Spanish pharmacists fight plans to increase sale of over the counter drugs
Authors: Xavier Bosch
Journal: BMJ (2001)

Spanish pharmacists, worried about recent developments by the health ministry to contain spending on drugs, are trying to prevent the authorisation of sales of over the counter medicines in shops and supermarkets.

In a meeting held last week in Granada, Andalucia, the Forum for the Defence of the  Model of Pharmacy announced that it had already gathered 160 000 signatures since early January in support of a call on the government not to liberalise the sale of drugs. The forum brings together the official colleges of pharmacists of Valencia, Almeria, and Cordoba, along with 3000 health and pharmacy professionals.

The Spanish parliament told the forum that it has to gather at least 500 000 signatures in six months for discussion of the Basic Principles of Drugs bill, drawn up by the Official College of Pharmacists of Valencia and submitted to the parliament last November. This bill intends that medicines should be maintained as an essential good of universal interest and not as merchandise and that drugs should be sold only by pharmacies.

Mr Javier Climent, member of the board of directors of the college, said that the objective was to consolidate the current model of pharmacy in Spain and to face the head-on attack against our pharmaceutical model—that is, the liberalisation of our model. He believes there are currently powerful distribution companies and lobbies in Spain that are pressurising the government to get control of over the counter drugs so that these can be sold in supermarkets ithout the supervision of the pharmacist.

In his opinion, and in the opinion of the forum, the Spanish model of pharmacy is an example of the Mediterranean model of pharmacy, which considers that medicines are basic essentials. The model is based on a higher number of pharmacies per inhabitant, homogeneous and low prices nationwide, a direct and personalised sale, and the possibility of acquiring drugs all night and on public holidays without charging extra.

By contrast, other liberalised models, such as the US model, would give priority to commercial aspects over the consideration of the public service, argued Mr Climent. He said that Spain has one pharmacy per 2065 inhabitants, France has one per 2500 inhabitants whereas, Chile—an example of a liberalised model—has one per 35 000 inhabitants.

The move by the forum follows a royal decree approved last June calling for urgent measures to contain pharmaceutical expenditure. These measures included several liberalising steps, such as a reduction of benefit margins and the possibility of applying up to 10% discounts in over the counter agents. In addition, last year a Spanish organisation of food distribution companies announced plans to sell non-prescription drugs in supermarkets on grounds that these have a similar status as breast milk substitutes, whose sale had been liberalised in 1994.

The forum argues that the sale of non-prescription drugs in supermarkets may have hugely negative health consequences as it would probably lead to an increase in the number of hospital admissions related to self medication.

The General Council of Pharmaceutical Colleges estimates that up to 25% of emergency visits to hospitals are due to adverse events, interactions, and overdoses (mainly as consequence of suicide attempts). Experts argue that the sale of over the counter drugs in shops and supermarkets would initially lower prices and would lead to the closing of many small pharmacies.