Pharmacy Practice

Community pharmacy in Europe 55pharmacists and sometimes hospital administrators.Pharmacies are usually either independent or part of a chain. In Sweden the pharmacysystem is different from the rest of Europe. In fact all Swedish pharmacies are owned bya ‘company’, Apoteket (called Apoteksbolaget up until 1999). All community andhospital pharmacists are employees of this company. Although there have been attemptsto break this ‘company’s’ monopoly on drug-distribution, the issue is not scheduled to beaddressed until 2001.Other providers of medicinesIn a number of European countries such as Austria, France, Iceland, the Netherlands andthe UK, physicians may supply medicines to patients, usually in sparsely populated areas.The reason for this is that pharmacies in those areas are not commercially viable, andphysicians are the most ready source of expertise about medicines. Often they aresupported by pharmacists who compound preparations and occasionally supply drugs tothe physician’s pharmacy. However, in Switzerland dispensing doctors can also be foundin cities and compete with pharmacists for their share of the drug-market.Veterinary medicines are also sometimes dispensed through pharmacies, for instance inFinland, Iceland and Luxembourg. In other countries veterinarians dispense these drugs.Although some attempts have been made to establish mail-order pharmacy in differentEuropean countries, this form of dispensing has not (yet) become popular, probablybecause Europe is relatively densely populated compared with the USA. Internetpharmacies have also not yet really penetrated the European market, although there aresignals that some Europeans are starting to buy their medicines from internet companies.This applies especially to lifestyle drugs and alternative remedies.Availability of over the counter medicinesAlthough Prescription Only Medicines (POM) are routinely supplied from pharmacies,the outlets for over the counter (OTC) medicines are varied. For a long time OTCmedicines were only available from pharmacies, with the exception of the Netherlandsand Germany where druggists (a person with a license obtained after a two-year part timenon university education) were allowed to sell a limited assortment. The increasingpressure from the pharmaceutical industry in the 1990s has changed this situation. ManyOTC medicines are now available in many countries through outlets, such assupermarkets and petrol/gas stations. Some Scandinavian and southern Europeancountries still do not have this option with all medicines being sold through pharmacies,although change is imminent. In order to reduce drug costs, there has been a move tomake some previously prescription only medicines available for sale. Consequently, thesale of OTC medicines from pharmacies and other outlets in some countries hasincreased (see also Chapters 9 and 10).Professional protectionIn the past, throughout Europe, only pharmacists could own a pharmacy (one pharmacy,