Pharmaceutical Distribution in Europe: The Emergence of Direct-to-Pharmacy Supply

Executive Summary

• The pharmaceutical supply chain
• Pharmaceutical manufacturers in the EU
• Pharmacies in the EU
• Wholesalers in the EU
• The hospital sector
• Prewholesaling
• History of the pharmaceutical supply chain
  • Dynamics in the supply change
  • Relationships within the supply chain
  • Vertical integration
  • New changes in the supply change
• Outlook for the supply chain
• Global lessons for the supply chain
• Case study: Consolidation among Japanese pharmaceutical wholesalers
• European status of the supply chain
  • Stability of the European supply chain
  • Product shortages in the supply chain
• Case study: Vaccine shortages and the effect on the supply chain
• Case study: Supply chain disruption in Latin America
• Traceability throughout the supply chain
• Counterfeit products
• Internet trading and pharmaceuticals
• Parallel trade
  • The view of pharmaceutical manufacturers
  • The view of parallel importers
  • Legalities of parallel trade
  • Exhaustion of intellectual property rights
  • Repackaging and relabelling of products
  • Consumer views of intellectual property rights
• The European Union
  • History of the EU
  • The set-up of the EU
  • EU law
  • Primary legislation
  • Secondary legislation
  • Case-law
  • Decision-making in the EU
• The institutions of the EU
• The European Economic Area (EEA)
  • The creation of the EEA
  • EU Enlargement and the EEA
  • The Euro
  • The Euro and pharmaceuticals

• The role of the pharmaceutical wholesaler
• Channels of distribution
  • Wholsalers and the Single European market
  • Wholesaler opposition to supply quotas
  • Case study: Bayer' s Export Policy for Adalat
  • Case study: Syfait versus GlaxoSmithKline
  • Wholesaler views of Direct-to-Phamacy distribution
  • Crossborder mergers and acquisitions
• Case study: Double acquisition by Phoenix ensures successful market entry into Croatia
  • EU harmonisation and the outlook for pan-European wholesaleing
  • The major players in pan-European wholesaleing
  • Celesio AG
  • The PHOENIX Group
  • OPG Group
  • Alliance Boots
• European regulations for wholesalers
• Guidelines on Good Distribution Practice of Medicinal Products for Human Use (94/C 63/03)
• Lack of harmonisation and the supply chain
• Wholesaler technology solutions
  • Electronic data interchange
  • Collaborative planning forecasting and replenishment
  • Enterprise resource planning
  • Wholesalers develop value added services
  • Case study: GEHE Pharma Handel chosen as "Best-Practice-Enterprise" for value added services
  • Case study: PHOENIX wins pharmacy partner award
  • Order fulfilment packages
  • Database technology
  • Electronic point-of-sale technology
  • Bar coding
  • Case study: US highlights benefits of bar code and RFID technologies
  • Case study: Pfizer France reviews the RFID system for Viagra
  • Case study: AstraZeneca opts for mass serialisation to prevent counterfeiting
• European wholesaler opinions on technological solutions
• Warehouse technology
• Dispensing technology
• Techology in the future of pharma distribution
• Consumers and e-commerce
  • Case study: DocMorris
• Pharmaceutical distribution in UK
• Pharmaceutical distribution in France
  • Case study: Industry support of the Masters Degree in Pharmaceutical Distribution at University of Limoges
  • Pharmaceutical distribution in Germany
  • Pharmaceutical distribution in Italy
• Case study: IBS introduces supply chain management solutions into the Italian pharmaceutical market
• Pharmaceutical distribution in Spain
• Pharmaceutical distribution in Switzerland
  • Case study: Galenica expands its service offerings

• Pharmaceutical manufacturers in Europe
• The pharmaceutical industry and the supply chain
• The role of pharmaceuticals
  • Drug development and innovation
• Cost containment
• The pharmaceutical market
• Lack of harmonisation in the EU pharmaceutical market
• Counterfeiting
  • Pharmaceutical industry efforts to combat counterfeiting
• Manufacturers exert control over the supply chain
• The Office of Fair Trading investigation
• Implications of changes in the supply chain
  • Service standards to patients
  • Rationale behind changes in the supply chain
• Pfizer' s feedback on Direct-to-Pharmacy distribution
• Case study: Pfizer UK' s Direct-to-Pharmacy website
• Reaction to the Office of Fair Trading enquiry
• AstraZeneca changes its supply chain arrangements
• Sanofi-Aventis changes its supply chain arrangements
• Napp Pharmaceuticals changes its supply chain arrangements
• Novartis considers changes to supply chain arrangements
• Eli Lilly considers changes to supply chain arrangements
• Astellas adopts direct distribution for Transplant Medicines
• Patients and healthcare
  • Case study: The International Alliance of Patients' Organizations
  • Pharmaceutical manufacturers and the developing countries
  • Collaborations with healthcare providers
• Case study: Novartis makes agreement with the World Health Organization for distribution of malaria treatment
• Case study: Diversion of anti-retroviral drugs destined for Africa
  • Anti-diversion tactics

• Pharmacies in Europe
  • Additional pharmacy services
  • Differences in pharmacy regulations
• Hospital pharmacy in Europe
• Wholesaler Margins and VAT
  • Rebates and discounts
• Distribution of OTCs
• Generics
• Independent pharmacies
• Pharmacy chains
  • Wholesaler involvement in pharmacy chains
  • Pharmacy purchasing groups
  • Supermarkets
  • Drugstore chains
  • Mail-order pharmacy
• Removing restrictions in the European pharmacy sector
  • Case study: European Commission challenges Italian legislation concerning pharmacies
  • Case study: European Commission challenges Spanish legislation concerning pharmacies
  • Case study: European Commission challenges Austrian legislation concerning pharmacies
  • Sale of non-prescription products outside pharmacies
• Implications of liberalisation in the European pharmacy sector
  • Liberalisation of the pharmacy sector and accessibility
  • Liberalisation of the pharmacy sector and market dominance
  • Liberalisation of the pharmacy sector and quality of service
• Pharmacies and changes in the supply chain

REFERENCES

• Figure 1.1 Outline of the Supply Chain
• Figure 1.2 Number of pharmacists (per 1000 population)
• Figure 1.3 Total revenue of European pharmaceutical wholesalers (without VAT)
• Figure 1.4 Worldwide Vaccine Market
• Figure 1.5 Share of parallel imports in European pharmacy markets
• Figure 2.1 Number of Full-line Wholesalers
• Figure 2.2 Average gross margin of wholesalers in 9 West Europe Countries
• Figure 2.3 Celesio AG Wholesale Revenue by Market (2006)
• Figure 2.4 Celesio AG Pharmacy Revenue by Market (2006)
• Figure 2.5 Phoenix Group Turnover (2002 - 2007)
• Figure 2.6 Breakdown of OPG Sales (2006)
• Figure 2.7 Alliance Boots Wholesale Division Revenue (Q1,2,3 2006)
• Figure 2.8 Percentage of electronic orders from pharmacies to wholesalers
• Figure 3.1 Pharmaceutical R&D Expenditure in Europe 1195 - 2006
• Figure 3.2 Pharmaceutical R&D Expenditure across Europe
• Figure 3.3 NHS expenditure per person in the UK
• Figure 3.4 Community prescribing in the UK: Prescriptions Per head
• Figure 3.5 Patient satisfaction with quality and effectiveness of healthcare received
• Figure 3.6 Patient satisfaction with ability to access information on new medicines or treatments
• Figure 4.1 Number of Public Pharmacies (12 European Countries)
• Figure 4.2 Pharmacy sales per inhabitant Europe (€ )
• Figure 4.3 Number of Hospital Pharmacies in 8 Countries
• Figure 4.4 VAT rates applied to prescription medicines across Europe
• Figure 4.5 Share of generics in European pharmaceutical markets
• Figure 4.6 Percent change in number of pharmacies N, E, N, A, F, S(1995 - 2005)
• Figure 4.7 UK Pharmacy respondent views on potential costs of setting up a separate Pfizer account for DTP

• Table 1.1: Types of manufacturer medicines
• Table 1.2: The institutions of the EU
• Table 1.3: Adoption of the euro
• Table 2.1: OPG' s activities in Europe
• Table 2.2: Summary of GDP Guidelines
• Table 2.3: The BAPW' s Gold Standard of Good Distribution Practice by Pharmaceutical Wholesalers as endorsed by the MHRA
• Table 2.4: Process of adoption of IBS supply chain management solution by Itriafarma
• Table 3.1 Key areas of focus for the International Medicinal Products Anti-Counterfeiting Taskforce (IMPACT)
• Table 3.2: Overall risks due to DTP identified by OFT
• Table 3.3: Implications of reduced service standards due to DTP (adapted from OFT, 2007)
• Table 3.4: Anti-diversion tactics employed by pharmaceutical manufacturers and cited by WHO
• Table 4.1: Goals of the EAHP
• Table 4.2: Summary of liberalised pharmacy sector in "case study" countries chosen by ÖBIG
• Table 4.3: Summary of regulated pharmacy sector in "reference study" countries chosen by ÖBIG