Minister's commitment to agreeing with the parties on the measures that will find a place in the bill».
The same, a few days before the institutional meeting, had defined «absurd and clearly instrumental to insist on the request for deregulation of the pharmaceutical sector after both the European Court of Justice that the Italian Constitutional Court they reaffirmed the full legitimacy and effectiveness of the rules that regulate the activity of pharmacies, with a view to guaranteeing citizens and collective health".
THE MAIN NEWS OF THE DRAFT
The draft bill includes measures to increase the freedom of access for private individuals the exercise of health activities not affiliated with the National Health System, which he represents in fact – as he explained The newspaper – a limitation of regional health plans. While, as regards the rationalization of accreditation procedures, each Region must verify every two years the achievement of the objectives set by the Regional health plan concerning the number and location of the accredited structures. On measures for increase competition in pharmaceutical distribution the bill includes two options: one, indicated by the antitrust, in which the maximum number of pharmacies is transformed into the minimum number: one passes from "one pharmacy" to "at least one". The second concerns the further lowering of the population threshold required for the opening of pharmacies, which drops from 3,300 to 1,500 inhabitants.
THE PAINFUL CHAPTER OF RANGE "C" DRUGS
One of the most delicate and controversial chapters of the bill concerns the parapharmacies. With regard to urgent interventions in the field of drug distribution, the bill adds that commercial businesses can sell drugs to the public belonging to the so-called band "c" and that therefore they are not "essential drugs and for chronic diseases" or "of significant therapeutic interest". The bill also provides for an alternative option, according to which commercial establishments can sell drugs in category "c", limited to the equivalent preparations indicated in the lists drawn up by theItalian drug agency.
NATIONAL MOVEMENT FOR FREE PHARMACISTS: "THE RIGHT WAY TO CREATE JOBS"
According to a note released by National free pharmacists movement (mnlf), the bill could be the right tool to open the market to competition through liberalization. "But the change of course is not easy when corporations are involved," reads the note. The reference is to the intervention of the Undersecretary of the Ministry of Economic Development Simona Vicari (in the photo), which in recent days has said it is against any provision that expands the number of pharmacies or allows the liberalization of class C drugs. According to the Vicars, in fact, the Monti government in 2012 it has already made reforms in the pharmaceutical sector and therefore no more are needed.
"It is a pity that to date, or after about three years from that provision, not even one of the feared 5,000 new pharmacies has opened its doors and if the bankruptcy procedure is ever completed, it will be a real "miracle" if they can open a number of pharmacies that will correspond to an increase in establishments of just 5%", reads the note from mnlf, which underlines how the sector has suffered less from the crisis than the others. "The priority for the country is the creation of new jobs and when there are not enough funds to make investments, it is necessary to stimulate growth by removing the obstacles placed in defense of few and limited interests", he concludes.
THE CONTROVERSY RAISED BY THE NATIONAL FEDERATION OF ITALIAN PARAPHARMACIES
Use harsh tones the president of National Federation of Italian parapharmacies, David Gullotta, who answers the interview given to Pharmacist33 from Simona Vicari, in which the parapharmacies are called into question because they would not have taken up the possibilities offered by the liberalizations of the Monti Government: «That the Honorable Vicars advances the contents of the liberalization package by making a formidable assistance to the lobbies it was somewhat predictable since they are the reference electorate of the New centre-right. Instead, what escapes is – he continuesGullotta – know the real position of this government in this regard: of the prime minister Matthew Renziin primis, and of the holder of the dicastery, the minister Federico Guidi who, until proven otherwise, has coordination of the entire competition law in his hands.
Gullotta he explains that those presented would be "pseudo-liberalisations thanks to which parapharmacies would have had concrete possibilities to compete and develop: galenic preparations and the sale of veterinary drugs in the national context do not reach the 7% of the entire Italian pharmaceutical market". And he asks provocatively Vicars: «In your opinion, would this have been the great opportunity to be exploited, kind gentleman?».
THE FEDERATION OF PHARMACIST ORDERS ON THE OPENING OF NEW PHARMACIES
Andrea Mandelli, president of the Federation of Orders of Pharmacists (Fofi), in a note released by the organization after the "recent comments on the extraordinary competition for the assignment of new pharmaceutical offices" he explained that in a contracting market "it is not the increase in operators due to the opening of new pharmaceutical offices, which will give an answer in terms of employment, but rather bring the figure of the professional who works in the community pharmacy and his professional services to the fore, to be recognized and remunerated". Fofi he specifies how the bankruptcy procedures have been completed in all the regions and how "the provincial Orders have given their maximum collaboration so that the procedures could be completed as quickly as possible, making their databases and documentation available".
THE REJECTION OF SOME ECONOMISTS
On the site of Fedefarmameanwhile, the opinions of economists opposed to liberalization are being published. Among which Fabrizio Gianfrate, teacher of Health economics atUniversity of Ferrara, which sees "in the hypothetical liberalization of organic plan and band C more problems than advantages". "As economic doctrine teaches," he explains Gianfrate «the increase in points of sale and competition should have beneficial effects on the quality level of the service and on prices». But for the economist not in the case of the drug. This is because the demand for medicines is inelastic, so if the number of points of sale were increased, the market would do nothing but redistribute itself over a greater number of operators, resulting in lower average unit revenues, "already reduced by the trend of the market itself, deflationary in revenues but inflationary in costs".
Gianfrate also expresses doubts on the beneficial effects that excessive competition would have on prices and gives the example of the OTC experience: Bersani they reduced the price lists of the 12%-15% on average, but then the trend stopped. This is because there is a limit below which one cannot go down «dictated by the level of ex-factory prices of the producers and by the absence of economically strong intermediate subjects such as large-scale consumer buying groups, capable of negotiating large volumes and therefore greatly reduced prices».
For Gianfrate many pharmacies, already suffering for several years, with these liberalizations would in fact be forced "to revise their income statement downwards again". While the weakest pharmacies "would be forced to close, with the risk of also penalizing the supply of NHS medicines, in contrast to the principle on which the Organic Plant is based, created to guarantee the economic profile of the pharmacy so that it can ensure its "health" function in the appropriate way".
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