Aspirins sharing shelves with umbrellas – Does the expanded list of products sold in pharmacies undermine pharmacists' role or provide an opportunity for stable operations?

For about half a year now, in addition to standard medicines and medical products, hygiene and skin care products, pharmacies in Serbia have been offering umbrellas, detergents, socks, underwear, toilet paper... These articles became available in pharmacies thanks to the Regulation on the list of products that can be sold in pharmacies, which came into effect on May 30, 2017.

Even before it was adopted, however, controversy arose about whether such a change was needed at all.

The Pharmaceutical Chamber advocates the revocation of this Regulation, because, as they say, with the expansion of the range of products offered in pharmacies, pharmacists will no longer have time for patients, but be forced to operate as traders in order to sell more, in line with the principle of market policy and commercialization of pharmacies' operations. The Ministry of Health, on the other hand, believes that the Regulation enables pharmacies to be well-stocked and secures consumer satisfaction. They also believe that this will lead to stable operations of pharmacies.

Svetlana Stojkov, president of the Pharmaceutical Chamber, recently explained for our portal that, although the list of products is not mandatory, it still provides owners of the capital to have a strong influence on pharmaceutical healthcare through sales plans and profit goals which can jeopardize the ethical concept of the operations and the principles of the pharmaceutical profession.

– The Regulation expands the range of the types of products to include products completely inappropriate for health institutions, like pharmacies, such as umbrellas, paper goods, house cleaning products and similar items. Indirectly, this Regulation reduces the time dedicated to patients, and with that, the focus on their health. Instead of enabling pharmacists to expand the services dedicated to patients, the range of products is expanded in order to fulfill the profit goals of companies – our interviewee is clear.

The Ministry of Health is of another opinion. They claim that the adoption of the Regulation does not jeopardize the functioning of pharmacies, as its publication in no way jeopardizes pharmaceutical activities as the core activities of pharmacies, namely, retail sale of medicines and medical products. As they said for our portal, as an organization, a pharmacy continues to perform pharmaceutical activities as primary activities, in line with the Law on Health Protection and the Law on Medicines and Medical Products. They add that nothing has changed regarding the conditions for establishing a pharmacy and performing pharmaceutical activities either and that the question of workers, equipment and premises is still regulated by the Law on Health Protection.

– In essence, the Regulation merely provides additional possibilities for an expansion of the range of products, allowing pharmacies to be better stocked and securing greater consumer satisfaction, which will ultimately lead to stable operations in pharmacies – the ministry says.

The National Consumer Organization of Serbia (NOPS) also believes that a greater offer and the strengthening of retail competition are always good for consumers, because healthy competition in the market has an indirect influence on the reduction in prices as well.

– From that angle, we believe that the implementation of the Regulation will have a positive effect on end users – NOPS says for our portal.

The Pharmaceutical Chamber, however, believes that, due to there being too many pharmacies, their competitiveness is no longer based on the quality of pharmaceutical services, but exclusively on market principles, with the clear distinction between “medicines and medical products” and “consumer goods” entirely lost.

– Pharmacists are marginalized by the loss of this distinction and the reduction of the sale of medicines as regular goods. The primary task of a pharmacist is of a professional and logistics nature, as they need to secure adequate and safe therapy necessary for patient treatment, honoring the principle of “the five right ones”: the right medicine in the right dosage to the right patient in the right way at the right time. Furthermore, a pharmacists needs to correct each potential error in the prescription, provide advice and educate patients about the safe consumption of medicines and side-effects.

The basic problem of this Regulation, the chamber believes, is that it is the minister that adopts it, not the professional chamber.

– When the minister forms a work group for the adoption of a draft legal act, the practice is for them to honor the professionals they themselves have appointed by respecting their positions. Precisely the opposite happened in this case. A regulation was adopted in opposition to the positions of professionals and in agreement with the Chamber of Commerce, not the Pharmaceutical Chamber, and with consumer organizations instead of patients. The latter is telling in itself – Stojkov said.

The Ministry of Health confirms that there have been various positions regarding the list of items that can be sold in pharmacies, from having the list narrowed down, to having it expanded as much as possible. They add that, taking all the positions into consideration, they proposed a compromise in line with the practice in the EU countries and the neighboring states.

Those directly affected by this Regulation, pharmacists, do not have a fully clear position on this issue, nor do they want to talk about it publicly. As they say informally, the Regulation provides them with certain possibilities, but service quality is still the topmost concern for them. They say that the important thing is for customers, that is, patients to be satisfied with the service provided, so that they would return, as that is the way for them to persevere in the increasingly competitive market.

– A wider range of products will not have that great an impact on the role of pharmacists, as each one has self-respect and is aware that they are health workers primarily, and only then are they traders as well – pharmacists say.

They do not specify whether they've expanded their offer to include the newly approved items or to what extent, and they can't say how big the demand is, but they point out that inputs must exist, seeing that the regulation has been prepared.

– It is good for us to be able to offer in our pharmacies what those who come there want to buy. Nevertheless, regardless of state regulations, service quality and patient health are paramount.

NOPS didn't wish to comment on whether the Regulation undermines the role of pharmacists at the expense of patients and to what extent, because, as they says, the protection of rights and interests of patients is regulated by special acts they are not directly responsible for. They do say, however, that, to their knowledge, no complaints have been recorded.

Ivana Bezarevic

Farmaceutska komora Srbije

Ministarstvo zdravlja Republike Srbije

Nacionalna organizacija potrošača Srbije NOPS

National Consumer Organization of Serbia

NOPS

Regulation on the list of products that can be sold in pharmacies

Svetlana Stojkov

Law on Health Protection

Law on Medicines and Medical Products

list of products that can be sold in pharmacies

pharmaceutical protection

pharmacists

medicine retail

pharmaceutical activities

sale of medical drugs in pharmacies

non medicines