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ABOUT THE ABDA

» The ABDA – Federal Union of German Associations of Pharmacists is the foremost organisation for phar-

macists in Germany. The ABDA represents the interests of the pharmaceutical healthcare professions in

politics and society while promoting high-quality, comprehensive pharmaceutical care in Germany.

» The ABDA has 34 members: 17 regional chambers of pharmacists and 17 regional associations of

pharmacists – one from each of Germany’s 16 federal states plus an additional representative from

North Rhine-Westphalia which has been divided into North Rhine and Westphalia-Lippe due to its size.

» The 17 chambers of the Federal Chamber of Pharmacists (BAK) and the 17 associations in the German

Pharmacists’ Association (DAV) are combined under one roof in ABDA. Membership in the Chamber of

Pharmacists is mandatory for all pharmacists while membership in associations for pharmacy owners,

on the other hand, is voluntary.

» ABDA’s Executive Board is composed of 13 members: the president, the vice president, an employed

pharmacist from a community pharmacy along with five members each from the BAK and DAV

executive boards.

» The annual general assembly for pharmacists takes place once per year as part of German Pharmacist Day.

The annual general assembly is used to form political positions. Its resolutions are binding for the ABDA

committees’ actions.

» The offices of ABDA, BAK and DAV are in Berlin and are run by the general manager. In addition to the

four business areas, a) pharmacy, b) pharmaceuticals, c) economics and d) law, there are staff positions

for a) finances, personnel and administration, b) communications and c) European affairs.

» European representation for ABDA is headquartered in Brussels (Belgium) and is responsible for represent-

ing its interests in European Union (EU) institutions.

» The ABDA is a member of the German Federation of Independent Professionals (BFB), the Pharmaceutical

Group of the European Union (PGEU), and the International Pharmaceutical Federation (FIP).

» The ABDA receives professional support from many institutions, including the Drug Commission of German

Pharmacists (AMK), the German Institute for Drug Use Evaluation (DAPI) as well as the Central Laboratory of

German Pharmacists (ZL).

GERMAN PHARMACIES – FIGURES, DATA, FACTS 20182

PHARMACIES IN GERMANY

» The red pharmacy A (with chalice and snake) is the identifying symbol for community pharmacies in Germany.

This registered trademark of the German Pharmacists Association (DAV) enjoys special legal protection

throughout Germany and Europe.

» In order to work as a pharmacist in Germany, one must study for 5 years at university: 2 years each of basic

and main studies and 1 year of practical training. Each course of study ends with a state examination. Upon

successful completion, one must apply for a license to practice pharmacy, which is authorisation to exercise

the profession.

» Pharmacists with a foreign pharmaceutical diploma or certificate need to have it recognised prior to starting

to work. There is a responsible authority for the recognition in every federal state. The responsible authority

will check the equivalency level of the qualification. If there are significant divergences in the qualification,

the responsible authority might propose measures to compensate the gaps. Moreover, applicants need to

give proof of their language skills in German. Additionally, citizens from outside the European Union (EU) or

the European Economic Area (EEA) will need a work and residence permit and eventually a visa for entry,

residence and employment in Germany.

» Pharmacists in Germany are not only part of the healthcare professions (like doctors) and freelance pro-

fessions (such as architects), but also pharmacy owners which means they are also merchants who are

therefore required to pay business taxes.

» Freedom of establishment has been created for pharmacists in Germany. According to this principle, a

pharmacist may establish a pharmacy anywhere and anytime, provided that he complies with the law.

This also means that no pharmacist is protected from unwanted competition in the vicinity.

» In Germany, the owner / operator of a pharmacy must always be a pharmacist. This third-party ownership

ban emphasises a pharmacist’s personal responsibility and liability – and decouples the provisioning of

pharmaceuticals from corporate profit goals.

» The ownership of multiple pharmacies is forbidden in Germany. However, a pharmacist may, in addition to

the main pharmacy, operate up to three subsidiary pharmacies in the nearby local vicinity. Each of these

locations must also have a pharmacist in place as subsidiary manager. There are no pharmacy chains in

Germany.

» Selling pharmaceuticals via mail order is allowed in Germany. Approved mail-order pharmacies are “normal”

community pharmacies with a special mail-order permit. According to a list from the Federal Ministry of

Health, the mail-order trade is also allowed from a few other European countries.

» Prices for prescription-only pharmaceuticals are uniform nationwide; this is stipulated by the Drug Price

Ordinance to protect patients and pharmacists. However the European Court of Justice undermined this

law in 2016 when it ruled that foreign mailorder pharmacies may grant discounts on nationwide fixed

prices. In contrast, all pharmacies are free to set their own price for non-prescription medications.

» The pharmacist’s fee for consultation on a prescription medication is regulated by the Drug Price Ordinance.

Broadly speaking, this is a fixed fee of 8.35 euros per package. Each pharmacist may calculate their own

fee for non-prescription pharmaceuticals.

» Pharmacists in Germany assume an obligation for the common good of society. This is not individually

remunerated but, rather, it is individually subsidised. This includes creating formulations, dispensing

narcotic substances and performing comprehensive evening and emergency services.

GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 3

LOWER SAXONY

BREMEN

WESTPHALIA-LIPPE

NORTH RHINE

Düsseldorf

HanoverMünster

Bremen

Hamburg

Kiel

Schwerin

Berlin

Potsdam

Dresden

Erfurt

Munich

Stuttgart

Saarbrücken

Wiesbaden

Mainz

Magdeburg

RHINELAND-PALATINATE

SAARLAND

BADEN-WUERTTEMBERG

BAVARIA

THURINGIAHESSE

SAXONY

BRANDENBURG

MECKLENBURG-WESTERN POMERANIA

SCHLESWIG- HOLSTEIN

NORTH SEA

THE NETHERLANDS

BELGIUM

LUXEM-BOURG

FRANCE

SWITZERLAND

AUSTRIA

CZECH REPUBLIC

POLAND

DENMARKBALTIC SEA

HAMBURG

SAXONY-ANHALT

BERLIN

MAP OF GERMANY


“APOTHEKE 2030” PERSPECTIVE PAPER

» The policy paper “Pharmacy 2030 – Perspectives on provision of pharmacy services in

Germany” (“Apotheke 2030”), was adopted by a vast majority on German Pharmacist Day

2014 in Munich. This was preceded by an opinion-forming process in which several

thousand pharmacists participated over the course of an entire year.

» The preamble reads as follows: “Pharmacists in Germany are experts in pharmaceuticals.

Based on this core competency, they make an indispensable contribution to patients’

well-being in outpatient care. As freelance health professionals, they carry out their legal

mandate of comprehensive pharmaceutical provisioning to the German public via public,

owner-operated pharmacies.”

» The healthcare system in Germany faces great challenges such as demography, a lack of

professionals and financial pressure on resources. Therefore, for the benefit of our patients,

the healthcare role of the pharmacy must be actively defined so that healthcare may

maintain a key role in the future as well.

» “Apotheke 2030” describes how the pharmacy’s role and range of services should be

advanced as a pillar of the healthcare system. Essentially, it concerns ways in which phar-

macies may strengthen their role in healthcare while collaborating as part of a network with

doctors and other specialised professionals thus making true medication management for

patients possible.

» Three issues are at the forefront when strategically implementing the document: First,

pharmacists must define the correct way in which to systematically implement medication

management. Secondly, provisioning frameworks must be adapted for the future. Thirdly,

pharmacists must determine what the future holds regarding pharmacist qualification

(education, advanced and continuing education).

» Pharmacies in Germany wish to continue offering medication management as a crucial

instrument for safe, effective and economical pharmaceutical therapy in the future. In so

doing, all of a patient’s medication, including self-medication, will be continually analysed.

The goal is to avoid, detect, and solve problems related to pharmaceuticals and, in so

doing, increase the effectiveness and efficiency of pharmaceutical therapy.

» Pharmacists wish to collaborate collegially both among each other and with other health-

care professions as part of a healthcare network. Pharmacies will actively co-design the

healthcare network with clearly defined competencies and interfaces. As an integral com-

ponent of the network, they will assume responsibility for pharmaceuticals, the safety of

pharmaceutical therapy and the optimization of practices.


CONTENTS

PHARMACIES’ PROVISION, SUPPLY AND SERVICES

Overview of Patient Care and Services ....................................................................................................................9

Night-time and Emergency Service .......................................................................................................................10

Formulations .........................................................................................................................................................12

Standard Formulations ..........................................................................................................................................13

PHARMACY LANDSCAPE

Number of Pharmacies ..........................................................................................................................................14

Pharmacy Numbers by German Federal State ......................................................................................................15

Geographical Coverage .........................................................................................................................................16

Pharmacy Density in Europe .................................................................................................................................17

Subsidiary Structure ..............................................................................................................................................18

Specific Types of Pharmacies ................................................................................................................................19

Mail Order Trade ................................................................................................................................................... 20

EMPLOYMENT IN PHARMACY

Number and Age of Pharmacists ...........................................................................................................................21

Jobs in Pharmacies .............................................................................................................................................. 22

Trainee Positions in Pharmacies ............................................................................................................................23

Pharmacy Students and Approbations ..................................................................................................................24

Professional Language Proficiency Exams for Foreign Pharmacists ..................................................................... 26

Continuing Professional Education and Postgraduate Specialisation .....................................................................27

PHARMACEUTICALS IN GERMANY

Pharmaceuticals Approved in Germany ................................................................................................................ 28

Pharmaceutical Price Index .................................................................................................................................. 29

Value-Added Tax on Pharmaceuticals .................................................................................................................. 30

Pharmaceuticals Pricing ........................................................................................................................................31

Pricing for Standard Formulations .........................................................................................................................32

PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)

Breakdown of Total SHI Expenditures .................................................................................................................. 33

Miscellaneous Health Insurance Fund Expenditures ............................................................................................. 34

SHI Expenditures for Pharmaceuticals ................................................................................................................. 35

Pharmaceuticals by Price Classes ........................................................................................................................ 36

Pharmacy and Manufacturer Markdowns ..............................................................................................................37

Rebate Pharmaceuticals....................................................................................................................................... 38

Patient Co-Payments ............................................................................................................................................39

Co-Payment Exemptions .......................................................................................................................................40

QUALITY ASSURANCE

Guidelines and Working Aids .................................................................................................................................41

AMK: Reporting of Pharmaceutical Risks ..............................................................................................................42

Quality Assurance of Formulations ....................................................................................................................... 44

Challenges Involving Polymedication .................................................................................................................... 45

Risks Involving Pharmaceutical Misuse ..................................................................................................................46

SPECIFIC COVERAGE AREAS

Pharmaceuticals for Serious Illnesses ................................................................................................................... 48

Medical Cannabis ..................................................................................................................................................49

Antibiotics ............................................................................................................................................................ 50

Antidiabetics ..........................................................................................................................................................51

Blood Sugar Testing Strips ....................................................................................................................................52

Consultation-Intensive Pharmaceuticals ............................................................................................................... 53

Pharmaceuticals with Specific Requirements ....................................................................................................... 54

OTC Pharmaceuticals: Leading Indication Areas .................................................................................................. 55

Non-Prescription Pharmaceuticals: Special Treatment Services and Therapies .................................................... 56

Green Prescriptions ...............................................................................................................................................57

Dispensing of Emergency Contraceptives ............................................................................................................ 58

Provision of Medical Aids.......................................................................................................................................59

Vaccines ............................................................................................................................................................... 60

OPERATING RESULTS

Prerequisites for the Operation of a Pharmacy .......................................................................................................62

Operating Results for the Average Pharmacy ........................................................................................................63

Development of Pharmacy Remuneration .............................................................................................................64

Pharmacies by Sales Volume Categories ..............................................................................................................65

Sales Structure and Dispensed Packages ........................................................................................................... 66

Supplementary Products Commonly Found in Pharmacies .................................................................................. 69

Pharmacy Climate Index 2017 ...............................................................................................................................70

LEGAL NOTICE

The following may contain variations in totals due to the rounding of figures.

OVERVIEW OF PATIENT CARE AND SERVICES

Pharmacies have the legal mandate to ensure the provision of pharmaceuticals to the population. This applies

to each individual pharmacy as well as to a comprehensive distribution of pharmacies throughout Germany.

As well as providing pre-packaged medications, pharmacies fulfil obligations to the common good, such as,

night-time and emergency services or the preparation of formulations.

Source: ABDA-Statistik, Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH, infas Institut für angewandte Sozialwissenschaft GmbH

19,748 community pharmacies provide medication to the population in

Germany. (as of 31st December 2017)

1 billion patient interactions in community pharmacies every year.

3.6 million patients are served in community pharmacies each day.

250,000 delivery services are performed daily.

6 million industrially manufactured pharmaceuticals inspected

by pharmacists annually.

88 % of patients who regularly take three or more medications usually

patronize the same pharmacy.

83 % of German citizens have faith and trust in pharmacists.



VERSORGUNGSLEISTUNGEN DER APOTHEKEN

Night-time and Emergency Services in 2017 470,000

of these full shift (8 P.M.– 6 A.M.) 410,000

partial shift 60,000

Open Pharmacies per Night-time and Emergency Shift 1,300

Patients Served per Night-time and Emergency Shift 20,000

The number of emergency shifts performed by each pharmacy varies. An example taken from the state

of Bavaria: a pharmacy in the city of Munich has 14 shifts annually. During the same period, one in the

comparatively rural community of Rothenburg performs these services 74 times.

NIGHT-TIME AND EMERGENCY SERVICE

Night-time and emergency services are one of the most important services performed for the common good of

society. The chamber of pharmacists responsible for each region regularly defines and assigns these service

duties to each pharmacy according to need. Pharmacies receive additional remuneration for the performance

of these services. This is paid for out of the Emergency Service Fund of the German Pharmacists’ Association.

Apothekenfinder 22 8 33 is a service for assisting patients in quickly and easily finding the nearest available

(emergency-) pharmacy.

Sources: Nacht- und Notdienstfonds, aponet.de, Deutsches Arzneiprüfungsinstitut e. V. (DAPI)

Prescriptions without Emergency Service Fees for SHI Insured 2017

Many patients visit pharmacies during night-time and emergency service hours because of urgent self-medi-

cation needs (e. g. “morning after pill”) or to fill prescriptions. These include, for instance, private prescriptions

or pink prescriptions charged to the SHI. If a doctor performing emergency services has marked the “noctu”

(lat. night) field on the pink prescription, the patient is not required to pay the emergency service fee of 2.50

euros and the fee is, in these cases, covered by their insurance fund. In 2017, this service provision was utilized

by patients when filling prescriptions for nearly two million packages.

prescription-only pharmaceuticals

1,370,000

non-prescription pharmaceuticals

540,000

Total

1,910,000 Packages



Sources: aponet.de, Nacht- und Notdienstfonds

Emergency service fee per full shift performed in euros

Apothekenfinder 22 8 33service for assisting patients in finding the nearest available (emergency-) pharmacy

0

100

200

300

4th Quarter3rd Quarter2nd Quarter1st Quarter

275.

13

286.

51

278.

15

273.

96

267.

33

268.

07

279.

47

280.

12

2016

Average: 275 euros

2017

Average: 277 euros

www.aponet.de (12.2 million)

Smartphone App Use

(580,000)

Telephone, Text Message and Mobile (350,000)

Visits in 2017

13.1 million



FORMULATIONS

In many cases, there are no ready-made pharmaceuticals for a patient’s specific pharmaceutical needs.

Pharmacies fill this gap by providing extemporaneous preparations as per a doctor’s prescription. In 2016,

a total of 13.3 million formulations were prepared for those insured under statutory health insurance (SHI).

Sources: Wissenschaftliches Institut der AOK (WIdO)

0

3

6

9

12

15

2016 20152014

1.1

2.4

7.8

2.6

13.913.5

1.2

2.4

7.3

2.4

1.1

2.4

7.4

2.6

13.3

Individually prepared parenteral solutions

Cytostatic preparations

Methadone preparations

Standard formulations

in millions



Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)

STANDARD FORMULATIONS

Each year pharmacies prepare more than seven million standard formulations according to doctors’ prescrip-

tions for SHI-insured patients. Whether it be skin cream or fever suppositories, all pharmacies are able to prepare

these individually according to the patient’s needs. Children, in particular, benefit from this; for instance, when

a medication is not available as a pre-packaged pharmaceutical at a certain dosage. Many pensioners and

seniors also require “special preparations”.

Standard Formulations by Age Groups number per 1,000 SHI insured

0

40

80

120

160

136

13313

7

82

73

79

76

72

78

140

133

144

98

93

100

Children

(under 15 years)

Youth

(15 to under 20 years)

Adults

(20 to under 65 years)

Seniors

(65 years and older)

ø All SHI insured

(average)

2015 2016 2017



NUMBER OF PHARMACIES

The number of community pharmacies in Germany has been in decline since 2009 (highest level 2008: 21,602).

At the end of 2017, it reached 19,748, its lowest point since the late 1980s. The causes of this include healthcare-

related political conditions as well as competition among individual pharmacies. Comprehensive pharmaceutical

care for the population remains, however, unthreatened.

1990 1995 2000 2005 2010 2015 2016 2017

Number of Pharmacies

(incl. subsidiaries) 19,898 21,119 21,592 21,476 21,441 20,249 20,023 19,748

of which are

Main / Individual

Pharmacies * 19,898 21,119 21,592 20,248 17,963 15,968 15,607 15,236

Subsidiaries — — — 1,228 3,478 4,281 4,416 4,512

New Openings — 372 187 326 263 154 123 120

Closings — 156 185 242 370 346 349 395

Development / Change — +216 +2 +84 −107 −192 −226 −275

year-end statistics

* Pharmacies with an operating licence pursuant to Section 2 of the German Pharmacies Act [Apothekengesetz]

Source: ABDA-Statistik

1990 1995 2000 2005 2010 2015

20,000

21,000

22,000

21,1

19

19,8

98 20,1

08 20,3

50

20,6

48 20,9

03

21,2

90 21,4

57

21,5

56

21,5

90

21,5

92

21,5

69

21,3

05

21,4

65

21,3

92

21,4

76

21,5

51

21,5

70

21,6

02

21,5

48

21,4

41

21,2

38

20,9

21

20,6

62

20,4

41

20,2

49

20,0

23

19,7

48


PHARMACY LANDSCAPE

APOTHEKENLANDSCHAFT

PHARMACY NUMBERS BY GERMAN FEDERAL STATE

The number of community pharmacies in the individual federal states depends, among other things, on the

number of inhabitants, the population’s demographic structure and the physical area. The most populous

state, North Rhine-Westphalia, has been divided into the two chamber districts of North Rhine and Westphalia-

Lippe and accounts for the highest number of pharmacies with more than 4,000 in total.

Federal State Community Pharmacies of these main / individual

pharmacies *

of these subsidiaries

Number Pharmacy Density **

Baden-Wuerttemberg 2,506 23 1,891 615

Bavaria 3,179 25 2,480 699

Berlin 812 23 642 170

Brandenburg 576 23 431 145

Bremen 145 21 103 42

Hamburg 404 22 307 97

Hesse 1,485 24 1,150 335

Mecklenburg-Western Pomerania 404 25 320 84

Lower Saxony 1,935 24 1,496 439

North Rhine-Westphalia 4,210 24 3,236 974

North Rhine 2,237 23 1,751 486

Westphalia-Lippe 1,973 24 1,485 488

Rhineland-Palatinate 1,008 25 779 229

Saarland 301 30 255 46

Saxony 982 24 758 224

Saxony-Anhalt 597 27 458 139

Schleswig-Holstein 658 23 517 141

Thuringia 546 25 413 133

Total 19,748 24 15,236 4,512

year-end statistics 2017

* Pharmacies with an operating licence pursuant to Section 2 of the German Pharmacies Act [Apothekengesetz]

** Pharmacies per 100,000 residents



PHARMACY LANDSCAPE


GEOGRAPHICAL COVERAGE

On average, there are 24 pharmacies for every 100,000 residents in Germany. There are, however, regional

differences to be found across the country: pharmacy density varies greatly according to the number of

residents or area and structure of cities and districts. At present comprehensive pharmaceutical care for

the population remains guaranteed nationwide.

22 or less

(125 districts)

23 – 25

(137 districts)

26 or more

(139 districts)

Pharmacy Density in Administrative Districts 2017

Pharmacies per

100,000 residents


PHARMACY LANDSCAPE

PHARMACY DENSITY IN EUROPE

Germany, with 24 pharmacies per 100,000 inhabitants, lies below the European average.

On average, the 28 European Union member states have a density of 31 pharmacies per 100,000 inhabitants:

* last available year

Sources: ABDA-Statistik, Zusammenschluss der Apotheker in der Europäischen Union (ZAEU), nationale Apothekerverbände, Europäische Kommission (EC)

Greece 87

22,046

871

8Denmark

12The Netherlands

14Sweden

15Finland

16Austria

16Slovenia

16Luxembourg

22United Kingdom

23Hungary

24Germany

24Czech Republic

26Croatia

28Slovakia

28Portugal

31Italy

31EU Average

32France

37Estonia

38Poland

39Ireland

44Latvia

43Romania

47Spain

47Lithuania

51Bulgaria

55Cyprus

9,500

Number of Pharmacies *Pharmacies per 100,000 residents

210

477

3,714

8,673

4,929

1,387

21,403

—

490

14,584

1,854

19,748

2,559

1,114

1,516

2,935

18,549

1,352

331

95

14,000

2,315

452

1,994

1,392

812

51Malta

44Belgium


PHARMACY LANDSCAPE

SUBSIDIARY STRUCTURE

Of the combined 19,748 pharmacies, exactly 15,236 were individual or main pharmacies with subsidiaries as of

the end of 2017. Subsidiary expansion is on the rise. Introduction of the SHI (statutory health insurance) Mod-

ernisation Act of 2004 means that a pharmacist is now allowed to have up to three subsidiaries. Each subsidi-

ary must have a pharmacist acting as the subsidiary manager and all (main and subsidiary pharmacies) must be

physically located in close proximity to one another.

2005 2010 2015 2016 2017

Pharmacies without subsidiaries

(individual pharmacies) 19,148 15,277 12,851 12,399 11,989

Main pharmacies

with one subsidiary 989 2,057 2,229 2,290 2,282

Main pharmacies

with two subsidiaries 94 466 612 628 665

Main pharmacies

with three subsidiaries 17 163 276 290 300

Main / Individual Pharmacies 20,248 17,963 15,968 15,607 15,236


year-end statistics

0

4,000

8,000

12,000

16,000

20,000

20172016201520102005

19,148

1,100

15,277

2,686

12,851

3,117

20,248

17,963

15,968

12,399

3,208

15,607

11,989

3,247

15,236

Pharmacies without subsidiaries Pharmacies with at least one subsidiary


PHARMACY LANDSCAPE

SPECIFIC TYPES OF PHARMACIES

Hospital pharmacies do not belong to “community pharmacies”. All community pharmacies are owner- operated

with some pharmacies legally operated by several pharmacists as a general partnership (German: OHG).

Leased pharmacies do exist on a temporary basis. This occurs, for example, when an owner has passed

away. To ensure service and coverage at a local level, so-called prescription collection containers may also

be established. Prescriptions are collected (sometimes digitally) and filled by an authorised pharmacy.

* German: Apothekengesetz / ** German: Apothekenbetriebsordnung

Sources: ABDA-Statistik, IQVIA Commercial GmbH & Co. OHG

2015 2016 2017

Hospital pharmacies (Section 14 German Pharmacies Act *) 390 384 379

Pharmacies supplying hospitals (Section 1a Para. 1 Ordinance

on the Operation of Pharmacies **)183 178 171

OHG pharmacies (Section 8 German Pharmacies Act) 662 689 709

Leased pharmacies (Section 9 German Pharmacies Act) 880 832 774

Branch pharmacies (Section 16 German Pharmacies Act) 11 12 12

Emergency pharmacies (Section 17 German Pharmacies Act) 0 0 0

Prescription Collection Containers § 24 Ordinance on the Operation of Pharmacies

Baden-Wuerttemberg 110

Bavaria 132

Berlin –

Brandenburg 77

Bremen –

Hamburg –

Hesse 173

Mecklenburg-Western Pomerania 112

Lower Saxony 107

North Rhine-Westphalia 35

North Rhine 3

Westphalia-Lippe 32

Rhineland-Palatinate 66

Saarland 10

Saxony 124

Saxony-Anhalt 139

Schleswig-Holstein 46

Thuringia 77

Total 1,208


PHARMACY LANDSCAPE

MAIL ORDER TRADE

Mail order trade of prescription and OTC medications has been allowed in Germany since 2004. Mail order

trade already accounts for a double-digit market share in self-medication. As concerns prescription pharma-

ceuticals, this share is considerably lower. However, sales of mail order, prescription-only pharmaceuticals

have risen considerably since the European Court ruled, in October 2016, that foreign (non-German) mail order

traders are no longer bound to mandatory German price structures for prescription pharmaceuticals.

Changed source: the quality of the currently available data regarding mail order trade of prescription-only pharmaceuticals is limited.

* values at manufacturer sales price (ApU) minus manufacturer markdowns

** professional web-shop and listing with price search engines

Sources: IQVIA Commercial GmbH & Co. OHG, ABDA-Statistik, own calculations

Sales Volume 2017

Sales Volume 2017

Pharmacies with a Mail Order License (Section 11a German Pharmacies Act)

2,958Pharmacies with a

Mail Order License

(§ 11a German

Pharmacies Act)

of which approx. 150 are actively engaged in mail order trade **

Prescription-only Pharmaceuticals

8 million packages (1.1 %)

Change from previous year (5.8 %)



842 million euros (17.0 %)


305 million euros (1.0 %)



Change from previous year (−0.3 %)

736 million packages

(86.8 %)

Change from previous year

(−1.0 %)

4,118 million euros

(83.0 %)

Change from previous year

(0.8 %)

28,849 million euros (99.0 %)


OTC Pharmaceuticals and Non-Pharmaceutical Products

Community Pharmacies Mail Order Trade

Sales * 2017(without VAT)

Sales * 2017(without VAT)


PHARMACY LANDSCAPE

NUMBER AND AGE OF PHARMACISTS

At the end of 2017, there were more than 64,000 active pharmacists in Germany and this number has been

growing. The overwhelming majority work in community pharmacies yet pharmacists are also employed in the

pharmaceutical industry, in hospital pharmacies, universities and government agencies. More than two-thirds

of all licensed pharmacists are women.

Active Pharmacists in: 2015 2016 2017 Percentage of

Women 2017

Community Pharmacies 50,356 50,123 51,098 72.6 %

of which are owner managed 15,968 15,607 15,236 48.4 %

Hospital Pharmacies 2,212 2,307 2,382 70.4 %

Industry, Administration, Associations,

Science 10,189 10,518 10,899 60.4 %

Pharmaceutical Industry 5,867 6,136 6,530 60.8 %

Federal Armed Forces 229 243 241 35.7 %

Government Agencies and

Statutory Corporations 937 907 954 61.6 %

Universities 1,187 1,169 1,219 50.8 %

Educational Institutions and

Vocational Schools 465 465 482 79.5 %

Other 1,504 1,598 1,473 63.7 %

Total 62,757 62,948 64,379 70.5 %

Age of Occupationally Active Pharmacists: total female male

Community Pharmacies 47.2 45.7 51.2

of which are pharmacy owners 51.5 50.0 53.0

of which are licensed staff 44.7 44.2 47.4

Hospital Pharmacies 43.0 40.5 48.1

Industry, Administration, Associations, Science 41.5 39.8 44.1

All Areas of Activity (as of 31st December 2014) * 46.2 44.8 49.5

* data collection performed every four years.


Average Age of Pharmacists



BESCHÄFTIGUNG IN DER PHARMAZIE

JOBS IN PHARMACIES

The number of people working in community pharmacies grew to 157,000 in 2017. About one-third of these

are approbated (licensed) pharmacists: Two-thirds work as pharmaceutical technical assistants (PTA) or

pharmaceutical commercial employees (PCE).

2015 2016 2017 Percentage of

Women 2017

Pharmacists 50,356 50,123 51,098 72.6 %

Pre-approbation Trainee Pharmacists

(PhiP) 1,608 1,651 1,693 73.7 %

Pharmacist’s Assistants;

Pharmaceutical Engineers 6,145 5,803 5,591 96.8 %

Pharmaceutical Technical Assistants PTA

(incl. interns) 63,660 65,658 65,823 97.2 %

Pharmaceutical Commercial Employees

(PCE) / Assistants 32,759 33,193 33,079 98.4 %

Total Number of Positions 154,528 156,428 157,284 89.2 %

year-end statistics




TRAINEE POSITIONS IN PHARMACIES

Pharmacies offer apprenticeships for about 7,400 young people. These trainees complete their practical

training period at a pharmacy. This year is completed either as part of dual training to become a pharma-

ceutical commercial employee (PCE), the programme to become a pharmaceutical technical assistant (PTA),

or as the final, practical stage of their pharmacy studies at university.

2015 2016 2017

Pharmaceutical Commercial Employees (PCE)

in Training 3,724 3,805 3,626

Pharmaceutical Technical Assistants (PTA) in Training2,117 2,085 2,076

Pre-approbation Trainee Pharmacists (PhiP) 1,608 1,651 1,693

Total Number of Trainee Positions 7,449 7,541 7,395

year-end statistics


3,626

1,693

2,076

Pharmaceutical Commercial

Employees (PCE) in TrainingPharmaceutical Technical Assistants

(PTA) in Training

Pre-approbation Trainee Pharmacists (PhiP)

Trainee Positions 2017

7,395 total



PHARMACY STUDENTS AND APPROBATIONS

The number of pharmacy students and newly-approbated pharmacists in Germany is increasing as is the

demand for pharmacists across the job marketplace in general, e. g. in industry and hospitals. 22 universities

in 14 federal states offer pharmacy programmes. The programme is structured into three sections: basic

studies (2 years), main studies (2 years) and practical training (1 year).

Academic Year Students New Students Approbations Promotions

2016 / 2017 15,682 2,766 2,202 415

2015 / 2016 15,548 2,752 2,025 385

2014 / 2015 15,268 2,748 2,079 407

2013 / 2014 14,632 2,708 1,947 350

2012 / 2013 14,183 2,754 1,929 329

Source: Statistisches Bundesamt (Destatis), Landesbehörden



Places of Study

Federal State UniversityRegistrations 2016 / 2017

Winter Semester

Registrations 2017

Summer Semester

Baden-Wuerttemberg

Freiburg 90 0

Heidelberg 45 0

Tübingen 140 0

Bavaria

Erlangen-Nurnberg 127 0

Munich U 108 100

Regensburg 134 0

Würzburg 47 47

Berlin Berlin FU 69 62

Brandenburg — — —

Bremen — — —

Hamburg Hamburg 58 0

HesseFrankfurt / Main 90 90

Marburg 145 95

Mecklenburg-Western

Pomerania Greifswald 67 66

Lower Saxony Braunschweig 80 69

North Rhine-Westphalia

Bonn 86 89

Düsseldorf 65 67

Münster 78 78

Rhineland-Palatinate Mainz 49 43

Saarland Saarbrucken 32 28

Saxony Leipzig 36 0

Saxony-Anhalt Halle-Wittenberg 179 0

Schleswig-Holstein Kiel 62 62

Thuringia Jena 77 0

Total 1,864 896

Source: Stiftung für Hochschulzulassung (ZVS)



PROFESSIONAL LANGUAGE PROFICIENCY EXAM FOR FOREIGN PHARMACISTS

Pharmacists with a mother tongue other than German who apply for approbation in Germany are required to

provide proof of German language skills specific to and required for their profession. This is done by means of

three-part proficiency exams based on the Common European Framework of Reference of Languages (CEFR).

Almost all chambers of pharmacists have been charged with the execution of these tests by the competent

authorities at the state level and the number of tests carried out nearly doubled in the last year.

Number of Professional Language Examinations and Success Rates

Source: Bundesapothekerkammer (BAK)

Number of Exam Candidates, Gender Ratios and Countries of Origin

passed on first attempt

Men

passed on further attempts

Women

Non-EU StatesEuropean Union (EU, EEA, Switzerland)

22 %

78 %

20 %

80 %

22 %

78 %

20 %

80 %

2017769 Professional

Language Proficiency

Exams

2016345 Professional

Language Proficiency

Exams

Iraq

Bosnia and Herzegovina

Ukraine

Other

Syria

Egypt

234 109 343

73932

21 3413

82315

713

6

41 54 95Croatia

Bulgaria

Spain

Greece

Poland

Romania

Hungary

Italy

3710 27

3214 18

2310 13

233 20

84 4

66

55

86 2

Other

308 22

346

373

719 total from 60 countries



2015 2016 2017

Events 3,494 3,458 3,339

Participants 161,905 159,266 166,869

Area Field

General Pharmacy 11,574 Nutritional Consultation 2,234

Clinical Pharmacy 1,739 Naturopathy Treatment and Homeopathy 2,205

Pharmaceutical Analysis 807 Geriatric Pharmacy 800

Medication Information 690 Prevention and Health Promotion 583

Pharmaceutical Technology 534 Oncological Pharmacy 226

Theoretical and Practical Education 157 Infectiology 111

Public Health Care 123 Care Services 69

Toxicology and Ecology 93

Specialised Pharmacist Titles – Total 15,717 Field Designations – Total 6,228

2015 2016 2017

Number of Educational Programmes Completed 423 486 523


CPE Events Held by the State Chambers of Pharmacists (LAK) and State Pharmacists’ Associations (LAV)

Postgraduate Specialisation Completions per Year(in area and field of pharmacy)

Pharmacists Completing / Postgraduate Specialisation 2017

CONTINUING PROFESSIONAL EDUCATION AND POSTGRADUATE SPECIALISATION

Continuing professional education (CPE) serves to refresh and expand upon existing knowledge. Postgraduate

specialisation refers to the acquisition of specialised knowledge and skills in a specific field or area of pharmacy.

A three-year training programme in one of these areas entitles a pharmacist to the right to call themselves a

specialised pharmacist. Following a one-year programme in one of these fields, the corresponding identifying

designation may be used.



Prescription-only Narcotic Pharmaceuticals * 1,854

Pharmaceuticals Requiring a Special Prescription

(T-prescription) ** 16

Other Prescription-only Pharmaceuticals 48,281

Pharmacy-only Pharmaceuticals 19,423

Unrestricted OTC Pharmaceuticals 34,123

Total Number of Marketable Pharmaceuticals 103,697

PHARMACEUTICALS APPROVED IN GERMANY

More than 100,000 different pharmaceuticals have been governmentally approved in Germany. Each pack-

aging size, potency or dosage form is considered an individual pharmaceutical even if the brand name is

the same. About half of all pharmaceuticals are prescription-only. Governmental approval for nationwide

use may be granted at either the federal level in accordance with the Medicinal Products Act (AMG) or

at the European level.

* pharmaceuticals subject to prescription regulations for narcotics in Germany e. g. strong painkillers

** pharmaceuticals which may be utilized only in very specific situations due to their hazardous potential e. g., the active ingredient Thalidomide

As of: January 2018

Source: Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM)


50,151


53,546



ARZNEIMITTEL IN DEUTSCHLAND

PHARMACEUTICAL PRICE INDEX

The pharmaceutical price index describes the average price development (incl. VAT) of pharmaceuticals

which are prescribed at the expense of statutory health insurance (SHI). Pharmaceutical prices have sharply

decreased over the past decade, while consumer prices have risen continually.

* Pharmacy markdowns, manufacturer markdowns, savings resulting from rebate contracts and patient co-payments are not taken into account.

Sources: Wissenschaftliches Institut der AOK (WIdO), Statistisches Bundesamt (Destatis)

2008 2011 2014 20172005

70

0

140

100.

0

101.

6

103.

2

105.

6

108.

4

108.

7

109.

9

112.

2

114.

4

116.

2

117.

1

117.

5

118.

1

120.

2

100.

0

99.5

97.2

95.9

94.5

94.9

94.8

92.6

91.4

91.7

90.6

88.5

87.1

85.9

Pharmaceutical Price Index * Consumer Price Index



VALUE-ADDED TAX ON PHARMACEUTICALS

Value-added tax (VAT) on pharmaceuticals varies greatly among the 28 member states of the European Union.

Germany has one of the highest VAT rates on pharmaceuticals – behind only Denmark and Bulgaria. In contrast,

Malta, the United Kingdom, Ireland and Sweden have all made certain pharmaceuticals exempt from the tax.

Source: Europäische Kommission (EC)

Tax Rate for

Pharmaceuticals

in 2018

General VAT

tax rate in 2018

Denmark 25.0 25.0

Bulgaria 20.0 20.0

Germany 19.0 19.0

Latvia 12.0 21.0

Finland 10.0 24.0

Italy 10.0 22.0

Czech Republic 10.0 21.0

Austria 10.0 20.0

Slovakia 10.0 20.0

Slovenia 9.5 22.0

Estonia 9.0 20.0

Romania 9.0 19.0

Poland 8.0 23.0

Greece 6.0 24.0

Portugal 6.0 23.0

Belgium 6.0 21.0

The Netherlands 6.0 21.0

Hungary 5.0 27.0

Croatia pharmaceuticals covered by the NHS


5.0

25.0

25.0

Lithuania reimbursable pharmaceuticals

non-reimbursable pharmaceuticals

5.0

21.0

21.0

Cyprus 5.0 19.0

Spain 4.0 21.0

Luxembourg 3.0 17.0

France reimbursable pharmaceuticals

non-reimbursable pharmaceuticals

2.1

10.0

20.0

Sweden prescription-only pharmaceuticals


0.0

25.0

25.0

Ireland pharmaceuticals for oral use

pharmaceuticals for non-oral use

0.0

23.0

23.0

United Kingdom pharmaceuticals covered by the NHS


0.0

20.0

20.0

Malta 0.0 18.0



PHARMACEUTICALS PRICING

The selling prices for prescription pharmaceuticals and the pharmacy fee are determined according to legal

stipulations laid out in the Drug Price Ordinance [AMPreisV]. To ease the financial burden on health insurance

funds, lawmakers have stipulated markdowns and discounts along with co-payments from insured individuals.

Example of a Prescription-only, Pre-packaged Medication

Manufacturer sales price (ApU) 50.00 Euro

+ maximum wholesale mark-up (3.15 % of the ApU + 0.70 euros) 2.28 Euro

= pharmacy purchase price (AEP) 52.28 Euro

+ pharmacy mark-up (3 % of the AEP + 8.35 euros) 9.92 Euro

+ emergency services mark-up (0.16 euros) 0.16 Euro

= Net Pharmacy Sales Price (net AVP) 62.36 Euro

+ value-added tax (19 % of the net AVP) 11.85 Euro

= Gross Pharmacy Sales Price (AVP) 74.21 Euro

− statutory co-payment from the insured individual (10 % of gross AVP) 7.42 Euro

− statutory pharmacy markdown (1.77 euros) 1.77 Euro

− statutory manufacturer markdown * (7 % of ApU) 3.50 Euro

= Effective Expenditures for Statutory Health Insurance (SHI) ** 61.52 Euro

* The manufacturer markdown for pharmaceuticals which are not bound to fixed prices amounts to 7 percent for patent-protected originals and 16 % for generics.

The amount for generic medication that is bound to fixed prices is, however, 10 percent. The manufacturer markdown is waived if the pharmaceutical price lies 30

percent under the fixed price. (§ 130a SGB V).

** does not take into consideration any rebate contracts which reduce costs for statutory health insurance (SHI)




PRICING FOR STANDARD FORMULATIONS

The sales pricing for standard formulations is determined according to legal stipulations laid out in the Drug

Price Ordinance [AMPreisV] in a fashion similar to industrially produced, prescription medications. Discounts

and mark-ups are precisely defined therein. The rules governing remuneration for standard formulations were

adjusted in 2017.

Example for a Prescription-only Ointment (100 g)

Pharmacy purchase price (AEP) for an active ingredient (1 g powder),

base (99 g ointment base) and container (1 dispenser for 100 g) 5.00 Euro

+ fixed mark-up (90 % of AEP) 4.50 Euro

+ formulation mark-up for production

(6.00 euros for preparation of ointments up to 200 g) 6.00 Euro

+ fixed fee 8.35 Euro

= Net Pharmacy Sales Price (net AVP) 23.85 Euro

+ value-added tax (19 % of the net AVP) 4.53 Euro

= Gross Pharmacy Sales Price (AVP) 28.38 Euro

− statutory co-payment from the insured individual

(10 % of AVP, minimum 5 euros) 5.00 Euro

− statutory pharmacy markdown (1.77 euros) 1.77 Euro

= Effective Expenditures for for Statutory Health Insurance (SHI) 21.61 Euro




BREAKDOWN OF TOTAL SHI EXPENDITURES

Of the more than 230 billion euros that the statutory health insurance (SHI) spent in 2017, the largest percentage

went to hospitals and doctors. Pharmaceutical expenditures (incl. pharmacies) ranked third with 14.6 percent.

2.2 percent of this were accounted for by pharmacies and their services. This is less than half of that spent on

SHI administration (4.7 percent).

* from pharmacies

Notice: “Medical Aids from Pharmacies” are, in contrast to the previous year’s publication,

no longer grouped with pharmaceuticals but, rather, with remedies and medical aids.

Sources: Bundesministerium für Gesundheit (BMG), ABDA-Statistik

2017 230.56 16.3 6.1 6.3 32.2 4.7 19.8 14.6 2.2

2016 222.73 16.1 6.2 6.4 32.1 4.9 19.8 14.5 2.3

2015 213.67 16.1 6.3 6.4 32.2 4.9 19.6 14.6 2.3

2014 205.54 16.0 6.3 6.4 32.7 4.9 19.2 14.5 2.3

2013 194.49 16.2 6.5 6.2 33.0 5.1 19.1 13.9 2.4

2012 184.25 15.3 6.4 6.2 33.5 5.2 19.1 14.3 2.3

2011 179.61 15.4 6.5 6.2 33.4 5.3 18.7 14.6 2.3

2010 175.99 15.4 6.5 6.0 33.0 5.4 18.1 15.6 2.5

2009 170.78 15.5 6.6 6.0 32.5 5.2 18.2 16.0 2.6

2008 160.94 15.2 6.8 6.1 32.4 5.1 18.3 16.1 2.6

2007 153.93 15.1 6.9 6.1 32.8 5.3 17.6 16.1 2.6

Total SHI Expenditures 2017: 230.56 billion euros

Miscellaneous Expenditures 19.8 %

Administration 4.7 %

Remedies and Medical Aids 6.3 %

Dentists (incl. dentures) 6.1 % Hospitals 32.2 %

Pharmaceuticals from Pharmacies 14.6 %

of which is pharmacy added-value

share as per Drug Price Ordinance

(AMPreisV) 2.2 %

Doctors 16.3 %

Tota

l SH

I Exp

endi

ture

s

(bill

ion

euro

s)

Doc

tors

of w

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in %

Den

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(inc

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Rem

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edic

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Hos

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Adm

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Mis

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neou

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ARZNEIMITTELVERSORGUNG IN DER GKV

MISCELLANEOUS HEALTH INSURANCE FUND EXPENDITURES

Miscellaneous health insurance fund expenditures include, among other things, sick pay, home nursing and travel

expenses as well as “vaccinations incl. doctor’s fees”. “Pharmaceuticals from Others / Mail Order” refers to overseas

mail order pharmacies or health authorities.


5.3 % Sick Pay

2.6 % Home Nursing

2.4 % Travel Expenses

1.0 % Early Diagnosis

0.9 % Dialysis Material Costs in

Doctor’s Offices

0.8 % Integrated Care

0.6 % Vaccinations

(incl. doctor’s fees)

0.6 % Pregnancy, Maternity

0.3 % Services Abroad

2.2 % Other

1.5 % Outpatient & Inpatient Benefits

and Rehab Services

1.6 % Pharmaceuticals from

Others / Mail Order

Total Miscellaneous Expenditures 2017:

19.8 %



SHI EXPENDITURES FOR PHARMACEUTICALS

Approximately two-thirds of statutory health insurance’s (SHI) pharmaceutical expenditures went to the

pharmaceutical industry. In 2017, expenditures for the 19 percent value-added tax on pharmaceuticals

exceeded those for pharmacy services.

* provisional

** formulations, pre-packaged pharmaceuticals and surgical dressings from pharmacies

(in contrast to the previous year’s publication, medical aids are no longer included)


2015 2016 2017 *

in billion

euros

in billion

euros

in billion

euros

Pharmaceutical Industry and

Advance Services

(such as raw materials) 20.28 65.0 % 21.06 65.1 % 22.01 65.3 %

Pharmaceutical Wholesaling 1.05 3.4 % 1.07 3.3 % 1.11 3.3 %

VAT (state) 4.98 16.0 % 5.17 16.0 % 5.37 16.0 %

Pharmacies 4.86 15.6 % 5.05 15.6 % 5.17 15.4 %

Total SHI Expenditures

for Pharmaceuticals **

31.17 100.0 % 32.35 100.0 % 33.66 100.0 %

Pharmacies 15.4 %

VAT (state) 16.0 %

Pharmaceutical Industry

and Advance Services

(such as raw materials) 65.3 %

Pharmaceutical

Wholesaling 3.3 %

SHI Expenditures for Pharmaceuticals 2017: 33.66 billion euros



PHARMACEUTICALS BY PRICE CLASSES

The pharmacy sales price (AVP) for every prescription-only medication is legally regulated by the Drug Price

Ordinance (AMPreisV) and based on the manufacturer sales price (ApU). For nine out of ten medications,

this amounts to 100 euros or less. Despite a lower number of actual packages, higher priced, innovative

medications account for a growing percentage of the total sum spent.

Price Classes * 2015 2016 2017

to 100.00 euros 91.1 % 90.9 % 90.5 %

100.01– 500.00 euros 7.8 % 8.0 % 8.4 %

500.01–1,500.00 euros 0.6 % 0.6 % 0.6 %

more than 1,500.00 euros 0.4 % 0.4 % 0.5 %

Price Classes * 2015 2016 2017

to 100.00 euros 37.7 % 36.6 % 35.1 %

100.01– 500.00 euros 25.0 % 25.3 % 25.6 %

500.01–1,500.00 euros 9.1 % 9.0 % 9.1 %

more than 1,500.00 euros 28.3 % 29.1 % 30.3 %

Sales Volume Percentage SHI of Prescription-only Pre-packaged Medications

Sales Revenue Percentage of SHI Prescription-only Pre-packaged Medications

* at pharmacy sales prices




PHARMACY AND MANUFACTURER MARKDOWNS

Over the years, lawmakers have introduced various instruments to limit statutory health insurance (SHI) expendi-

tures for pharmaceuticals. Pharmacies as well as pharmaceutical manufacturers must grant markdowns to

the SHI when dispensing prescription-only pharmaceuticals. The pharmacy markdown is currently set at 1.77

euros (incl. VAT). This amount must be reimbursed to the health insurance fund from the pharmacist’s fees for

each package dispensed at the expense of the SHI. This amounts to more than one billion euros per year.

Source: Deutscher Apothekerverband e. V. (DAV)

0

300

600

900

1,200

1,500

1,800

201720162015

1,533

1,081

1,562

1,096

1,563

1,090

in million euros

Pharmacy Markdowns Manufacturer Markdowns

(without rebate contracts)



Rebate Pharmaceuticals: Agreements and SHI Savings

REBATE PHARMACEUTICALS

Since 2007, health insurance funds have been able to enter into rebate contracts with manufacturers to dispense

pharmaceuticals at a lower cost. There are currently more than 27,000 fund-specific rebate contracts stipulating

which insured person can receive which pharmaceutical from which manufacturer. Compliance with these

manifold agreements as part of patient care has resulted in a drastic increase in administrative effort for

the pharmacies.

Sources: ABDATA, Pro Generika e. V., Bundesministerium für Gesundheit (BMG), IQVIA Commercial GmbH & Co. OHG

27,300 number of rebate contracts at the end of 2017

4.0 billion euros in savings from rebate contracts in the year 2017

112 health insurance funds and companies involved at the end of 2017

178 pharmaceutical companies involved at the end of 2017

16,500 number of rebate pharmaceuticals (central registration numbers) at the end of 2017

25 % percentage of rebated, prescription-only pharmaceuticals either exempt from or having reduced co-payments at the end of 2017

409 million packages of prescription medication with rebate contracts dispensed in 2017

11.9 million data sets used in pharmacy computer systems at the end of 2017

2015 2016 2017

Number of rebate contracts at year’s end 21,100 24,600 27,300

SHI savings in year 3.7 billion euros 3.9 billion euros 4.0 billion euros



PATIENT CO-PAYMENTS

SHI (statutory health insurance) insured patients must make co-payments to their health insurance funds for

certain services. This amounts to ten percent of a pharmaceutical’s price for prescribed medications and must

lie between a minimum of five but no more than ten euros. There is a 2.90 euro average due to co-payment

exemptions for some medications and insured persons. The co-payments, which community pharmacies are

legally required to collect from patients, have saved health insurers two billion euros annually.

Source: Deutscher Apothekerverband e. V. (DAV)

1,200

1,400

1,600

1,800

2,000

2,200

2,400

201720162015201420132012

2.5

3.0

201720162015201420132012

1,862

1,9782,027

2,0842,143 2,149

2.60 2.60

2.70

2.80 2.80

2.90

Patient Co-payments for Pharmaceuticals in Million Euros

Average Co-payment per Package in Euros



CO-PAYMENT EXEMPTIONS

A hardship provision in Section 62 of the Social Insurance Code (SGB V) stipulates that SHI insured persons

need only make co-payments amounting to two percent of their yearly gross income. This limit is reduced

to one percent for chronically ill persons. One in eleven of the approximately 72 million SHI insured people

in Germany are exempt from additional co-payments. This ratio has been in decline for years.

Co-Payment Exemptions 2011 2012 2013 2014 2015 2016

Chronically Ill Patients in millions 6.9 7.0 6.5 6.4 6.2 6.0

Other Patients in millions 0.5 0.5 0.4 0.4 0.3 0.3

Total Number of Co-payment

Exempt Persons in millions 7.4 7.5 6.9 6.8 6.5 6.3

Percentage of SHI Insured Persons

Exempt from Co-payments 10.7 % 10.7 % 9.9 % 9.6 % 9.2 % 8.8 %

Source: Bundesministerium für Gesundheit (BMG)



GUIDELINES AND WORKING AIDS

The Federal Chamber of Pharmacists’ guidelines, including commentary and working aids, are recommendations

addressing common situations and designed to ensure a high quality of service and skills in pharmacies. They

consider applicable laws and regulations as well as the current state of the art in science and technology. They

do not, however, relieve individuals of the responsibilities which come along with their health care profession.

Materials are available for the following pharmacy related topics and activities:

1. Pharmaceutical Information

2. Pharmaceutical Risks

3. Asthma

4. Blood Pressure Measurement

5. Blood Testing

6. Dosage Forms

7. Diabetes

8. Nutritional Consultation

9. Supply to Care Homes and Centres

10. Provision of Medical Aids

11. Hygiene Management

12. Hospital Supply

13. Manual Repackaging

14. Medication Analysis

15. Opiate Substitution

16. Production of Parenterals

17. Inspection of Source Materials / Primary Packaging

18. Inspection of Proprietary Medicinal Products

19. Prescription Delivery

20. Preparations / Formulas

21. Self-medication

22. Mail Order Trade

Materials available at: www.abda.de/themen/apotheke/qualitaetssicherung0/leitlinien/leitlinien0



QUALITY ASSURANCE

QUALITÄTSSICHERUNG

AMK: REPORTING OF PHARMACEUTICAL RISKS

Pharmacists check the quality of pharmaceuticals and report any quality deficiencies to the Drug Commission

of German Pharmacists (AMK). The AMK collects and evaluates reported drug safety issues and, when

nece ssary, issues warnings, helping greatly to protect consumers and ensure their safety.

Issues Reported to the Drug Commission of German Pharmacists (AMK)

* reported suspicious cases (pharmaceuticals and other product groups)

** manufacturer defect / technological errors

Source: Arzneimittelkommission der Deutschen Apotheker (AMK)

2015 2016 2017

Absolute Absolute Absolute Percentage

Change from

Previous Year

Packaging Errors 2,446 2,640 2,780 30.6 % 5.3 %

Undesired Pharmaceutical Reactions *

and Other Reported Issues 2,676 2,640 2,702 29.7 % 2.3 %

Galenic Deficiencies ** 1,413 1,547 1,494 16.4 % −3.4 %

Mechanical Errors 788 1,060 1,095 12.1 % 3.3 %

Declaration Errors 699 725 623 6.9 % −14.1 %

Other 387 279 390 4.3 % 39.8 %

Total 8,409 8,891 9,084 100.0 % 2.2 %

30.6 %4.3 %

6.9 %

12.1

%

16.4 %

29.7 %

Other

Undesired Pharmaceutical Reactions *

and Other Reported Issues

Galenic Deficiencies **

Mechanical Errors

Declaration ErrorsPackaging Errors


QUALITY ASSURANCE

Risks by Pharmaceutical Group

* OTC = Over the Counter

Source: Arzneimittelkommission der Deutschen Apotheker (AMK)

1,990 OTC

Pharmaceuticals *

332 Non-Pharmaceuticals

6,762 Prescription-only

Pharmaceuticals

3.7 %

21.9

%

74.4 %

2017 Absolute Percentage

Prescription-only Pharmaceuticals 6,762 74.4 %

OTC Pharmaceuticals* 1,990 21.9 %

Non-Pharmaceuticals 332 3.7 %

Total 9,084 100.0 %


QUALITY ASSURANCE

QUALITY ASSURANCE OF FORMULATIONS

The Central Laboratory of German Pharmacists (ZL) in Eschborn contributes, by means of ring trials, to ensuring

the quality of formulations. Any pharmacy may participate by preparing and submitting a formulation specified

by the ZL. This is then tested for the identity, quantity and distribution of the active ingredient as well as other

testing parameters such as pH values, particle size, density, etc. The number of participating pharmacies has

been growing for years with nearly every third pharmacy voluntarily having their formulations tested at least

once a year.

* number of participants includes multiple participations by individual pharmacies

** figures for 2017 were not available at the time of publication

Source: Zentrallaboratorium Deutscher Apotheker e. V. (ZL)

Year Number of Participants

(formulations examined)

Number of

Pharmacies *

Participation Percentage

(of total number of pharmacies)

2016 ** 7,619 6,036 29.3

2015 7,674 6,099 29.3

2014 7,343 5,706 27.3

2013 6,502 4,952 23.5

2012 5,720 4,452 20.9

2011 4,982 3,835 17.7

2010 4,814 3,644 16.7

2009 3,876 2,901 13.2

2008 3,437 2,488 11.3

2007 2,685 1,886 8.6

2006 2,081 1,515 6.7

Ring Trials of the Central Laboratory of German Pharmacists (ZL)


QUALITY ASSURANCE

Patients with Polymedication

Source: Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH (data collection 2015)

CHALLENGES INVOLVING POLYMEDICATION

Polymedication (or “multi-medication”) is defined as the situation in which a patient regularly takes several

different medications for a prolonged period. Leading definitions require a minimum of three to five such medi-

cations. Approximately every fourth German regularly takes three or more medications. Several initiatives for

medication management such as ARMIN (“Pharmaceutical Initiative Saxony – Thuringia”) or PRIMA (Primary

System Integration of Medication Plans with Acceptance Examination) exist to address the risks involved in

polymedication.

9%

5%

9%

47%

9%

5%

9%

30%

no medications

1– 2 medications

3 medications

4 medications

5 or more

medications

One Person in Four is Affected by Polymedication23 % of all adult German citizens (15 million) take three or more medications on a regular basis.

Problems with Polymedication Type of Medications

Yes 40 % only prescription medications 71 %

No 60 % also non-prescription medications 29 %


QUALITY ASSURANCE

RISKS INVOLVING PHARMACEUTICAL MISUSE

Approximately 4 to 5 percent of all prescribed pharmaceuticals in Germany are associated with abuse, misuse

or potential for dependency. The total number of those affected is estimated at 1.4 to 1.5 million. Dependency

on sleeping aids and sedatives is most common. A differentiation must be made, for substances which lead

to a physical dependency, between addiction (dependence) and misuse. For substances which do not lead to

physical dependence, only misuse is possible. In terms of the entire range of products, 10 to 12 percent of all

self-medication packages contain ingredients with a potential for misuse. 1 percent of the population and 5 to

8 percent of those suffering from headaches misuse analgesics (painkillers) by taking them too often or taking

dosages which are too high. Taking these medications too often can lead to painkiller-induced headaches.

Experience with Consumption of Prescription-only Medicationswithout Medical Necessity *

56 %

1 %

26 %

17 %

43 %

2 %

25 %

30 %

Willingness to Consume Prescription-only Medicationswithout Medical Necessity *

0 5 10 15 20 25 30 35

13 % 20 %

5 % 22 %

3 % 10 %

2 % 9 %

0 5 10 15 20 25 30 35 40

13 % 26 %

19 %19 %

9 % 11 %

5 % 11 %

to improve mood or to reduce

fear / nervousness

to improve mental performance

to improve physical appearance

to improve physical performance

no, but it is possible /

imaginable

yes

don’t know

no, not imaginable


imaginable

yes

* Survey of 5008 Germans aged between 16 and 70 performed by Forsa for ABDA. The survey was conducted between December 15,

2017 and January 5, 2018.

Sources: Bundesapothekerkammer, Deutsche Hauptstelle für Suchtfragen (DHS), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH


QUALITY ASSURANCE

Experience with Consumption of Non-prescription medications without Medical Necessity *

56 %

1 %

26 %

17 %

43 %

2 %25

%

30 %


imaginable

yes

don’t know

no, not imaginable

0 5 10 15 20 25 30 35

13 % 20 %

5 % 22 %

3 % 10 %

2 % 9 %

0 5 10 15 20 25 30 35 40

13 % 26 %

19 %19 %

9 % 11 %

5 % 11 %

to improve mood or to reduce

fear / nervousness

to improve mental performance

to improve physical appearance

to improve physical performance

Willingness to Consume Non-prescription medications without Medical Necessity *

no, but it is possible / imaginableyes

* Survey of 5008 Germans aged between 16 and 70 performed by Forsa for ABDA. The survey was conducted between December 15,

2017 and January 5, 2018.

Sources: Bundesapothekerkammer, Deutsche Hauptstelle für Suchtfragen (DHS), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH


QUALITY ASSURANCE

PHARMACEUTICALS FOR SERIOUS ILLNESSES

Recently, innovative pre-packaged pharmaceuticals have played an increasingly important role in treating

illnesses such as cancer (oncology) or autoimmune disorders (immuno suppressive drugs) The costs are

presented alongside their respective therapeutic uses. Specially formulated, individually prepared formulations

(cytostatics) are used in oncology treatments alongside pre-packaged pharmaceuticals. In addition, there

are also parenteral solutions; some of which with monoclonal antibodies. The manufacture of these special

formulations is subject to special technical requirements. The stipulations of section 35a of the Ordinance on

the Operation of Pharmacists (ApBetrO) are met, across Germany, by roughly 300 pharmacies by means of

a special clean room laboratory.

0

1,000

2,000

3,000

201720162015

2,53

12,

497 2,82

9

2,57

9

3,18

52,

696

0

1,000

2,000

3,000

4,000

201720162015

3,29

12,

966

3,76

8

3,07

5

4,38

8

3,64

7

Immuno Suppressive

Cytostatic Agents

Oncology

Dispensed in community pharmacies at the expense of SHI: Special Formulations

Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI), Arzneiverordnungsreport (AVR)

Volume in thousands of packagesSales in million euros

2014 2015 2016

Prescriptions

(millions)

Sales

(million euros)

Prescriptions

(millions)

Sales

(million euros)

Prescriptions

(millions)

Sales

(million euros)

Cytostatic Preparations 2.4 1,255 2.4 1,232 2.4 1,245

Parenteral Solutions 1.1 1,812 1.1 1,966 1.2 2,388

of which:

with monoclonal

antibodies 0.6 1,620 0.6 1,776 0.8 2,199

Dispensed in community pharmacies at the expense of SHI: Pre-packaged Pharmaceuticals



SPEZIFISCHE VERSORGUNGSBEREICHE

MEDICAL CANNABIS

Doctors have been allowed, since March 10, 2017, to prescribe medical cannabis in individual cases as part of

their therapeutic freedom. All pharmacies are allowed to create and dispense corresponding medications on

prescription. Cannabis can be prescribed in various forms. These include the plants’ flowers or as an isolated

main ingredient Dronabinol, also known as “THC”. The doctor decides the form and dosage. Pharmacists provide

their patients with appropriate direction when dispensing the prescribed medication. When authorisation has

been granted, health insurance funds cover the costs of the medication as prescribed by doctors.

Number of

Prescriptions

Number of Units

Dispensed

Preparations containing cannabis and unprocessed

cannabis flowers 26,718 44,224

Pre-packaged pharmaceuticals containing cannabis 34,154 35,821

Total 60,872 80,045

Cannabis Prescriptions for SHI Insured 2017




ANTIBIOTICS

Antibiotics are essential in treating bacterial infections. Incorrect or excessive use leads, however, to the

develop ment of resistant bacterial strains. Certain antibiotics have no effect on these resistant varieties.

The proper handling of antibiotics includes using them only when and as prescribed by a doctor. The use

of antibiotics in Germany has been on the decline since 2013.

Oral Antibiotics

Oral antibiotics dispensed in community pharmacies at the expense of SHI. Prescriptions from dentists are not taken into account.

Source: Insight Health GmbH & Co. KG

Defined Daily Doses per 1,000 insured (DDD)

0

3

6

9

12

15

12.612.812.814.113.1

20162015201420132012



ANTIDIABETICS

Approximately 6.7 million people are currently living with diabetes mellitus in Germany. About 95 percent suffer

from type 2 diabetes. The progression and prognosis of diabetes is significantly dependent upon the actions

of the individual patient. Diabetic patients receive medication from community pharmacies and, upon request,

provided consultation and monitoring while using the pharmaceuticals.

Active Ingredients Used Mainly in the Treatment of Diabetes

2017 (rounded)

Volume per 1,000

SHI Insured

Sales per 1,000

GKV Insured

Biguanide 124 1,900 €

Fast working insulin and analogues 82 9,400 €

Slow working insulin and analogues 53 6,900 €

DPP-4 inhibitors 32 3,600 €

Combinations of oral antidiabetics 32 4,300 €

Sulphonylureas 20 400 €

Combination of fast working and intermediate or slow

working insulins and analogues 17 1,600 €

SGLT2 inhibitors 14 2,000 €

Intermediately working insulin and analogues 14 1,100 €

GLP-1 receptor agonists 9 2,700 €

Other 4 200 €

All Antidiabetics 400 34,000 €

Antidiabetics dispensed in community pharmacies at the expense of SHI.

Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI), Deutscher Gesundheitsbericht Diabetes 2018



2015 2016 2017

Packages dispensed in millions 25.1 25.2 23.8

Quantity in millions 1,311 1,314 1,235

Sales in million euros (incl. VAT) 705.3 695.2 630.5

BLOOD SUGAR TESTING STRIPS

Several million patients live with Diabetes in Germany. Pharmacies play a role in the care and supply of these

patients’ needs. This includes not only dispensing pharmaceuticals, but also the supply of blood-sugar testing

devices and the accompanying testing strips. The pharmacists’ associations have, accordingly, concluded

state and nation-wide supply contracts with the health funds and insurers.

Blood-sugar testing strips dispensed in community pharmacies at the expense of SHI (excluding in-office / consultation needs).




CONSULTATION-INTENSIVE PHARMACEUTICALS

In 2017, pharmacies dispensed more than 190 million pharmaceuticals which, independent of their active

ingredients, required high levels of consultation due to their dosage form. This represents about 30 percent of

all pre-packaged pharmaceuticals dispensed at the expense of statutory health insurance funds. One example

of complex, intensive consultation can be seen in the case of an asthma spray where the inhaler’s proper use

must be demonstrated.

3.6 % Pharmaceuticals for injection

13.9 % Pharmaceuticals, which may not be separated / split *

3.4 % Pharmaceuticals for inhalation

2.0 % Other

0.9 % Pharmaceuticals for rectal application

1.5 % Pharmaceuticals for nasal application

1.6 % Pharmaceuticals which must be prepared

(e. g. dry syrups)

2.6 % Pharmaceuticals for application

at the eyes

All SHI Pre-packaged Pharmaceuticals 2017 (648.4 sales volume in millions of packages)

* Dosage forms such as medications which are enteric coated or retard-pharmaceuticals

which should not be split / separated without consulting a doctor or pharmacist


All dosage forms requiring complex, intensive consultation: 29.5 %



PHARMACEUTICALS WITH SPECIFIC REQUIREMENTS

Certain pharmaceuticals are subject to special requirements. For instance, narcotics (strong painkillers) require

a special prescription and documentation in order to avoid misuse or undesired effects. The same is true of

pharmaceuticals containing Thalidomide (T-Prescription). There are also special regulations in place to ensure

the safety and quality of temperature sensitive pharmaceuticals.

Sales Volume in Packages 2015 2016 2017

Narcotics (Pre-packaged Pharmaceuticals) 10.2 million 10.5 million 10.5 million

Narcotics (Formulations) — — 6.8 million

Pharmaceuticals prescribed on a T-prescription basis 44,000 53,000 62,000

Refrigerated articles (storage temp. max. 8° C) 19.0 million 19.3 million 19.5 million

Temperature sensitive pharmaceuticals * 8.2 million 8.4 million 8.2 million

* must be cooled to between 2° C and 8° C, without interruption, during the entire delivery and storage chain process (e. g. vaccines)

Pre-packaged pharmaceuticals and vaccines dispensed in community pharmacies at the expense of SHI.




* inter alia respiratory illnesses

** mainly gastrointestinal illnesses

*** skin-related illness remedies


OTC PHARMACEUTICALS: LEADING INDICATION AREAS

OTC (over the counter) medications are non-prescription, freely saleable medications sold mainly for use in

self-medication. Consultations are, in these situations, particularly important as they allow for the opportunity

to re-examine the patient’s diagnosis of their own ailment. Large variations in demand are common due to

seasonal fluctuations in cold and flu viruses or pollen allergies.

25.2 %

23.8 %

12.7 %

10.7 %

7.0

%

20.7 %

31.7 %

18.1%17.9 %

10

.4 %

4.7

%

17.2 %

25.2 %

23.8 %

12.7 %

10.7 %

7.0

%

20.7 %

31.7 %

18.1%17.9 %

10

.4 %

4.7

%

17.2 %

Alimentary System

+ Metabolism **

1.1 billion euros (without VAT)

Alimentary System

+ Metabolism **


Sales 2017total 4.8 billion euros

(without VAT)

Sales 2017total 632 million

packages

Respiratory System *


Respiratory System *


All Other Indication Areas


All Other Indication Areas


Muscular and Skeletal Systems


Muscular and Skeletal Systems

33 million packages

Dermatology ***


Dermatology ***

66 million packages

Nervous System


Nervous System




Sales Development

Sales Volume Development


NON-PRESCRIPTION PHARMACEUTICALS SPECIAL TREATMENT SERVICES AND THERAPIES

Extra-ordinary types of therapies covered by the Medicinal Products Act (AMG) include herbal, homeopathic and

anthroposophical medications. The non-prescription medications (incl. healthcare products) are popular and in

high demand in pharmacies.

2015 2016 2017

Herbal Medicines 966 961 974

Homeopathic Medicines 412 405 392

Anthroposophical Medicines 92 89 87

2015 2016 2017

Herbal Medicines 102 99 99

Homeopathic Medicines 43 41 37

Anthroposophical Medicines 9 9 9

in million euros (without VAT)

in millions of packages



GREEN PRESCRIPTIONS

A green prescription is a way for a patient’s doctor to recommend a non-prescription medication. The patient

must pay for the medication themselves in the pharmacy, but the prescription contains a notification that it may

be submitted to many health insurance funds for reimbursement as part of their coverage programme. On all

accounts, the green prescription serves patients as a good reminder of the doctor’s recommendation, active

ingredient and dosage form.

Dispensing of Non-prescription Medications 2017

Distribution of Green Prescriptions Doctor Type 2017 *

45.7

%

31.6 %22.7 %

2017148.6 million

packages

Green Prescription

Private Prescription

SHI Prescription

All Physician Groups

Ear, Nose, and Throat Specialists

Dermatologists

General Practitioners **

Gynaecologists

Paediatricians

Urologists

Orthopaedists

Internists Pneumology

Specialisations ***

Neurologists / Psychiatrists

68 %

84 %

77 %

76 %

73 %

72 %

66 %

54 %

42 %

38 %

23 %

* percentage of per specialist type for doctors which prescribed at least one green prescription in the 4th quarter of 2017

** general practitioners, internal specialists and doctors working as GPs

*** cardiologists, gastroenterologists, rheumatologists

Sources: IQVIA Commercial GmbH & Co. OHG (IMS VIP®), Bundesverband der Arzneimittelhersteller e. V. (BAH)



DISPENSING OF EMERGENCY CONTRACEPTIVES

Emergency contraception (“the morning after pill”) has been available without prescription in German pharma-

cies since March 15, 2015. Lawmakers wanted to make this form of contraceptive more readily available to

women. Accordingly, sales figures have risen (as self-medication) while there has been a fall in the number of

doctor’s prescriptions. As is the case with other contraceptives, women have the legal right, until their 21st

birthday, to financial reimbursement by the statutory health funds. In order to claim this, though, they must

have the medication prescribed by a doctor (pink prescription).

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

2017201620152014

96,000

379,000

475,000

49,000

467,000

146,000

662,000

27,000

665,000

65,000

757,000 23,000

732,000

53,000

808,000

Emergency Contraceptive Sales in Community PharmaciesSales in packages (rounded)


without prescription with private prescription with SHI prescription



PROVISION OF MEDICAL AIDS

Pharmacies are, alongside health care supply stores, allowed to supply SHI insured with therapeutic or medical

aids. This usually requires the pharmacy’s participation in a supply agreement between the health insurance

fund and the pharmacists’ association. A requirement for participation is a so-called pre-qualification which

confirms all the necessary conditions for sale of particular types of aids in advance. Approximately 18,000

pharmacies have at least one product-group specific pre-qualification.

Application Aids (e. g. insulin pens) 258

Incontinence Aids (e. g. urine bags) 120

Aids for Compression Therapy (e. g. compression stockings) 98

Measuring Instruments: Bodily Function and Condition (e. g. Lancets and Blood

Pressure Devices) 47

Inhalation and Respiratory Therapy Devices (e. g. nebulisers) 42

Aids for Caregiver Use (e. g. gloves and face masks) 24

Extraction Units (e. g. breast pumps) 20

Vision Aids (e. g. eye pads) 18

Bandages 11

Stoma Articles 9

Orthoses / Splints 6

Other Product Groups 18

Total 671 million euros (incl. VAT)

* individual prescriptions and consultation overhead at pharmacy sales prices


SHI Medical Aid Sales * in Community Pharmacies 2017 in million euros



VACCINES

Statutory health insurance (SHI) spends over one billion euros per year (incl. VAT) on vaccines. These are generally

prescribed on a pink prescription slip by doctors during consultation hours. Flu epidemics and recommendations

from the standing vaccine commission account for seasonal or annual fluctuation.

1 incl. combination vaccines with diphtheria, tetanus etc. 2 incl. combination vaccines with mumps, rubella, chickenpox

Figures reflect only vaccines dispensed by community pharmacies.


0 5 10 15 20 25 30 35

2016

1,2500 250 500 750 1,000

2016

2015

2017

34.5

35.2

12.4 7.3 3.3 3.2 1.90.9 0.8

2.51.3 0.9

12.4 7.8 3.4 3.4 2.00.9 0.7

2.41.3 0.9

34.9

1,170

12.7 7.2 3.3 3.2 2.30.8 0.8

2.51.2 0.9

121 304 192 107 142 30 118 5255 49

2017

1,200

1,229

152 308 191 113 122 32 122 5159 50

151 334 186 122 130 33 109 5361 50

2015

0 5 10 15 20 25 30 35

2016

1,2500 250 500 750 1,000

2016

2015

2017

34.5

35.2

12.4 7.3 3.3 3.2 1.90.9 0.8

2.51.3 0.9

12.4 7.8 3.4 3.4 2.00.9 0.7

2.41.3 0.9

34.9

1,170

12.7 7.2 3.3 3.2 2.30.8 0.8

2.51.2 0.9

121 304 192 107 142 30 118 5255 49

2017

1,200

1,229

152 308 191 113 122 32 122 5159 50

151 334 186 122 130 33 109 5361 50

2015

Influenza

Pertussis (Whooping Cough)¹

Pneumococcus

TBE Meningoencephalitis

Measles²

Rotavirus

Meningococcus

Hepatitis

Human Papilloma Virus (HPV)

Other

Volume in millions of vaccine doses

Sales in million euros (incl. VAT)



There are regional as well as seasonal differences found in vaccination numbers. The higher figures found in the

former East German states are mainly a result of the higher amount of influenza vaccination coverage. Specific

individual states in both the east and west see a higher number of measles vaccinations. The high number of TBE

(Tick-borne Encephalitis) vaccinations in southern Germany can be explained by the spread of the disease there

in the summer months.

* incl. combination vaccines with mumps, rubella, chickenpox

Figures reflect only vaccines dispensed by community pharmacies.


501

447

387

420

403

418

424

466

445

473570

678

688

566584

583

443

133

150

124

163

151

140

157

162

160

153222

344

305

222289

290

124

27

28

26

23

24

31

25

32

29

3424

25

29

3724

22

25

93

50

27

38

14

15

1612

23

19 78

47

60

2125

20

91

Doses of Vaccine Issued at the Expense of SHI per 1,000 SHI Insured in 2017

Measles Vaccine *national average:

25

TBE Vaccine *national average:

45

Vaccine Doses Totalnational average:

462

Influenza Vaccine *national average:

170



PREREQUISITES FOR THE OPERATION OF A PHARMACY

Several requirements must be met to legally operate a pharmacy. These are laid out in the German Pharmacies

Act (ApoG) and the Ordinance on the Operation of Pharmacies (ApBetrO). Many pharmacies far exceed these

minimal requirements to ensure high quality product and customer service as well as general good business

practice.

Source: ABDA – Bundesvereinigung Deutscher Apothekerverbände e. V.

Operating License » licensed pharmacist

» personal management

» 1st hand responsibility

Operational Spaces » min. 110 square meters of floor space

» offices, laboratory, storage, night-time service room

Pharmaceuticals » prescription and pharmacy-only pharmaceuticals as special goods

» pre-packaged pharmaceuticals, formulations and narcotics

» reserves covering at least one week of average demand

Quality Management » pharmaceutical staff incl. technical assistants (PTA), pharmacists,

pharmaceutical engineers

» compulsory QMS system for pharmacy processes

» guidelines of the Federal Chamber of Pharmacists (BAK) and certification

(chamber certificate, TÜV etc.) as orientation

Standby Duty » proper supply of pharmaceuticals to the population

» obligation of constant duty, regular exemption by the pharmacists’ chambers

» notification – at every pharmacy – informing of the nearest, open and operating

pharmacy


OPERATING RESULTS

OPERATING RESULTS FOR THE AVERAGE PHARMACY

Three-fourths of a pharmacy’s average revenue of 2.31 million euros per year are spent on the cost of sales

operations. Payroll and other expenses must be deducted from the remaining gross revenue. Pre-tax earnings

averaged 144,000 euros in 2017. However, this amount does not translate directly into a gross income because

pharmacy owners, as self-employed freelancers, not only deduct from this amount to pay taxes, but also to

make investments and cover their own retirement plans fully.

2015 2016 2017

Net Revenue * in thousands of euros 2,110 2,220 2,315

− Cost of Sales 1,593 1,683 1,760

= Gross Revenue 517 537 555

− Staff / Payroll 225 235 247

− Other Tax-Deductible Expenses 161 165 170

= Fiscal Operating Result (pre-tax profit) ** 136 143 144

of which partial operating result for the SHI *** 80 83 84

of which, subsidies from DAV Night-time and Emergency

Service Fund 5 5 6

* excluding sales tax and SHI markdowns

** incl. subsidies from the night-time and emergency service fund

*** Cost allocation was performed using the 50-50 sales / revenue method.

Source: Treuhand Hannover GmbH (ABDA-Datenpanel)


OPERATING RESULTS

DEVELOPMENT OF PHARMACY REMUNERATION

In 2004, the pharmacy fee was set at 8.10 euros per prescription-only pharmaceutical. In 2013, it was raised,

for the first time in ten years, to 8.35 euros. There is also a 3 percent mark-up on the pharmacy purchase price

as well as a charge of 0.16 euros to support the night-time and emergency services fund. The effective pharma-

cists’ remuneration is reduced by the pharmacy markdown for pharmaceuticals dispensed at the expense of

SHI. This markdown is currently set at 1.77 euros (incl. VAT). Material costs (e. g. energy costs) and personnel

costs (e. g. standard wages) have risen significantly more than remuneration.

Index (2004 = 100)

* pharmacy remuneration per prescription-only pharmaceutical package as per Section 1 of the German Drug Price Ordinance (AMPreisV)

in conjunction with Section 130 of the Social Insurance Code (SGB V)

** provisional

Sources: Bundesministerium für Gesundheit (BMG), Statistisches Bundesamt (Destatis), ADEXA, ABDA-Statistik

90

100

110

120

130

140

150

160

170

2018**20172016201520142013201220112010200920082007200620052004

SHI Revenues167.8

Gross Domestic Product149.1

Negotiated (standard) Wages in Pharmacies128.9

In�ation Rate (CPI)122.2

Pharmacy Remuneration*114.3


OPERATING RESULTS

PHARMACIES BY SALES VOLUME CATEGORIES

Average sales for a pharmacy in Germany amount to roughly 2.31 million euros annually (without VAT). There

are, however, large differences found when comparing individual pharmacies. About 60 percent of pharmacies

do not reach the average sales amount with individual, large pharmacies greatly exceeding it.

Percentage of Pharmacies in %

Sales in million euros (without VAT)

Source: Treuhand Hannover GmbH (ABDA-Datenpanel)

0

3

6

9

12

15

> 5

.00

< 5

.00

< 4

.75

< 4

.50

< 4

.25

< 4

.00

< 3

.75

< 3

.50

< 3

.25

< 3

.00

< 2

.75

< 2

.50

< 2

.25

< 2

.00

< 1

.75

< 1

.50

< 1

.25

< 1

.00

< 0

.75

2.3

5.8

8.9

10.7

10.9

10.6

10.4

8.9

6.8

5.2

4.0

2.8 3.0

1.7

1.5

3.8

1.1

1.2

0.5

Average sales:

2.31 million euros


OPERATING RESULTS

BETRIEBSWIRTSCHAFTLICHE DATEN

supplementary,

pharmacy-typical

products

4.88 billion euros

Pharmacy Sales 2017 (without VAT)49.05 billion euros = 100 %

MEASURED IN SALES FIGURES

9.9 %

pharmaceuticals44.17 billion euros

volume of pharmaceuticals covered by SHI,

private insurance or other

40.48 billion euros

self-medication

3.69 billion euros

not prescribed

3.43 billion

euros

prescribed

1.11 billion

euros


39.36 billion euros

pharmacy-only

pharmaceuticals

(non-prescription)

4.54 billion euros

unrestricted

OTC pharma-

ceuticals

0.26 billion

euros

80.3 % 9.3 %

2.3 %

82.5 % 7.5 %

7.0 %

0.5 %

90.1 %

SALES STRUCTURE AND DISPENSED PACKAGES

Dispensed pharmaceuticals account for more than 90 percent of revenue in pharmacies with supplementary

products commonly found in pharmacies accounting for the remainder. More than 80 percent of sales resulted

from prescription-only pharmaceuticals prescribed by a doctor or dentist.

Sources: Insight Health GmbH & Co. KG, ABDA-Statistik


OPERATING RESULTS

MEASURED IN NUMBER OF PACKAGES


pharmaceuticals 20171,373 million packages = 100 %



volume of pharmaceuticals covered by SHI,

private insurance or other


pharmacy-only

pharmaceuticals

(non-prescription)


self-medication


not prescribed

468 million

packages

prescribed

123 million

packages

unrestricted OTC

pharmaceuticals

41 million packages

54.0 % 43.0 %

8.9 %

62.9 % 37.1 %

34.1 %

3.0 %


OPERATING RESULTS

in billion euros 2015 2016 2017

Pharmacy sales (without VAT) 47.19 48.15 49.05

Prescription-only pharmaceuticals 37.57 38.46 39.36

Pharmacy-only pharmaceuticals (non-prescription) 4.59 4.59 4.54

Prescribed 1.13 1.13 1.11

Not prescribed 3.46 3.46 3.43

Unrestricted OTC pharmaceuticals 0.28 0.28 0.26

Volume of pharmaceuticals covered by SHI, private insurance or other 38.71 39.59 40.48

Self-medication 3.74 3.73 3.69

Supplementary, pharmacy-typical products 4.74 4.83 4.88

in million packages 2015 2016 2017

Pharmaceuticals 1,412 1,408 1,373

Prescription-only pharmaceuticals 748 754 741

Pharmacy-only pharmaceuticals (non-prescription) 620 610 591

Prescribed 128 127 123

Not prescribed 492 483 468

Unrestricted OTC pharmaceuticals 45 43 41

Volume of pharmaceuticals covered by SHI, private insurance or other 876 881 864

Self-medication 536 527 509



OPERATING RESULTS

SUPPLEMENTARY PRODUCTS COMMONLY FOUND IN PHARMACIES

The supplementary pharmacy-typical range of products is made up of all non-pharmaceuticals dispensed and

sold in the pharmacy and includes certain therapeutic aids, dietary supplements, vitamins and minerals or blood

sugar testing strips as well as cosmetics and sunscreen. They account for 9.9 percent of total revenue.

* when not classified as a pharmaceutical


Medical-technical aids and supplies

Eye-related products *

Gastrointestinal *

Other

Vitamins and

minerals

Diet aids and dietetics

Bandaging and

dressings

Diagnostic and measurement devices

(e. g. blood sugar test strips)

Dermatology *

(incl. hygiene products,

cosmetics, sunscreen)

Total: 4.88 billion

euros

Sales 2017 (without VAT)in billion euros

1.05

0.43

0.51

0.

27

0.81

0.65

0.92

0.14

0.10

Total:4.88 billion euros


OPERATING RESULTS

PHARMACY CLIMATE INDEX 2017

Since 2016, pharmacists’ expectations, outlook and planning for the short-term future have also been

collected alongside their quantifiable, commercial results. The survey at hand was conducted prior to

the European court’s October 2016 ruling that foreign mail order traders need not adhere to the Drug

Price Ordinance (AMPreisV) and indicates that small pharmacies and those with low sales volumes

hold particularly pessimistic views of the future.

Do you plan to hire employees in the next two to three years?

Do you plan to dismiss employees in the next two to three years?

0 10 20 30 40 50 60

56.4 %

41.4 %

5.5 %

0 20 40 60 80 100

89.3 %

7.4 %

5.1 %

No, no hiring planned

No, no dismissals planned

Yes, the hiring of

pharmaceutical staff is planned.

Yes, the dismissal of

pharmaceutical staff

is planned.

Yes, the hiring of

non-pharmaceutical

staff is planned.

Yes, the dismissal of

non-pharmaceutical

staff is planned.

Source: TNS infratest / bonsai GmbH


OPERATING RESULTS

0 10 20 30 40 50

23.3 %

30.3 %

37.2 %

34.2 %

32.2 %

53.8 %

19.5 %

20.7 %

14.8 %

11.6 %

0

Do you currently train / educate in your main pharmacy?

No, I am not currently

training / educating anyone.

Yes, one or more

pre-approbation, trainee

pharmacists (PhiPs)

Yes, one or more

pharmaceutical technical

trainees (PTA)

Yes, one or more

pharmaceutical commercial

trainees (PKA)

Yes, other apprenticeships

e. g. student interns or in

other occupations


Total Larger Pharmacies (11 or more employees)


OPERATING RESULTS

APOTHEKENKLIMA-INDEX 2016

If you were planning to sell your (main-) pharmacy or look for a replacement to take over for you in the next two to three years, how many seriously interested parties would you expect to have?

20.8 %

13.6 %

46.3 %

19

.4 %

0.0 %

51.1 %

27.0

%

21.9 %

20.8 %

13.6 %

46.3 %

19

.4 %

0.0 %

51.1 %

27.0

%

21.9 %

Total

Smaller Pharmacies<1 million euros

in sales turnover

0 interested parties

1 interested party

2 – 4 interested parties

5 or more interested parties



OPERATING RESULTS

Do you plan investments in the next two to three years?

0 10 20 30 40 50 60 70

44.5 %

51.9 %

25.3 %

21.7 %

25.2 %

22.6%

13.7 %

9.1%

3.9 %

7.6 %

No, no investments

are planned.

Yes, the renovation /

modification of

pharmacy spaces or

technical facilities.

Yes, the improvement /

expansion of IT

resources.

Yes, other

investments

Yes, opening or

takeover of a

subsidiary pharmacy.


Total Pharmacy owners 50 years of age

and older


OPERATING RESULTS

Which type of economical / business development do you expect for your own (main-) pharmacy in the next two to three years?

32.1

%

3.3 % 22.6 %

8.8 %

33.2 %

3.3 %

10.2 %

18.3 %

26.4

%

41.7 %

32.1

%

3.3 % 22.6 %

8.8 %

33.2 %

3.3 %

10.2 %

18.3 %

26.4

%

41.7 %

Total

Smaller Pharmacies

(4 to 5 employees)

significantly better

somewhat better

unchanged

somewhat worse

significantly worse



OPERATING RESULTS

Which type of economical / business development do you expect for “Pharmacies in general” in the next two to three years?

significantly better

somewhat better

unchanged

somewhat worse

significantly worse

0

25

50

75

100

20172016

37.2 %

39.0 %

11.8 %

11.6 %

44.7 %

19.7 %

25.6 %

9.5 %

0.5 %0.4 %



OPERATING RESULTS


Has the European court’s October 2016 ruling that foreign mail order traders are no longer bound to the Drug Price Ordinance (AMPreisV) influenced your commercial or operative decisions in a negative fashion?

Total

small communities

(less than 5,000

residents)

investments 56.3 % 61.2 %

staff 33.9 % 37.0 %

training 18.9 % 32.7 %

none of the above named 37.1 % 29.0 %


OPERATING RESULTS

Which of the following healthcare-related, political topics do you believe to be most important for the coming two to three years?


0 17 34 51 68 85

83.7 %

73.6 %

72.1 %

75.6 %

67.8 %

67.1 %

38.0 %

40.5 %

29.2 %

28.3 %

24.0 %

22.3 %

23.7 %

27.0 %

23.2 %

24.7 %

1.3 %

1.6 %

planning security (i. e. stable

legal frameworks such as

retention of the Drug Price

Ordinance (AMPreisV)

stable / improved commercial

framework conditions

bureaucracy reduction

recruitment and fostering of

trainees / apprentices

introduction of “medication

management” and other

remunerated pharmaceutical

services

improved cooperation

with doctors

improved cooperation with

insurers and healthcare funds

more flexibility and leeway

regarding patient care / supply

other than the aforementioned

2017 2016


OPERATING RESULTS

LEGAL NOTICE

Publisher

ABDA – Federal Union of German

Associations of Pharmacists

Unter den Linden 19–23

10117 Berlin, Germany

www.abda.de

Design

Cyrano Kommunikation GmbH

Hohenzollernring 49–51

48145 Münster, Germany

Production

Köllen Druck + Verlag GmbH

Hessische Straße 11

10115 Berlin, Germany

Print

October 2018


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