about the abda

ABOUT THE ABDA

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

pharmacists 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).

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

professions (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. Since the Pharmacy Strengthening Act (VOASG) came into

force in December 2020, mail order pharmacies have been prohibited from offering discounts on prescrip-

tion drugs to SHI-insured patients. The amendment to § 129 German Social Code V (SGB V) thus restored

equal pricing / nationwide fixed prices between community pharmacies and mail order pharmacies. In con-

trast, 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 2021GERMAN PHARMACIES – FIGURES, DATA, FACTS 2021 32

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

Pharmacies in the Pandemic Response .............................................................................................................. 10

Night-Time and Emergency Service ..................................................................................................................... 12

Formulations ....................................................................................................................................................... 14

Standard Formulations ........................................................................................................................................ 15

Delivery Services ................................................................................................................................................. 16

Digital Pharmacy ................................................................................................................................................. 17

Telematics Infrastructure and the e-prescription .................................................................................................. 18

PHARMACY LANDSCAPE

Number of Pharmacies ........................................................................................................................................ 19

Number of Pharmacies by German Federal State ............................................................................................... 20

Geographical Coverage ....................................................................................................................................... 21

Subsidiary Structure ........................................................................................................................................... 22

Specific Types of Pharmacies .............................................................................................................................. 23

Mail Order Trade ...................................................................................................................................................24

EMPLOYMENT IN PHARMACIES

Number and Age of Pharmacists ......................................................................................................................... 25

Jobs in Pharmacies ............................................................................................................................................ 26

Personnel Planning .............................................................................................................................................. 27

Trainee Positions in Pharmacies ......................................................................................................................... 28

Pharmacy Students and Approbations ............................................................................................................... 29

Places of Study ................................................................................................................................................... 30

Continuing Professional Education and Postgraduate Specialisation ................................................................... 31

PHARMACEUTICALS IN GERMANY

Pharmaceuticals Approved in Germany ............................................................................................................... 32

Pharmaceutical Price Index ................................................................................................................................ 33

Pricing for Pre-Packaged Pharmaceuticals ......................................................................................................... 34

Pricing for Standard Formulations ...................................................................................................................... 35

PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE

Breakdown of Total SHI Expenditures ................................................................................................................ 36

Miscellaneous Health Insurance Fund Expenditures ............................................................................................ 37

SHI Expenditures for Pharmaceuticals ............................................................................................................... 38

Pharmaceuticals by Price Classes ....................................................................................................................... 39

Pharmacy and Manufacturer Markdowns ............................................................................................................ 40

Rebate Pharmaceuticals ...................................................................................................................................... 41

Patient Co-Payments .......................................................................................................................................... 42

Co-Payment Exemptions .................................................................................................................................... 44

QUALITY ASSURANCE

Guidelines and Working Aids .............................................................................................................................. 45

AMK: Reporting of Pharmaceutical Risks ............................................................................................................ 46

Management of Delivery Shortages .................................................................................................................... 48

Consequences of Delivery Shortages ................................................................................................................. 50

Quality Assurance of Formulations ...................................................................................................................... 52

securPharm ........................................................................................................................................................ 53

Challenges Involving Polymedication .................................................................................................................. 54

Risks Involving Pharmaceutical Misuse ............................................................................................................... 56

SPECIFIC COVERAGE AREAS

Pharmaceuticals for Serious Illnesses ................................................................................................................. 58

Pharmaceuticals with Specific Requirements ...................................................................................................... 59

Antibiotics .......................................................................................................................................................... 60

Antidiabetics and Blood Sugar Test Strips ........................................................................................................... 61

Pain Relievers ...................................................................................................................................................... 62

Consultation-Intensive Pharmaceuticals .............................................................................................................. 63

Medical Cannabis ................................................................................................................................................ 64

OTC Pharmaceuticals: Leading Indication Areas ................................................................................................. 65

Non-Prescription Pharmaceuticals: Special Treatment Services and Therapies .................................................. 66

Green Prescriptions ............................................................................................................................................. 67

Dispensing of Contraceptives ............................................................................................................................. 68

Substitution Therapy .......................................................................................................................................... 69

Provision of Medical Aids and Bandages ............................................................................................................. 70

Vaccines .............................................................................................................................................................. 71


OVERVIEW OF PATIENT CARE AND SERVICES

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

every single pharmacy, but also the nationwide distribution of all 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 statistics, Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH, infas Institut für angewandte Sozialwissenschaft, marpinion GmbH

18,753 community pharmacies provide medication to the population in

Germany.

1 billion patient interactions in community pharmacies every year.

3.3 million patients are served in community pharmacies each day.

300,000 courier deliveries are performed daily.

6 million industrially manufactured pharmaceuticals are inspected

by pharmacists annually.

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

patronize the same pharmacy.

83 % of German citizens trust and have confidence in their pharmacist.

93 % of Germans say they are satisfied, or even very satisfied, with their

local pharmacies.

OPERATING RESULTS

Pharmacies by Sales Revenue Categories .......................................................................................................... 73

Operating Results of the Average Pharmacy ....................................................................................................... 74

Development of Pharmacy Remuneration ........................................................................................................... 75

Future Expectations of Pharmacies ..................................................................................................................... 76

Pharmacy Operation and Investment ................................................................................................................... 79

Sales Structure and Dispensed Packages ........................................................................................................... 82

Supplementary Products Commonly Found in Pharmacies ................................................................................ 85

PHARMACIES AND EUROPE

Professional Language Proficiency Exams for Foreign Pharmacists ................................................................... 86

Pharmacy-Related Legal Stipulations in Europe ................................................................................................. 88

Pharmacy Density in Europe .............................................................................................................................. 90

Value-Added Tax on Pharmaceuticals ................................................................................................................. 91

Comparison of Countries: Vaccination in Pharmacies .......................................................................................... 92

LEGAL NOTICE

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


PHARMACIES’ PROVISION, SUPPLY AND SERVICES

VERSORGUNGSLEISTUNGEN DER APOTHEKEN

PHARMACIES IN THE PANDEMIC RESPONSE

Since the beginning of the Corona pandemic in spring 2020, public pharmacies in Germany have not only

continued to ensure that the nation’s medicinal needs are met but have also taken on several additional tasks.

These not only include protecting against new infections, but also things such as providing home delivery to

patients in home quarantine. Delivery services, disinfection, protective masks, rapid tests, and vaccines – these

represent only a part of the wide and partially new range of services for pharmacies during this pandemic.

Pharmacies were able to adapt to major legal mandates, often within days, to best support their patients

during these difficult times.

Source: ABDA statistics, Apothekenklima-Index 2020 (marpinion GmbH), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH,

infas Institut für angewandte Sozialwissenschaft GmbH

Source: ABDA statistics, Apothekenklima-Index 2020 (marpinion GmbH), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH,

infas Institut für angewandte Sozialwissenschaft GmbH

450 thousand

Delivery services per day (+50 percent) were

performed by local pharmacies during the

first wave of the pandemic in March 2020

to reduce personal contacts.

99.8 percent

of pharmacies were on duty. At the end of

April 2020, only 30 of 19,000 pharmacies

had been forced to close temporarily due to

possible infection among the staff.

16.7 million

unavailable rebate-contract medications

were substituted with replacement

preparations by pharmacists in 2020.

The true scope of the supply

bottlenecks is even larger. 40.6 percent

less time has been spent by pharmacies on the

management of delivery shortages since the start of

the pandemic and the loosening of legal requirements

for dispensing of rebate-contract medications.

25 percent

more revenue with SHI (statutory health

insurance) prescriptions in March 2020

because many patients secured supplies

of their vital medications before the first

lockdown. As a result, sales were lower than

usual in May and June.

19.3 million

doses of flu vaccine were delivered

by pharmacies to physicians and medical

specialists in 2020. The 2019 / 2020 season

ended late and vaccinations began early

in 2020 / 2021.

At least 1 million

doses of corona vaccines per week

have been distributed by pharmacies to

doctors’ practices since Easter 2021 –

at a growing rate, and generally

without any problems.

1,200 pharmacies

perform free-of-charge rapid corona

tests – they can all be found

according to city and postal code at

www.mein-apothekenmanager.de

(April 2021).

510 million

FFP2 protective masks for 34 million

people were procured, prepared and

distributed. Pharmacies were given

this supply mandate between

15 December 2020 and 15 April 2021.

11.0 percent

is the minimum amount of working

time pharmacy employees spend

managing delivery shortages.

5.1 million

litres of disinfectant were produced by the

pharmacies themselves between March and

May 2020 to cover delivery shortages of

industrial products.


PHARMACIES’ PROVISION, SUPPLY AND SERVICES PHARMACIES’ PROVISION, SUPPLY AND SERVICES

Night-time and Emergency Service Shifts in 2020 450,000

of these full shifts (8 p.m. to 6 a.m.) 400,000

partial shifts 50,000

Open Pharmacies per Night-time and Emergency Shift 1,200

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

The performance of emergency and night-time services by each pharmacy varies. This is shown by 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 more than 70 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 financial assistance for the additional

expenditure from the Emergency Service Fund of the German Pharmacists’ Association, which is financed by

the addition of a surcharge on each package of prescription medication dispensed. Apothekenfinder 22 8 33

is a service which helps patients to quickly and easily find the nearest available (emergency) pharmacy.

Source: Night-time and Emergency Service Fund, aponet.de, German Institute for Drug Use Evaluation (DAPI)

Prescriptions without Emergency Service Fees for SHI Insured 2020

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

medication 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, instead, covered by their insurance fund. In 2020, this fee was waived on more

than one million packages for patients with this statutory health insurance exemption.

prescription-only pharmaceuticals

860,000

non-prescription pharmaceuticals

260,000

Total

1,120,000 packages

* As of 1 January 2020, the fixed mark-up to support the night-time and emergency services

fund was raised from € 0.16 to € 0.21 per package of prescription-only pharmaceuticals.

Source: aponet.de, Night-time and Emergency Service Fund

Emergency Service Charge per Full Shift Performed (in euro)

Apothekenfinder 22 8 33

0

150

300

450

4th Quarter3rd Quarter2nd Quarter1st Quarter

291.

88

411.

53

284.

34

345.

36

280.

09

348.

96

292.

81

392.

94

2019

Average: 287 euros

2020 *

Average: 369 euros

www.aponet.de (9,900,000)

Mobile-Web

(1,460,000)

Smartphone app

(420,000) Telephone, Text Message and Mobile (140,000)

Retrievals in 2020:

11.92 million



FORMULATIONS

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

Pharmacies fill this gap by providing individually prepared formulations according to doctors’ prescriptions.

In 2020, an estimated 13 million formulations were prepared for those insured under statutory health

insurance (SHI).

0

3

6

9

12

15

202020192018

1.46

2.17

6.98

2.39

0.1413.14 12.92

1.65

2.11

6.36

2.27

1.56

2.08

6.72

2.35

12.660.21

0.27

Cannabis Preparations

Individually-prepared Parenteral Solutions

Cytostatic Preparations

Preparations for Substitution Therapy

Standard Formulations

in millions

Change in classification and data source compared to the previous year’s publication.

Source: National Association of Statutory Health Insurance Funds (GKV-Spitzenverband), ABDA statistics

STANDARD FORMULATIONS

Each year, pharmacies prepare more than six million standard formulations for SHI-insured patients according

to doctors’ prescriptions. All pharmacies are able to prepare them individually according to the patient’s needs,

whether these are skin creams or fever suppositories. Children, in particular, benefit from this service; for instance,

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

seniors also require “special preparations”.

Standard Formulations by Age Groupsper 1,000 SHI Insured

0

40

80

120

160

122

118

112

69

63

59

66

62

58

115

107

122

86

81

76

Children

(less than 15 years)

Youth

(15 to under 20 years)

Adults

(20 to under 65 years)

Seniors

(65 years and older)

ø All SHI insured

(average)

Source: German Institute for Drug Use Evaluation (DAPI)

2018 2019 2020



DELIVERY SERVICES

Nearly all pharmacies (97.6 %) offer delivery services in particular for, but not only to, immobile patients. This

service is performed approximately 300,000 times daily. At the peak of the first corona outbreak, this number

rose to over 450,000. Consultation regarding the medications occurred either beforehand at the pharmacy, on

the telephone, or by pharmacy staff upon delivery. Since April 2020, a portion of the delivery services can be

billed to statutory health insurance funds due to the creation of a subsidy grant.

* Survey as part of the ABDA-Datenpanels 2020

Source: ABDA-Datenpanel, German Pharmacists’ Association (DAV), German Institute for Drug Use Evaluation (DAPI)

DIGITAL PHARMACY

Digitalisation in the healthcare sector is picking up speed and pharmacies began using information technology

(IT) for their daily work even earlier than other providers. This includes not only ordering medicines from wholesalers

and managing stock levels while implementing rebate contracts. It also involves things such as database-supported

testing of side effects and interactions of medicines or billing with health insurance companies via the computer

centres. The digitalisation of processes and services in the run-up to the pharmacy has also started to gain

momentum – with e-prescriptions, the e-medication plan, or e-patient files. The aim is to improve patient care.

Source: ABDA – Federal Union of German Associations of Pharmacists, ABDATA, securPharm e. V., aponet.de

34 million times per week: medications are scanned in the pharmacies in order

to rule out counterfeit drugs with the help of a data matrix code in the

securPharm system.

15.33 million data sets are stored in the pharmacy computer systems for allocating

rebate contracts to health insurance companies, manufacturers and

pharmaceuticals (January 2021).

11.92 million times per year: patients usually search for the nearest emergency

pharmacy online using the “Apothekenfinder 22 8 33”, where current

opening hours and address details are stored.

550,000contract and pre-qualification checks per week are carried out by

pharmacies on the online contract portal (OVP) to provide their

patients with medical aids.

100,000medications approved in Germany can be called up in the pharmacy

computer systems using their pharmaceutical registration number (PZN)

(January 2021).

19,300different medications (pharmaceutical registration numbers) covered

by health insurance companies are listed as discount medicines

(January 2021).

9,000 images of pre-packaged pharmaceuticals are stored in the ABDA

database to improve drug safety in pharmacies.

Frequency of Delivery Services * 2020

more than once daily 41.7 %

once daily 50.0 %

2 to 3 times weekly 7.8 %

once weekly 0.5 %

Patient Groups Served by Delivery

Billed Delivery Services for SHI Insured 2020 Total: 19,880,000 (ID Code 06461110)

0 10 20 30 40 50 60 70 80

67.7%

60.2%

54.2%

49.8%

13.3%

5.2%

4.4%

3.0%

410,

000

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

DezNovOktSepAugJulJunMaiApr

2,35

0,00

0

2,37

0,00

0

2,43

0,00

0

2,22

0,00

0

2,43

0,00

0

2,45

0,00

0

2,54

0,00

0

2,69

0,00

0

more chronically ill

more mobility-challenged people

more acute cases

shut-in or immobile for other reasons

other

more in-home patients (stationary)

unknown

no change



Source: Apothekenklima-Index 2020 (marpinion GmbH)

SETUP FOR THE E-PRESCRIPTION

The upcoming introduction of the e-prescription is a decisive change for pharmacies. Surveys show that the

attitude towards the e-prescription is ambivalent. Six out of seven pharmacy owners (86.6 percent) fear more mail

order business due to e-prescriptions. Electronic prescriptions will replace the pink paper prescription by 2022.

The technical standards for this are defined by gematik GmbH on behalf of the Federal Ministry of Health (BMG).

What expectations do pharmacy owners associate with the introduction of electronic prescriptions?

Integration into the Telematics Infrastructure (as of March 2021)

More mail order for pharmaceuticals 86.6 %

Less regular customer loyalty 55.4 %

Fiercer competition among community pharmacies 52.8 %

Faster and more comfortable medication supply for patients 36.6 %

Fewer falsified prescriptions 29.2 %

Fewer doctor consultations 18.2 %

Fewer refusals for reimbursements from the health insurance companies 21.4 %

Reduction of unnecessary contacts such as in the Corona pandemic 16.6 %

None of the expectations mentioned 3.6 %

NUMBER OF PHARMACIES

The number of community pharmacies in Germany has been declining since 2009. In 2020, it reached 18,753,

the lowest level since the mid-1980s. Causes include healthcare-related political conditions as well as competition

among individual pharmacies. To date, comprehensive pharmaceutical care for the population continues to be

unthreatened.

Year-end figures

* Pharmacies with an operating licence pursuant to Section 2 of the German Pharmacies Act (Apothekengesetz)

Source: ABDA statistics

17,000

19,000

21,000

23,000

25,000

2020201520102005200019951990

1990 1995 2000 2005 2010 2015 2018 2019 2020

Number of Pharmacies

(incl. subsidiaries) 19,898 21,119 21,592 21,476 21,441 20,249 19,423 19,075 18,753

of which are

Main / Individual

Pharmacies * 19,898 21,119 21,592 20,248 17,963 15,968 14,882 14,473 14,110

Subsidiaries — — — 1,228 3,478 4,281 4,541 4,602 4,643

New Openings — 372 187 326 263 154 97 107 85

Closings — 156 185 242 370 346 422 455 407

Development / Change — +216 +2 +84 −107 −192 −325 −348 −322

90 % of all pharmacies (approx. 17,000) possess the institution cards (SMC-B)

75 % of all pharmacies are linked to the healthcare network of the telematics

infrastructure via roughly 14,000 so-called E-Health connectors (March 2021)

60 % of all pharmacy owners and managers (approx. 11,000) possess the electronic

healthcare professional card (HBA)


PHARMACY LANDSCAPEPHARMACIES’ PROVISION, SUPPLY AND SERVICES

APOTHEKENLANDSCHAFT

NUMBER OF PHARMACIES 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 makeup and the size of the state. The most populous state,

North Rhine-Westphalia, also has the highest number of pharmacies – 3,952 – and is divided into the two

chamber districts of North Rhine and Westphalia-Lippe.

Federal State Community Pharmacies of these Main /

Individual Pharmacies *

of these

Subsidiaries

Number Pharmacy Density **

Baden-Wuerttemberg 2,368 21 1,742 626

Bavaria 3,020 23 2,279 741

Berlin 765 21 601 164

Brandenburg 567 22 415 152

Bremen 140 21 89 51

Hamburg 389 21 282 107

Hesse 1,420 23 1,072 348

Mecklenburg-Western Pomerania 386 24 295 91

Lower Saxony 1,839 23 1,377 462

North Rhine-Westphalia 3,952 22 2,974 978

North Rhine 2,125 22 1,617 508

Westphalia-Lippe 1,827 22 1,357 470

Rhineland-Palatinate 939 23 730 209

Saarland 285 29 229 56

Saxony 952 23 725 227

Saxony-Anhalt 577 26 432 145

Schleswig-Holstein 626 22 472 154

Thuringia 528 25 396 132

Total 18,753 23 14,110 4,643

Year-end figures 2020

* Pharmacies with operating licence pursuant to Section 2 of the German Pharmacies Act (Apothekengesetz)

** Pharmacies per 100,000 residents

Source: ABDA statistics Source: ABDA statistics

GEOGRAPHICAL COVERAGE

On average, there are 23 pharmacies for every 100,000 residents in Germany. There are, however, regional

differences between the Baltic Sea and the Alps: depending on the number of inhabitants, the size and structure

of towns and districts, the density of pharmacies can vary. At present, comprehensive pharmaceutical care for

the population remains guaranteed nationwide.

up to 21

(135 districts)

22 – 24

(137 districts)

25 or more

(129 districts)

Pharmacy Density by Administrative Districts 2020

Pharmacies per

100,000 residents


PHARMACY LANDSCAPE PHARMACY LANDSCAPE

SUBSIDIARY STRUCTURE

At the end of 2020 there were 14,110 pharmacy owners responsible for 18,753 places of business. Expansion,

meaning the opening of subsidiaries, is on the rise. Following the introduction of the SHI Modernisation Act

of 2004, a main pharmacy is now allowed to have up to three additional locations. All main and subsidiary

pharmacies must be in close physical proximity to one another and each subsidiary must have a pharmacist

acting as the manager.

2005 2010 2015 2018 2019 2020

Pharmacies without Subsi-

diaries (Singular Pharmacies) 19,148 15,277 12,851 11,655 11,205 10,811

Main Pharmacies

with One Subsidiary 989 2,057 2,229 2,231 2,257 2,278

Main Pharmacies

with Two Subsidiaries 94 466 612 678 688 698

Main Pharmacies

with Three Subsidiaries 17 163 276 318 323 323

Main / Individual

Pharmacies

20,248 17,963 15,968 14,882 14,473 14,110

Year-end figures


0

4,000

8,000

12,000

16,000

20,000

202020192018201520102005

19,148

1,100

15,277

2,686

12,851

3,117

20,248

17,963

15,968

10,811

3,299

14,110

11,655

3,227

14,882

11,205

3,268

14,473

Pharmacies without subsidiaries Pharmacies with at least one subsidiary

Baden-Wuerttemberg 117 North Rhine-Westphalia 40

Bavaria 138 North Rhine 3

Berlin 0 Westfalia-Lippe 37

Brandenburg 73 Rhineland-Palatinate 74

Bremen 0 Saarland 8

Hamburg 0 Saxony 116

Hesse 158 Saxony-Anhalt 124

Mecklenburg-Western Pomerania 92 Schleswig-Holstein 46

Lower Saxony 105 Thuringia 77

Total 1,168

SPECIFIC TYPES OF PHARMACIES

Hospital pharmacies do not belong to the category “community pharmacies”. All community pharmacies

are owner-operated with some pharmacies legally operated as a general partnership by several pharmacists

(German: OHG). Leased pharmacies also exist on a temporary basis, e. g., when the owner can no longer

operate the pharmacy due to age. To ensure coverage at the local level, prescription collection points can

also be approved, through which prescriptions are transmitted digitally in some cases and supplied by an

authorised pharmacy.

* German: Apothekengesetz (ApoG)

** German: Apothekenbetriebsordnung (ApBetrO)

Source: ABDA statistics, IQVIA Commercial GmbH & Co. OHG

Prescription Collection Points(Section 24 Ordinance on the Operation of Pharmacies) 2020

2018 2019 2020

Hospital Pharmacies (Section 14 German Pharmacies Act *) 375 372 371

Pharmacies Supplying Hospitals (Section 1a Para. 1 Ordinance

on the Operation of Pharmacies **) 169 164 162

OHG Pharmacies (Section 8 German Pharmacies Act) 722 749 754

Leased Pharmacies (Section 9 German Pharmacies Act) 732 657 605

Branch Pharmacies (Section 16 German Pharmacies Act) 11 10 10

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


PHARMACY LANDSCAPE PHARMACY LANDSCAPE

MAIL ORDER TRADE

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

of self-medication, the mail order business has already achieved a double-digit percentage market share.

The market share for prescription pharmaceuticals is considerably lower.

* Valued at the effective sales price

** Without non-pharmaceutical articles

*** Prescription medications account for the majority of SHI expenditures.

**** Professional web shop and listing with price search engines

Source: Insight Health GmbH & Co. KG, Datamed IQ GmbH, Federal Ministry of Health (BMG), ABDA statistics, own calculations

Pharmacies with a Mail Order Trade Licence (Section 11a German Pharmacies Act)

SHI pharmaceutical expenditure ***

3,036Pharmacies with

Mail Order Trade Licence

(Section 11a German

Pharmacies Act)

of which approx. 150 are actively enga-

ged in mail order trade ****

Sales Volume 2020 Sales Revenue * 2020

OTC Pharmaceuticals **Packages

in millions

Change from

Previous Year

Market

Share

Packages

in millions

Change from

Previous Year

Market

Share

Community Pharmacies 547 −11.2 % 80.4 % 5,311 −9.1 % 79.8 %

Mail Order Trade

(Domestic and Foreign) 120 11.1 % 19.6 % 1,341 13.5 % 20.2 %

Change in data source compared to the previous year’s publication.

2016 2017 2018 2019 2020

in million

euros

Market

Share

in million

euros

Market

Share

in million

euros

Market

Share

in million

euros

Market

Share

in million

euros

Market

Share

Community

Pharmacies32,355 98.9 % 33,607 98.8 % 34,384 98.7 % 35,409 98.8 % 37,559 98.8 %

Foreign

Mail Order

Trade 367 1.1 % 407 1.2 % 437 1.3 % 422 1.2 % 457 1.2 %

NUMBER AND AGE OF PHARMACISTS

At the end of 2020, there were over 68,000 working pharmacists in Germany – and the trend is growing.

The overwhelming majority work in community pharmacies. However, pharmacists are also employed more

broadly in the pharma industry, in hospital pharmacies, universities and government agencies. Nearly three

quarters of all licensed pharmacists are women.

Active Pharmacists in: 2018 2019 2020 Percentage of

Women 2020

Community Pharmacies 52,048 52,876 52,996 73.3 %

of which are Head Pharmacists * 15,476 15,067 14,649 49.3 %

Hospital Pharmacies 2,445 2,539 2,677 72.2 %

Industry, Administration, Associations, Science 11,287 11,767 12,183 61.7 %

Pharmaceutical Industry 6,851 7,221 7,436 62.5 %

Federal Armed Forces 228 231 242 36.0 %

Government Agencies and Statutory Corporations 1,009 1,062 1,140 65.8 %

Universities 1,216 1,240 1,307 49.9 %

Educational Institutions and Vocational Schools 494 546 551 80.8 %

Other Areas 1,489 1,467 1,507 61.6 %

Total 65,780 67,182 67,856 71.2 %

Age of Occupationally Active Pharmacists in: total female male

Community Pharmacies 47.2 45.7 51.2

of which are Head Pharmacists 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 46.2 44.8 49.5

* Owners (incl. OHG partners), leaseholders and administrators; excl. employed subsidiary managers

** Last elevation dated 31 Dec. 2014


Average Age of Pharmacists **


EMPLOYMENT IN PHARMACYPHARMACY LANDSCAPE

BESCHÄFTIGUNG IN DER PHARMAZIE

JOBS IN PHARMACIES

More than 160,000 people were employed in community pharmacies in 2020. About one-third of these

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

pharmaceutical commercial employees (PKA).

2018 2019 2020 Percentage of

Women 2020

Pharmacists 52,048 52,876 52,996 73.3 %

Pre-Approbation Trainee

Pharmacists (PhiP) 1,612 1,641 1,656 76.6 %

Pharmacist’s Assistants,

Pharmaceutical Engineers 5,298 4,975 4,661 96.8 %

Pharmaceutical Technical

Assistants (incl. interns) 66,906 68,277 68,765 96.8 %

Pharmaceutical Commercial Employees *33,277 32,819 32,376 98.1 %

Total Number of Positions 159,141 160,588 160,454 89.1 %

* incl. pharmacy assistants, skilled workers, assistants, pharmaceutical assistants and PKA in training

Year-end figures


PERSONNEL PLANNING

In addition to the ascertainable number of employees, plans for hiring and firing in pharmacies also play a role in

the assessment of personnel requirements. More than half of the pharmacy owners plan to hire qualified staff in

the next two to three years. Nine out of ten owners do not plan to lay off employees. Overall, jobs in pharmacies

are therefore very secure.


Are pharmacy owners planning to hire in the next two to three years?

Are pharmacy owners planning layoffs in the next two to three years?

0

30

60

20202019201820172016

52.9

%

44.5

%

6.6

%

5.5

%

6.3

%

56.4

%

55.7

%

42.3

%

8.6

%

45.2

% 53.2

%

10.2

%

54.0

%

44.2

%

41.4

%

No, no recruitment

planned

Yes, recruitment of

pharmaceutical

personnel planned

Yes, recruitment

of non-pharmaceutical

personnel planned

0

19

38

57

76

95

20202019201820172016

90.0

%

7.3

%

3.7

%

5.1

%

4.9

%

89.3

%

90.6

%

88.4

%

6.4

%

9.0

%

3.6

%

89.2

%

7.8

%

4.0

%

7.4

%

No, no layoffs

planned

Yes, layoff of

pharmaceutical

personnel planned

Yes, layoff of non-

pharmaceutical

personnel planned


EMPLOYMENT IN PHARMACY EMPLOYMENT IN PHARMACY

TRAINEE POSITIONS IN PHARMACIES

Pharmacies offer apprenticeships for around 7,300 young people who either complete their practical

training there as part of a dual PKA (pharmaceutical commercial employee) apprenticeship, a school-based

PTA apprenticeship or in the final stage of their pharmaceutical studies. About half of the pharmacies are

currently training staff.

2018 2019 2020

Pharmaceutical Commercial Employees (PKA) in

Training 3,680 3,603 3,504

Pharmaceutical Technical Assistants (PTA) in Training 2,072 2,131 2,119

Pre-Approbation Trainee Pharmacists (PhiP) 1,612 1,641 1,656

Total Number of Trainee Positions 7,364 7,375 7,279

Source: ABDA statistics, Apothekenklima-Index 2020 (marpinion GmbH)

Do pharmacy owners currently provide training in their (main) pharmacy?

No, I am not currently training anyone 56.6 %

Yes, one or more PTA interns 20.4 %

Yes, other apprenticeships 19.6 %

Yes, one or more PKA interns 16.0 %

Yes, one or more PhiPs (pharmaceutical interns) 15.0 %

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 (two years), main studies (two years), and practical training (one year).

Academic Year Students New Students Approbations Promotions

2019 / 2020 16,123 2,780 2,304 362

2018 / 2019 15,986 2,833 2,281 372

2017 / 2018 15,894 2,775 2,233 374

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

Source: Federal Statistics Office (Destatis), State Agencies



Federal State University Registrations Winter

Semester 2019 / 2020

Registrations Summer

Semester 2020

Baden-Wuerttemberg

Freiburg 90 0

Heidelberg 45 0

Tübingen 140 0

Bavaria

Erlangen-Nurnberg 117 0

Munich U 102 100

Regensburg 131 0

Würzburg 69 58

Berlin Berlin FU 75 68

Brandenburg — — —

Bremen — — —

Hamburg Hamburg 63 0

HesseFrankfurt / Main 90 68

Marburg 145 95

Mecklenburg-Western

Pomerania Greifswald 64 64

Lower Saxony Braunschweig 81 70

North Rhine-Westphalia

Bonn 78 77

Düsseldorf 65 65

Münster 85 75

Rhineland-Palatinate Mainz 45 46

Saarland Saarbrücken 32 33

Saxony Leipzig 48 0

Saxony-Anhalt Halle-Wittenberg 135 0

Schleswig-Holstein Kiel 60 60

Thuringia Jena 75 0

Total 1,835 879

Source: Foundation for University Admissions (ZVS)

PLACES OF STUDY

2018 2019 2020

Events 3,241 3,351 2,141

Participants 173,389 187,651 185,122

Area Field

General Pharmacy 9,888 Naturopathy Treatment and Homeopathy 2,263

Clinical Pharmacy 1,819 Nutritional Consultation 2,190

Pharmaceutical Analysis 827 Geriatric Pharmacy 859

Pharmaceutical Technology 526 Prevention and Health Promotion 508

Medication Information 500 Oncological Pharmacy 283

Pharmaceutical Analysis and Technology 251 Infectiology 217

Toxicology and Ecology 202 Care Services 177

Theoretical and Practical Education 100 Medication Management in Hospitals 78

Public Healthcare 75

Clinical Chemistry 4

Specialised Pharmacist Titles – Total 14,192 Field Designations – Total 6,575

Source: Federal Chamber of Pharmacists (BAK)

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

2018 2019 2020

Number of Educational Programmes Completed 536 475 364

Postgraduate Specialisation Completions per Year (by area and field)

Pharmacists with Postgraduate Specialisation (end of 2020)

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 designation

may be used.



Prescription-only Narcotic Pharmaceuticals * 2,370

Pharmaceuticals Requiring a Special Prescription (T-prescription) ** 7

Other Prescription-only Pharmaceuticals 45,510

Pharmacy-only Pharmaceuticals 17,667

Unrestricted OTC Pharmaceuticals 34,911

Total Number of Marketable Pharmaceuticals 100,465

PHARMACEUTICALS APPROVED IN GERMANY

More than 100,000 different pharmaceuticals are governmentally approved in Germany. Each packaging 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 may be granted at either the federal

level in accordance with the Medicinal Products Act (AMG) or at the European level.

* Pharmaceuticals subject to regulations for prescribing narcotics due to their effects (BtMVV), e. g., strong painkillers

** Pharmaceuticals that may only be used under very specific circumstances because of their potential for risk and endangerment, e. g., containing thalidomide

As of: January 2021

Source: Federal Institute for Drugs and Medical Devices (BfArM)

prescription-only pharmaceuticals

47,887


52,578

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 been

on the decline for 15 years while consumer prices have, however, risen continually.

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

Source: AOK Research Institute (WIdO), Federal Statistical Office (Destatis)

2010 2015 202020050

25

50

75

100

125

100.

0

101.

5

103.

2

105.

5

108.

2

108.

6

109.

8

112.

1

114.

4

116.

0

117.

2

117.

8

118.

4

120.

1

122.

3

124.

0

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

86.3

85.1

84.4

124.

682

.1

Pharmaceutical Price Index * Consumer Price Index


PHARMACEUTICALS IN GERMANY PHARMACEUTICALS IN GERMANY

ARZNEIMITTEL IN DEUTSCHLAND

PRICING FOR PRE-PACKAGED PHARMACEUTICALS

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 euros

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

= Pharmacy Purchase Price (AEP) 52.28 euros

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

+ emergency services mark-up (0.21 euros) 0.21 euros

= Net Pharmacy Sales Price (net AVP) 62.41 euros

+ value-added tax (19 % of the net AVP) 11.86 euros

= Gross Pharmacy Sales Price (AVP) 74.27 euros

− statutory co-payment from the insured individual (10 % of gross AVP) 7.43 euros

− statutory pharmacy markdown (1.77 euros) 1.77 euros

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

= Effective Expenditures for Statutory Health Insurance (SHI) ** 61.57 euros

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

** Rebate contracts which reduce costs for statutory health insurance (SHI) are not taken into account.


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 euros

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

+ formulation mark-up for production

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

+ fixed fee 8.35 euros

= Net Pharmacy Sales Price (net AVP) 23.85 euros

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

= Gross Pharmacy Sales Price (AVP) 28.38 euros

− statutory co-payment from the insured individual

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

− statutory pharmacy markdown (1.77 euros) 1.77 euros

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



PHARMACEUTICALS IN GERMANY PHARMACEUTICALS IN GERMANY

BREAKDOWN OF TOTAL SHI EXPENDITURES

Of the more than 260 billion euros that the statutory health insurance (SHI) spent in 2020, the largest percentage

went to hospitals and doctors. Pharmaceutical expenditures (incl. pharmacies) ranked third with 14.3 percent.

At only 2.1 percentage points, the costs of pharmacies and their services in the system continue to decline,

accounting for less than half of SHI administrative expenditure (4.5 percent).

Note. Expenses for integrated care are no longer listed separately. These are now placed within the individual service areas.

* from community pharmacies (excl. foreign mail trade, hospital pharmacies and others)

** preliminary

Source: Federal Ministry of Health (BMG), ABDA statistics

2020 ** 262.64 16.8 5.7 6.9 31.0 4.5 20.9 14.3 2.1

2019 252.25 16.3 6.0 7.0 31.6 4.4 20.8 14.0 2.1

2018 239.27 16.5 6.1 6.7 31.9 4.8 19.7 14.4 2.2

2015 213.67 16.1 6.3 6.4 32.5 4.9 19.0 14.6 2.3

2010 175.99 15.4 6.5 6.0 33.0 5.4 18.1 15.6 2.5

2005 143.81 15.2 6.9 6.2 33.7 5.7 16.3 15.9 2.8

Total SHI Expenditure 2020 **: 262.64 billion euros

Miscellaneous Expenditures 20.9 %

Administrative 4.5 %

Remedies and Medical Aids 6.9 %

Dentists (incl. dentures) 5.7 %

Hospitals 31.0 %

Pharmaceuticals from Pharmacies 14.3 %

of which is pharmacy added-value

share as per Drug Price Ordinance

(AMPreisV) 2.1 %

Doctors 16.8 %

Tota

l SH

I Exp

endi

ture

s

(bill

ion

euro

s)

Doc

tors

of w

hich

in %

Den

tists

(inc

l. de

ntur

es)

Rem

edie

s an

d M

edic

al A

ids

Hos

pita

ls

Adm

inis

trat

ion

Mis

cella

neou

s Ex

pens

esP

harm

aceu

tical

s *

of w

hich

is p

harm

acy

adde

d-

valu

e sh

are

as p

er D

rug

Pric

e

Ord

inan

ce (A

MP

reis

V)

MISCELLANEOUS HEALTH INSURANCE FUND EXPENDITURES

Miscellaneous SHI fund expenditures include, among other things, sick pay, home nursing and travel expenses.

“Pharmaceuticals from Others / Mail Order Trade” refers to overseas mail order pharmacies or health authorities.

“Vaccinations including doctor’s fees” are also included under miscellaneous expenditures.

* 1.0 % corresponds to 2.59 billion euros, of which 457 million euros is attributable to the foreign mail order business (see chapter Mail-Order

Trade). Until 2018, pharmaceuticals from hospital pharmacies were included in miscellaneous expenditures and are now shown separately.


6.1 % Sick Pay

2.8 % Home Nursing

2.7 % Travel Expenses

0.9 % Early Diagnosis

1.0 % Pharmaceuticals from

Hospital Pharmacies

0.7 % Dialysis Material Costs

in Doctor’s Offices

0.8 % Vaccinations incl. Doctor’s Fees

0.6 % Pregnancy, Maternity

0.3 % Services Abroad

2.8% Other

1.0 % Pharmaceuticals from Others / Mail

Order Trade *

1.2 % Outpatient & Inpatient Preventative

and Rehabilitation Benefits

Miscellaneous Expenditures

2020 total: 20.9 %


PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI) PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)

ARZNEIMITTELVERSORGUNG IN DER GKV

SHI EXPENDITURES FOR PHARMACEUTICALS

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

pharmaceutical industry. Expenditures for value-added tax (VAT) on pharmaceuticals exceeded those

for pharmacy services despite the temporary reduction of the VAT for the 2nd half of 2020.

* preliminary

** Pre-packaged pharmaceuticals, formulations and bandaging materials from community pharmacies (excluding foreign mail order and other)


2018 2019 2020 *

In billion

euros

In billion

euros

In billion

euros

Pharmaceutical Industry

and Advance Services

(such as raw materials) 22.46 65.3 % 23.28 65.7 % 25.36 67.5 %

Pharmaceutical Wholesaling 1.10 3.2 % 1.13 3.2 % 1.16 3.1 %

VAT (state) 5.49 16.0 % 5.65 16.0 % 5.59 14.9 %

Pharmacies 5.33 15.5 % 5.35 15.1 % 5.45 14.5 %

Total SHI Expenditures

for Pharmaceuticals **

34.38 100.0 % 35.41 100.0 % 37.56 100.0 %

Pharmacies 14.5 %

VAT (state) 14.9 %

Pharmaceutical Industry and Advance

Services (such as raw materials) 67.5 %

Pharmaceutical

Wholesaling 3.1 %

SHI Expenditures on Pharmaceuticals 2020: 37.56 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.

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

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


0 20 40 60 80 100

2018

2019

2020 89.7 %

90.0 %

90.3 %

8.8 %

0.8 %

0.6 %

0.7 %

0.5 %

0.7 %

0.5 %

8.7 %

8.6 %

0 20 40 60 80 100

2018

2019

2020 24.3 %

25.2 %

25.4 %

10.2 %

9.3 %

9.1 %

34.9 %

33.1 %

31.8 %

30.5 %

32.5 %

33.8 %

8,8 %

8,7 %

8,6 %

0 20 40 60 80 100

2018

2019

2020 89.7 %

90.0 %

90.3 %

8.8 %

0.8 %

0.6 %

0.7 %

0.5 %

0.7 %

0.5 %

8.7 %

8.6 %

0 20 40 60 80 100

2018

2019

2020 24.3 %

25.2 %

25.4 %

10.2 %

9.3 %

9.1 %

34.9 %

33.1 %

31.8 %

30.5 %

32.5 %

33.8 %

8,8 %

8,7 %

8,6 %

to 100.00 euros

to 100.00 euros

100.01 – 500.00 euros

100.01 – 500.00 euros

500.01 – 1,500.00 euros

500.01 – 1,500.00 euros

more than

1,500.00 euros

more than

1,500.00 euros



PHARMACY AND MANUFACTURER MARKDOWNS

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

expenditures for pharmaceuticals. Pharmacies, as well as pharmaceutical manufacturers, must grant mark-

downs 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 pharma-

cist’s fees for each package dispensed at the expense of the SHI. The discount amounts to more than one

billion euros per year.

Source: German Pharmacists’ Association (DAV)

0

300

600

900

1,200

1,500

1,800

202020192018

1,647

1,100

1,522

1,097

1,567

1,109

In million euros

Pharmacy Markdowns

Manufacturer Markdowns

(without rebate contracts)

Rebate Pharmaceuticals: Comparison of 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 32,000 fund-specific rebate contracts

stipulating which insured person can receive which pharmaceutical from which manufacturer. Taking into

account the growing number of these contracts in patient care means a high administrative effort for the

pharmacies, but savings in the billions for the health insurance companies.

Source: ABDATA, Pro Generika e.V., Federal Ministry of Health (BMG), IQVIA Commercial GmbH & Co. OHG

2018 2019 2020

Number of Rebate Contracts at Year’s End 28,000 31,300 32,700

SHI Savings in Year 4.5 Billion Euros 5.0 Billion Euros 5.0 Billion Euros

5.0 billion euros SHI savings from rebate contracts in 2020

32,700 number of rebate contracts at the end of 2020

19,300 number of rebate pharmaceuticals (pharmaceutical registration numbers) at the end of 2020

220 number of pharmaceutical companies involved at the end of 2020

23 % Percentage of rebated, prescription-only pharmaceuticals either exempt from or having reduced co-payments at the end of 2020



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 3.00 euro average due to co-payment ex-

emptions 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, and this figure is rising.


0

2,100

2,200

2,300

202020192018201720162015

2,243

2,084

2,1432,149

2,180

2,212

Patient Co-payments for Pharmaceuticals in million euros

0

2.6

2.7

2.8

2.9

3.0

202020192018201720162015

3.00

2.80 2.80

2.90 2.90

3.00

Average Co-payment per Package in euros




CO-PAYMENT EXEMPTIONS

A hardship provision in section 62 of the Social Insurance Code (SGB V) stipulates a co-payment maximum

limit of two percent of an insured patient’s gross annual income. This is reduced to one percent for chronically

ill persons. One in thirteen of the approximately 73 million SHI insured people in Germany are exempt from

additional co-payments. This ratio has been in decline for years.

Co-payment Exemptions 2014 2015 2016 2017 2018 2019

Chronically Ill Patients in Millions 6.4 6.2 6.0 5.9 5.8 5.5

Other Patients in Millions 0.4 0.3 0.3 0.3 0.3 0.3

Total Number of People Exempt

from Co-payments in Millions 6.8 6.5 6.3 6.2 6.1 5.8

Percentage of SHI Insured Exempt

from Co-payments 9.6 % 9.2 % 8.8 % 8.6 % 8.4 % 7.9%

Source: Federal Ministry of Health (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 that come along with their healthcare profes-

sion. 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 Tests

6. Dosage Forms

7. Diabetes

8. Nutritional Consultation

9. Influenza Vaccination (Model Project)

10. Supply to Care Homes and Centres

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

Materials at: www.abda.de/fuer-apotheker/qualitaetssicherung/leitlinien/leitlinien-und-arbeitshilfen

Source: Federal Chamber of Pharmacists (BAK)


QUALITY ASSURANCEPHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)

QUALITÄTSSICHERUNG

AMK: REPORTING OF PHARMACEUTICAL RISKS

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

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

necessary, issues warnings. This helps greatly in protect consumers and 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: Drug Commission of German Pharmacists (AMK)

2018 2019 2020

Absolute Absolute Absolute Percentage

Change from

Previous Year

Undesired Pharmaceutical Reac-

tions * and Other Reported Issues 2,959 3,110 2,371 27.2 % −23.8 %

Packaging Errors 2,883 3,046 2,652 30.5 % −12.9 %

Galenic Deficiencies ** 1,403 2,141 1,406 16.1 % −34.3 %

Mechanical Errors 1,269 1,335 1,512 17.4 % 13.3 %

Declaration Errors 628 748 499 5.7 % −33.3 %

Other 344 402 267 3.1 % −33.6 %

Total 9,486 10,782 8,707 100.0 % −19.2 %

27.2 %

3.1 %5.7 %

17.4

%

16.1 %

30.5 %

Other

Packaging Errors Galenic Deficiencies **

Mechanical Errors

Declaration Errors Undesired Effects * and

Other Reported Issues

Risks by Pharmaceutical Group

* OTC = Over-the-counter

Source: Drug Commission of German Pharmacists (AMK)

OTC Pharmaceuticals *

Non-pharmaceuticals

Prescription-only

Pharmaceuticals 15.6 %

81.4 %

3.0 %

2020

Absolute Percentage

Prescription-only Pharmaceuticals 7,089 81.4 %

OTC Pharmaceuticals * 1,357 15.6 %

Non-pharmaceuticals 261 3.0 %

Total 8,707 100.0 %


QUALITY ASSURANCE QUALITY ASSURANCE


Percentage of Pharmacy Staff Working

Time Spent Managing Supply Shortages Pharmacy Owners 2019

Less than 1 Percent 1.2 %

1 to 5 Percent 11.2 %

6 to 10 Percent 25.4 %

11 to 15 Percent 24.0 %

16 to 20 Percent 20.4 %

More than 20 Percent 17.8 %

MANAGEMENT OF DELIVERY SHORTAGES

Delivery shortages are a risk to the high-quality supply of medicines, affect different active ingredients and

have been one of the biggest annoyances in the day-to-day operation of pharmacies in recent years – and the

tendency is rising. The majority of pharmacy owners state that more than ten percent of employees’ working

hours are spent on procuring substitute products. In 2020 alone, pharmacists had to make a “divergent filling”

due to “unavailability of rebate pharmaceuticals” for 16.7 million packages.

Percentage of pharmacy owners who consider supply shortages to be one of the biggest annoyances in their daily work.

35.5 %

58.0 %

57.5 %

91.2 %

84.8 %

0 20 40 60 80 100

2016

2017

2018

2019

2020

Unavailable Pharmaceutical Packages 2018 2019 2020

Number of Packages of all SHI Pre-packaged

Pharmaceuticals Dispensed 651,000,000 651,600,000 642,900,000

Number of Packages with Special “not Available” Indicator 9,300,000 18,000,000 16,700,000


Most Common Supply Shortages

by Active Ingredients 2020

Pharmaceutical Grouping

for the Main Indication

Number of Packages

with “not Available”

1 Candesartan Antihypertensive Medication 2,150,000

2 Metformin Diabetes Medication 710,000

3 Pantoprazole Antacid / Acid Blockers 680,000

4 Ibuprofen Pain Relievers 600,000

5 Metoprolol Antihypertensive Medication 510,000

6 Diclofenac Pain Relievers 510,000

7 Venlafaxine Antidepressants 440,000

8 Etoricoxib Pain Relievers 350,000

9 Allopurinol Gout Treatment Medication 340,000

10 Esomeprazole Antacid / Acid Blockers 340,000

All Others 10,070,000

Total 16,700,000In a representative survey from March 2020, pharmacy owners said they had reduced the time spent on

managing supply shortages by an average of 40.6 percent since the German legal requirements concerning

the substitution of available replacement medications had been relaxed (SARS-CoV-2-Arzneimittel-

Versorgungsverordnung / Medicines Provision Act).



CONSEQUENCES OF DELIVERY SHORTAGES

According to surveys, supply shortages have not only become one of the biggest annoyances in the day-to-day

life of pharmacies. Despite all the efforts of local pharmacies, they also lead to a deterioration in the pharma-

ceutical therapy of patients in many cases, as missing preparations cannot be replaced in an equivalent way. This

was confirmed by a reference pharmacy survey conducted by the Drug Commission of German Pharmacists

(AMK) on the range and effects of supply shortages.

How often, in the last three months, have you experienced supply shortages at your pharmacy that, in your opinion, led, or could have led to health issues for the patients involved?

Community Pharmacies Hospital Pharmacies

never 11.4 % 19.4 %

< 5 times 27.6 % 25.0 %

5 – 10 times 28.2 % 33.4 %

11 – 15 times 10.4 % 2.8 %

> 15 times 22.4 % 19.4 %

100 % 100 %

Blood and Hematopoietic

Organs (19.2 %)

Other Indication Areas

(30.8 %)

Antineoplastic and

Immunomodulating

Substances * (11.5 %) Hormones, Systemic

(excl. sexual hormones)

(15.4 %)

Anti-Infectives for

Systemic Dosage

(23.1 %)

Hospital Pharmacies

* For use in cancer therapies

Source: Drug Commission of German Pharmacists (AMK) 2017

Cardiovascular System

(38.0 %)

Other Indication Areas

(12.3 %)

Alimentary

System and

Metabolism

(10.9 %)

Nervous Systems

(19.7 %)

Anti-Infectives for

Systemic Dosage

(19.1 %)

Community Pharmacies

Which observations have you made in your pharmacy in the last three months concerning delivery and supply shortages which have occurred (multiple answers are possible)?

0 15 30 45 60 75

54.9 %72.7 %

56.1 %63.6 %

15.0 %

25.8 %6.1 %

18.8 %21.2 %

39.4 %

20.1 %21.2 %

60.4 %18.2 %

A less suitable pharmaceutical agent

was prescribed (“2nd Choice”).

A less suitable delivery / dosage form

was applied.

Treatment was discontinued.

Patient risk was involved.

Essential therapy was not

possible or was delayed.

The substitute pharmaceutical was

used incorrectly (medication error).

The patient’s therapy was impaired

or interrupted while the substitute

pharmaceutical was being used.

Additional Observations *

* Increased expenditure of time and consultation, increased uncertainty of the patient, etc.

Source: Drug Commission of German Pharmacists (AMK) 2017

Hospital PharmaciesCommunity Pharmacies



QUALITY ASSURANCE OF FORMULATIONS

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

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

by the ZL, which 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. More than a third of pharmacies voluntarily have

their formulations tested at least once a year.

* Community pharmacies and hospital pharmacies (number of participants includes multiple participation by individual pharmacies)

Source: Central Laboratory of German Pharmacists (ZL)

Year Number of Participants

(Formulations Examined)

Number of

Pharmacies *

Participation Percentage

(of Total Number of Pharmacies)

2020 8,709 6,706 35.1

2019 8,899 6,862 35.3

2018 8,945 6,684 33.8

2017 8,600 6,437 32.0

2016 7,733 6,019 29.5

2015 7,674 6,086 29.5

2014 8,079 5,706 27.4

2013 6,578 4,955 23.5

2012 5,877 4,191 19.6

2011 4,845 3,490 16.1

2010 4,738 3,286 15.0

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

SECURPHARM

The European Anti-Counterfeiting Directive came into force in 2019. In Germany, this protective shield against

plagiarised pharmaceuticals is known under the name “securPharm”. While pharmaceutical companies upload

each individual package of prescription drugs into a manufacturer database, pharmacies book each package from

a corresponding system when it is given to the patient. Since every package with serial number and first-opening

protection is unique, a second checkout would trigger a suspected counterfeit alarm that would be thoroughly

investigated. In this respect, “securPharm” makes medications from German pharmacies even

safer than before.

Source: securPharm e. V.

Key Parties 2020

Pharmaceutical Companies 416

Pharmaceutical Wholesalers 708

Community Pharmacies 18,753

Hospital Pharmacies 361

Transactions

per Week

Products Subject

to Serialization

Uploaded

Package Data

2020 34 million 62,465 2.1 billion

2019 20 million 62,404 1.05 billion

securPharm System and Usage in Numbers



* Percent missing to 100 percent = “don’t know”

Source: Forsa Gesellschaft für Sozialforschung und statistische Analysen mbH (survey 2021)

* Percent missing to 100 percent = “don’t know”

Source: Forsa Gesellschaft für Sozialforschung und statistische Analysen mbH (survey 2021)

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

medications. 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.

Prolonged Use of Several Medications 55 % of adults over 70 take three or more medications on a prolonged, regular basis.

None One or Two Three FourFive or

MoreThree or

More (total)

Total 2021 46 % 29 % 9 % 6 % 10 % 25 %

Detailed Results 2021

Men 51 % 24 % 8 % 6 % 11 % 25 %

Women 41 % 35 % 9 % 6 % 9 % 24 %

18–29 Years of Age 66 % 30 % 2 % 1 % 1 % 4 %

30–49 Years of Age 59 % 31 % 5 % 2 % 3 % 10 %

50–69 Years of Age 37 % 31 % 12 % 8 % 12 % 32 %

70 Years and Older 22 % 23 % 16 % 14 % 25 % 55 %

Percentage of Prescription Only Medications Of all medications taken regularly over a prolonged period (3 or more medications) 74 % require a prescription.

AllMore

than Half HalfLess

than Half None *

Total 2021 74 % 20 % 3 % 2 % –


Men 77 % 19 % 2 % 1 % –

Women 71 % 21 % 4 % 3 % 1 %

18–29 Years of Age 63 % 23 % 6 % 6 % 2 %

50–69 Years of Age 78 % 18 % 2 % 1 % –

70 Years and Older 75 % 21 % 2 % 2 % –

Polymedication due to Several IllnessesFour out of five patients are being treated for two or more illnesses.

One Illness Two Illnesses Three IllnessesFour or More

Illnesses *

Total 2021 19 % 36 % 30 % 15 %


Men 20 % 36 % 29 % 15 %

Women 17 % 36 % 31 % 15 %

18–29 Years of Age 32 % 37 % 19 % 10 %

50–69 Years of Age 18 % 36 % 30 % 15 %

70 Years and Older 15 % 35 % 33 % 16 %



* Survey conducted by Forsa on behalf of the ABDA among 5,008 Germans between the ages of 16 and 70.

Data was collected between 15 December, 2017 and 5 January, 2018.

Source: Federal Chamber of Pharmacists (BAK), German Centre for Addiction Issues, Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH

Experience with Consuming of Non-prescription Medications without Medical Necessity *

56 %

1 %26 %

17 %

43 %

2 %

25 %

30 %

No, but it is possible /

imaginable

Yes

Don’t know

No, not imaginable

Willingness to Take Non-prescription Medication without Medical Necessity *

to improve mood or to reduce

fear / anxiety

to improve mental performance

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 physical appearance

to improve physical performance

RISKS INVOLVING PHARMACEUTICAL MISUSE

Approximately four to five percent of all prescribed pharmaceuticals in Germany are associated with the

potential for abuse, misuse or dependency. The total number of affected persons is estimated at 1.4 to

1.5 million. Dependency on sleeping aids and sedatives is most common. For substances which lead to a

physical dependency, a differentiation must be made between addiction 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.

Experience with Consuming of Prescription-only Medications without Medical Necessity *

56 %

1 %

26 %

17 %

43 %

2 %

25 %

30 %

Willingness to Consume Prescription-only Medications without 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 / anxiety

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

No, but it is possible / imaginableYes No, but it is possible / imaginableYes

* Survey conducted by Forsa on behalf of the ABDA among 5,008 Germans between the ages of 16 and 70.

Data was collected between 15 December, 2017 and 5 January, 2018.

Source: Federal Chamber of Pharmacists (BAK), German Centre for Addiction Issues (DHS), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH



PHARMACEUTICALS FOR SERIOUS ILLNESSES

Recently, innovative pre-packaged pharmaceuticals have played an important role, especially oncological

medications (to combat cancer) and immunosuppressants (to combat the body’s own rejection reactions).

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 all these individual formulations is subject to special technical requirements, which are met by around 300

pharmacies throughout Germany using a special cleanroom laboratory in accordance with section 35a of the

Pharmacy Operating Regulations (ApBetrO).

3.9

2.9

4.1

3.1

4.4

3.3

0.0

2.5

5.0

202020192018

4,98

8

3,60

2

5,59

2

4,15

6

5,86

7

4,74

4

0

1,000

2,000

3,000

4,000

5,000

6,000

202020192018

Sales Revenue in million euros

Cytostatic

Sales Volume in millions of packages

Special formulations prepared in community pharmacies at the expense of the SHI system.

Change in data source compared to the previous year’s publication.

Source: German Institute for Drug Use Evaluation (DAPI), National Association of Statutory Health Insurance Funds (GKV-Spitzenverband)

OncologyImmunosuppressants

2018 2019 2020

Prescriptions

(millions)

Sales

(million euros)

Prescriptions

(millions)

Sales

(million euros)

Prescriptions

(millions)

Sales

(million euros)

Cytostatic Preparations 2.2 988 2.1 948 2.1 964

Parenteral Solutions 1.5 2,951 1.6 3,492 1.7 3,952

Including: with

Monoclonal

Antibodies 1.0 2,755 1.1 3,294 1.2 3,759

Pre-packaged pharmaceuticals dispensed in community pharmacies and charged to the SHI.

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. Due to a change in the law since September

2020, roughly 4,000 patients with haemophilia now receive their essential medication from public pharmacies.

Sales Volume in Packages 2018 2019 2020

Narcotics (Pre-packaged Pharmaceuticals) 10.6 million 10.9 million 11.1 million

Narcotics (Formulations) 7.1 million 7.1 million 7.2 million

Pharmaceuticals Prescribed with a T-prescription 81,000 96,000 116,000

Blood Products as per German Transfusion Act

and Haemophilia Preparations 325,000 319,000 460,000

Refrigerated Articles (Storage Temp. max. 8 °C) 19.2 million 19.2 million 19.6 million

Temperature-sensitive Pharmaceuticals * 8.8 million 10.0 million 11.7 million

* Must be kept between 2 °C and 8 °C without interruption during the entire delivery and storage chain (e. g., vaccines)

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


1,600

1,600

2,300

1,500

1,900

2,000

2,500

2,400

8.6

7.8

9.1

6.6

6.5

8.7

10.0

9.1

0 20,000 40,000

Dec

Nov

Oct

Sep

Aug

Jul

Jun

May

Apr

Mar

Feb

Jan

0 20 40 60 80

Dec

Nov

Oct

Sep

Aug

Jul

Jun

May

Apr

Mar

Feb

Jan

28,100

33,500

33,300

37,300

52.1

62.6

65.7

69.4

Haemophilia Preparations 2020

Packages Dispensed Sales (AVP) in millions

Total: 148,100

Total: 316.0


SPECIFIC COVERAGE AREAS SPECIFIC COVERAGE AREAS

SPEZIFISCHE VERSORGUNGSBEREICHE

ANTIBIOTICS

Antibiotics are essential for the treatment of bacterial infections. However, incorrect or excessive use leads to

the development of resistant bacterial strains on which certain antibiotics have no effect. The proper handling of

antibiotics includes using them only as prescribed by a doctor. The use of antibiotics in Germany has been on the

decline since 2013. The stark reductions in 2020 might be explained by a general decline of infectious diseases

as a result of hygiene and distancing measures related to the coronavirus.

Oral Antibiotics

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


Packages Dispensed in Millions

0 5 10 15 20 25 30 35 40

2012

2013

2014

2015

2016

2017

2018

2019

2020

31.3

28.6

21.3

32.8

34.3

35.0

34.7

38.2

36.4

0 100 200 300 400 500 600 700 800

2012

2013

2014

2015

2016

2017

2018

2019

2020

584

542

414

607

635

650

645

700

648

0 5 10 15 20 25 30 35 40

2012

2013

2014

2015

2016

2017

2018

2019

2020

31.3

28.6

21.3

32.8

34.3

35.0

34.7

38.2

36.4

0 100 200 300 400 500 600 700 800

2012

2013

2014

2015

2016

2017

2018

2019

2020

584

542

414

607

635

650

645

700

648

Sales Revenue in Million Euros

ANTIDIABETICS AND BLOOD SUGAR TEST STRIPS

8 million currently live with diabetes mellitus in Germany. Around 95 percent suffer from type 2 diabetes. The

progression and prognosis of diabetes are significantly dependent upon the actions of the individual patient.

Diabetic patients receive their medications from community pharmacies along with ongoing consultation and

monitoring as necessary or requested. This not only includes the dispensing of pharmaceuticals, but also the

supply of blood glucose meters and the dispensing of associated blood sugar test strips. For this purpose, the

pharmacists’ associations conclude supply contracts with health insurance companies on a federal and state level.

2020

Sales Volume per 1,000

SHI insured

Sales Revenue per 1,000

SHI insured

Oral Antidiabetics 245 14,900 €

Insulin 153 18,400 €

Other Subcutaneous ** Antidiabetics 19 5,400 €

All antidiabetics 418 38,700 €

* Antidiabetics dispensed in community pharmacies at the expense of SHI.

** To be injected under the skin

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

Source: German Institute for Drug Use Evaluation (DAPI), German Health Report Diabetes 2021

Active Ingredients Used Mainly in the Treatment of Diabetes *

2018 2019 2020

Packages Dispensed in millions 22.4 20.6 18.9

Quantity in millions 1,158 1,062 973

Sales in million euros (incl. VAT) 584.9 533.5 479.4

Blood Sugar Test Strips ***



CONSULTATION-INTENSIVE PHARMACEUTICALS

In 2020, pharmacies dispensed approximately 181 million pharmaceuticals which – independent of their active

ingredient – required high levels of consultation due to their dosage form. This represents 28 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 proper use of the inhaler

must be demonstrated.

3.6 % Pre-packaged pharmaceuticals for inhalation

13.6 % Pre-packaged pharmaceuticals which may not be divided *

3.5 % Pre-packaged pharmaceuticals

for injection

1.7 % Other

0.7 % Pre-packaged pharmaceuticals for

rectal application


for nasal application

1.4 % Pre-packaged firm pharmaceuticals which cannot simply be swallowed (e. g., efferves-cent, chewable or sublingual tablets)


for application in the eyes

* Dosage forms such as gastrointestinal drugs or delayed-release drugs that should not be divided without consulting the doctor or pharmacist.

German Institute for Drug Use Evaluation (DAPI)

All dosage forms requiring complex, intensive consultation: 28.2 %

PAIN RELIEVERS

Pain relief medications belong to the most commonly used pharmaceuticals. They do, however, carry

the serious potential for abuse (doping, dependency, etc.). Prescription pain relievers – including so-called

narcotics – make up the highest percentage of revenues in euros. At the same time, their sales volume in

packages is lower than that of self-medication products. For non-prescription, pharmacy-only pain relievers –

often tablets or gels – the pharmacy is often the only institution where a patient’s self-diagnosis can be reviewed

and corrected together with a professional. The use of pain relievers for more than a few days is generally

ill-advised, and a visit to a doctor is recommended.

Top 10 Active Ingredients by Volume 2020

prescription-onlyin millions of

packagesnon-prescription

in millions of

packages

1 Metamizole 30.9 Ibuprofen 41.1

2 Tilidine + Naloxone (narcotic) 6.5 Paracetamol 25.0

3 Tramadol 3.0Acetylsalicylic Acid +

Paracetamol + Caffein8.0

4 Fentanyl (narcotic) 2.1 Acetylsalicylic Acid 3.7

5 Hydromorphone (narcotic) 1.5 Acetylsalicylic Acid + Ascorbic Acid 2.9

6 Oxycodone (narcotic) 1.4 Diclofenac 2.7

7 Sumatriptan 1.3 Naratriptan 1.5

8 Oxycodone + Naloxone (narcotic) 1.3 Ibuprofen + Caffein 1.3

9 Morphine (narcotic) 1.2 Paracetamol + Caffein 0.7

10 Tapentadol (narcotic) 1.0 Acetylsalicylic Acid + Paracetamol 0.3

All Others 3.8 All Others 0.8

Total 54.0 Total 88.0

Sales Revenue in million euros

Sales Volume in millions of packages

0

500

1,000

1,500

2,000

2,500

3,000

202020192018

2,5592,5902,451

1,980 2,113 2,102

471477 457 142145144

0

40

80

120

160

200

202020192018

93 92 88

51 53 54

non-prescriptionprescription-only

Dispensing of Pre-Packaged Pharmaceuticals in Public Pharmacies

Source: Insight Health GmbH & Co. KG

All SHI Pre-Packaged Pharmaceuticals 2020 (642.8 million packages)



* incl. also respiratory ailments

** Predominantly gastrointestinal ailments

*** Remedies for skin-related ailments

incl. only that dispended in public pharmacies


OTC PHARMACEUTICALS: LEADING INDICATION AREAS

OTC (over-the-counter) medications are non-prescription, pharmacy-only or freely saleable medications sold

primarily for use in self-medication. Consultations are, in these situations, particularly important as they can

re-examine the patient’s own diagnosis. Large variations in demand are common due to seasonal fluctuations

in cold and flu viruses or pollen allergies.

21.1 %

24.5

%

13.9 %

12.3 %

7.2

%

21.0 %

27.4 %

18.7 %

19.4 %

12

.0 %

4.8%

17.7 %

21.1 %

24.5

%13.9 %

12.3 %

7.2

%

21.0 %

27.4 %

18.7 %

19.4 %

12

.0 %

4.8%

17.7 %

Alimentary System +

Metabolism ** 1.14 billion

euros (without VAT)

Alimentary System +

Metabolism **

102 million Packages

Sales Revenue 2020total 4.52 billion euros

(without VAT)

Sales Volume 2020total 547 million Packages

Respiratory System * 0.95 billion

euros (without VAT)

Respiratory System *


All Other Indication Areas 0.95

billion euros (without VAT)

All Other Indication Areas

97 million Packages

Muscular and Skeletal Systems

0.33 billion euros (without VAT)

Muscular and Skeletal System

26 million Packages

Dermatology ***

0.55 billion euros (without VAT)

Dermatology ***

66 million Packages

Nervous System 0.63 billion

euros (without VAT)

Nervous System


MEDICAL CANNABIS

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

of their therapy. All pharmacies are allowed to create and dispense related medications on prescription.

Cannabis can be prescribed in various forms including the plants’ flowers or as an isolated main ingredient

Dronabinol, also known as “THC”. The doctor determines the form and dosage, and pharmacists provide their

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

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

Cannabis Prescriptions for SHI Insured (Total Units Dispensed)



Preparations Containing Cannabis

and Unprocessed Cannabis Flowers

Pre-packaged Pharmaceuticals

Containing Cannabis

0

100,000

200,000

300,000

400,000

2020201920182017

44,224

35,821

80,045

144,941

54,593

199,534

224,549

62,400

286,949

284,442

68,379

352,821



Sales Revenue

Sales Volume



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. These non-prescription medications (incl. healthcare products) are popular

and in high demand in pharmacies.

2018 2019 2020

Herbal Medicines 991 991 856

Homeopathic Medicines 378 368 325

Anthroposophical Medicines 91 93 86

2018 2019 2020

Herbal Medicines 101 98 80

Homeopathic Medicines 35 32 27

Anthroposophical Medicines 9 9 8

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 patients

must pay for the medication themselves in the pharmacy. However, 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 reminder of the doctor’s recommendation, active

ingredient and dosage form.

Non-prescription Medicines

with a Green Prescription

TOP 10 Pharmaceutical Groups:

Expectorant without Anti-infective Component (R05C)

Topical Nasal Congestion Remedies (R01A)

Pain Relievers (N02B)

Sore Throat Medication (R02A)

Antithrombotic Agent (B01C) *

Constipation Remedy (A06A)

Microorganisms for Diarrhoea (A07F)

Cough and Cold Remedies (R05F)

Dermatological Antimycotics (D01A)

Systemic Antihistamines (R06A)

45.4

23.8

6.5

3.4

2.4

2.3

2.1

1.6

1.5

1.5

1.2

1.4

* Platelet aggregation inhibitors

Source: IQVIA Commercial GmbH & Co. OHG (IMS Diagnosis Monitor)

Prescriptions 2019 in millions



DISPENSING OF CONTRACEPTIVES

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

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 significant fall in the number of

doctor’s prescriptions. As is the case with other contraceptives, women have the legal right, until they turn 22

years of age, to financial reimbursement by the statutory health funds. In order to claim this, though, the medica-

tion must be prescribed by a doctor (pink prescription).

31,000

0 200,000 400,000 600,000 800,000 1,000,000

2015

2016

2017

2018

2019

2020

770,000

820,000

53,000 23,000

27,000

732,000

665,00065,000

49,000

467,000146,000

835,000

808,000

757,000

662,000

19,00046,000

0 5,000,000 10,000,000 15,000,000 20,000,000

2015

2016

2017

2018

2019

2020

11,304,000

11,823,000

12,511,000

13,341,000

3,124,000

3,344,000

3,629,000

3,900,000

14,690,000

14,330,000

13,689,000

15,453,000

16,457,000

17,590,000

261,000

286,000

317,000

349,000

10,199,000 3,896,000

9,230,000 4,255,000

235,000

204,000

877,000

19,00038,000

800,000 848,000

17,000


With Private Prescription With SHI Prescription Without Prescription

31,000

0 200,000 400,000 600,000 800,000 1,000,000

2015

2016

2017

2018

2019

2020

770,000

820,000

53,000 23,000

27,000

732,000

665,00065,000

49,000

467,000146,000

835,000

808,000

757,000

662,000

19,00046,000

0 5,000,000 10,000,000 15,000,000 20,000,000

2015

2016

2017

2018

2019

2020

11,304,000

11,823,000

12,511,000

13,341,000

3,124,000

3,344,000

3,629,000

3,900,000

14,690,000

14,330,000

13,689,000

15,453,000

16,457,000

17,590,000

261,000

286,000

317,000

349,000

10,199,000 3,896,000

9,230,000 4,255,000

235,000

204,000

877,000

19,00038,000

800,000 848,000

17,000

Sales of Contraceptives in Community PharmaciesDispensed Packages (without Emergency Contraceptives)

Sales of Emergency Contraceptives in Community PharmaciesDispensed Packages

SUBSTITUTION THERAPY

Medical substitution therapy is used to improve and stabilise the physical condition of opioid-addicted patients.

The manufacture and dispensing of substituting agents are bound by regulatory requirements and are carried

out by about 2,300 public pharmacies. At the doctor’s request, it can be prescribed that the narcotic should be

administered directly in front of pharmacy staff (so-called visual proof administration). This is a voluntary service

performed by the pharmacies.

* Source: Substitutionsregister 2020 (Substitution Registry)

** Survey of the German Pharmacists’ Association (DAV) in 2018. The number of 2,300 involved pharmacies is an informed estimate.

Source: Federal Institute for Drugs and Medical Devices (BfArM), German Pharmacists’ Association (DAV), National Association of Statutory Health Insurance Funds

(GKV-Spitzenverband)

Substitution Therapy 2020 *

Substitution Treatment in Statutory Health Insurance

Methadone (36.6 %)

1 to 10 Patients (56.6 %)

11 to 30 Patients (20.9 %)

Buprenorphine

(23.4 %)

31 to 100

Patients

(15.4 %)

Morphine

(1.8 %)

Diamorphine (1.2 %)Dihydrocodeine (0.1 %)

Codeine (0.1 %)

more than 100

Patients

(7.0 %)

Levomethadone

(36.8 %)

Substituting Agents 2020: 2.27 million

Prescriptions

Substituting Pharmacies:

2,300 **

2018 2019 2020

Prescriptions in millions 2.39 2.35 2.27

Sales Revenue in millions of euros 86.4 87.4 90.0

Number of Listings

Patients 81,300

Doctors 2,545



PROVISION OF MEDICAL AIDS AND BANDAGES

Pharmacies are, alongside healthcare 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 the sale of particular types of aids in advance. Approximately 18,000 pharmacies

have at least one product-group specific pre-qualification. Another important function of pharmacies is the public

supply of bandages and wound dressings.

SHI Medical Aid Sales * in Community Pharmacies 2020 in million euros

Application Aids (e. g., insulin pens) 285

Incontinence Aids (e. g., urine bags) 120

Aids for Compression Therapy (e. g., compression stockings) 91

Consumable Aids for Caregiver Use (e. g., gloves and face masks) 70

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

Devices) 48

Inhalation and Respiratory Therapy Devices (e. g., nebulisers) 35

Extraction Units (e. g., breast pumps) 22

Vision Aids (e. g., eye pads) 18

Bandages 8

Stoma Articles 6

Orthoses / Splints 5

Other Product Groups 25

Total733 million euros

(incl. VAT)

SHI – Medical Dressings * in Public Pharmacies 2020 in million euros

Modern wound treatment (e. g., hydropolymer dressings) 418

Compresses 121

Bindings 93

Plasters 58

Klebemull Adhesive 23

Bandages 15

Swabs 5

Wadding 5

Other Product groups 19

Total757 million euros

(incl. VAT)* Individual prescriptions and consultation room supplies at pharmacy retail prices


VACCINES

The 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 for use during consultation hours. Flu epidemics

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

large rise in the volume of vaccines in 2020 is attributed to the population’s greater willingness to be vaccinated

against influenza, pneumococci or the varicella zoster virus.

* Incl. combination vaccines with diphtheria, tetanus etc.

** Incl. combination vaccines with mumps, rubella, chickenpox

Figures reflect only vaccines dispensed by community pharmacies.


Sales Volume

in millions of Doses

Sales Revenue

in millions of euros

2018 2019 2020 2018 2019 2020

Influenza (the Flu) 13.4 14.0 19.3 163 173 240

Pertussis (Whooping Cough) * 7.6 7.9 7.5 341 348 320

Pneumococcus 3.5 3.6 5.1 189 191 257

TBE (tick-borne encephalitis) 4.1 4.9 4.3 148 180 154

Measles ** 2.0 2.2 2.8 133 123 162

Varicella Zoster (Chickenpox, Shingles) 0.7 1.4 2.6 32 98 231

HPV (Human Papilloma Virus) 0.7 1.3 1.3 111 203 194

Rotavirus 1.3 1.3 1.2 62 61 59

Meningococcus 0.9 1.0 0.9 35 41 42

Hepatitis 0.9 0.8 0.7 50 48 37

Other 1.3 1.3 1.1 20 20 15

Total 36.4 39.7 46.8 1,284 1,486 1,711



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.

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

carriers there in the summer months.

* incl. combination vaccines with mumps, rubella, chickenpox

Figures reflect only vaccines dispensed by community pharmacies.


614

582

498

636

577

598

610

626

617

602715

845

876

715752

763

624

218

241

192

295

251

256

260

256

267

251324

453

384

305

377

385

217

39

36

34

35

38

42

37

48

39

3829

30

44

4530

30

43

101

55

30

47

16

19

36

16

27

2188

54

117

2529

21

112

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

Measles Vaccine *National

average:

36

TBE Vaccine National

average:

57

Vaccine Doses Total National

average:

620

Influenza Vaccine National

average:

263

PHARMACIES BY SALES REVENUE CATEGORIES

Average sales for a pharmacy in Germany amount to roughly 2.78 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 whereas some individual, large pharmacies greatly exceed it.

Percentage of Pharmacies

Sales Revenue in million euros (without VAT)

Reporting Year 2020

Source: Treuhand Hannover GmbH (Treuhand Data Panel)

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

1.6

2.8

5.3

7.0

8.6

9.5

8.9

8.9

7.7

7.2

5.8

5.0

4.2

2.8 3.

1

6.9

1.9

1.4

1.3

Average Sales Revenue:

2.78 million euros


OPERATING RESULTSSPECIFIC COVERAGE AREAS

BETRIEBSWIRTSCHAFTLICHE DATEN

OPERATING RESULTS OF THE AVERAGE PHARMACY

Three-quarters of a pharmacy’s average annual revenue of 2.78 million euros is spent on the cost of goods

and sales operations. Payroll and other expenses must be deducted from the remaining gross revenue. Profit

before taxes in 2020 averaged 168,000 euros; a number affected by unusual corona virus-related circum-

stances. The remaining amount does not translate directly into a gross income because pharmacy owners,

as self-employed freelancers, not only deduct taxes from this amount but also make investments and cover

their own retirement plans fully.

2018 2019 2020

Net Sales Revenue * in Thousands of euros 2,381 2,587 2,776

− Cost of Goods and Sales 1,815 1,991 2,152

= Gross Revenue 567 596 624

− Staff / Payroll 256 272 280

− Other Tax-Deductible Expenses 173 181 188

= Fiscal Operating Result (pre-tax) ** 144 148 168

of which Partial Operating Result for the SHI *** 83 84 85

of which Subsidies from Night-time and Emergency Service Fund 6 6 8

of which Subsidies for Delivery Services 0 0 4

Note: In 2020, a large pharmacists’ data processing centre was forced to file for bankruptcy. This led to a large number

of pharmacies suffering large, sometimes six-figure, payment defaults. The outstanding claims do not affect the taxable

operating results for this year. Until the final determination of the insolvency rates, these may be accounted for as a value

adjustment in the profit and loss calculations.

* Without 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 (Treuhand Data Panel)

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 an additional 3 percent mark-up on the pharmacy purchase

price as well as a charge of 0.21 euros to support the night-time and emergency services fund. The effective

pharmacists’ 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., negotiated standard wages) have risen significantly more than remuneration.

Index (2004 = 100)

* Pharmacy remuneration per prescription-only package as per section 1 AMPreisV (Drug Price Ordinance) in accordance with section 130 SGB V

** Prognosis

Source: Federal Ministry of Health (BMG), Federal Statistical Office (Destatis), ADEXA, ABDA statistics

90

100

110

120

130

140

150

160

170

180

190

2021**20192017201520132011200920072005

SHI Revenues185.3

Gross Domestic Product (nominal)151.6

Negotiated (standard) Wages in Pharmacies 137.3

In�ation Rate (CPI) 126.5

Pharmacy Remuneration*118.5


OPERATING RESULTS OPERATING RESULTS

0 20 40 60 80 100

83.7 %86.4 %

90.0 %83.6 %

72.1 %74.0 %

79.4 %74.6 %

67.8 %70.7 %

72.2 %72.2 %

38.0 %47.3 %

35.8 %43.4 %

23.7 %17.8 %

34.8 %34.8 %

29.2 %24.3 %

35.6 %34.4 %

24.0 %17.9 %

26.6 %25.4 %

27.6 %

23.2 %19.5 %

25.6 %45.0 %

1.3 %2.8 %

5.0 %3.6 %

Planning Security (i. e., Stable

Legal Frameworks such as

Retention of the Drug Price

Ordinance (AMPreisV)

Stable / Improved Commercial

Framework Conditions

Reduction of Bureaucracy

Recruitment and Fostering of

Trainees / Apprentices

Introduction of “Medication

Management” and Other Remun-

erated Pharmaceutical Services

Improved Cooperation with

Insurers and Healthcare Funds

Improved cooperation with

doctors

Fighting the corona pandemic

with vaccines and therapeutics

More Flexibility and Leeway

Regarding Patient Care / Supply

Other than the aforementioned


2020

2019

2018

2017

Pharmacy Owners’ Assessment of the Most Important Health Policy Challenges in the Next Two to Three Years

FUTURE EXPECTATIONS OF PHARMACIES

Alongside the retrospective assessment of the operating results, future expectations are also decisive for the

evaluation of the overall situation of pharmacies. The industry climate has clouded over in recent years, partly

because of unresolved regulatory issues.


Economic expectations of owners for their own business in the next two to three years

0 5 10 15 20 25 30 35 40

3.3 %

2.0 %

1.8 %

1.8 %

22.6 %

19.4 %

17.0 %

15.2 %

33.2 %

32.3 %

33.0 %

33.4 %

32.1 %

32.8 %

36.6 %

37.2 %

8.8 %

13.4 %

11.6 %

12.4 %

Significantly Worse

Significantly Better

Somewhat Better

Unchanged

Somewhat Worse

2020

2019

2018

2017

Despite the relatively stable average business results of pharmacies, the expectations of pharmacy owners

have gradually deteriorated in recent years. This is partly due to pharmacy remuneration developing below the

inflation rate for a prolonged period. The worsened outlook applies both to expectations for their own businesses

as well as to those of the industry as a whole. One major reason for this is the lack of planning security.



Owners’ Economic Expectations for the “Pharmacy” Industry as a Whole in the Next Two to Three Years

0 10 20 30 40 50

0.2 %

0.5 %

0.2 %

0.2 %

9.5 %

5.9 %

4.6 %

7.0 %

25.6 %

22.6 %

15.4 %

18.8 %

44.7 %

45.7 %

48.6 %

47.6 %

19.7 %

25.5 %

31.2 %

26.4 %


2020

2019

2018

2017

PHARMACY OPERATION AND INVESTMENT

Numerous conditions must be met to operate a community pharmacy. These are listed in the German

Pharmacies Act (ApoG) and in the Ordinance on the Operation of Pharmacies (ApBetrO). They require exten-

sive investments. Many pharmacies far exceed the minimum requirements in terms of quality management,

patient-friendliness and suitability for everyday use. However, this requires still more extensive investments.

Source: ABDA – Federal Union of German Associations of Pharmacists

Operating License » licensed pharmacist

» personal supervision

» sole responsibility

Operational Spaces » at least 110 square metres of floor space

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

Pharmaceuticals » prescription and pharmacy-only medicines as special goods

» pre-packaged products, formulations and narcotic pain relievers

» supply for at least one week of average requirements

Quality Management » pharmaceutical personnel including PTA, pharmaceutical engineers, pharmacists

» mandatory QMS system for processes in the pharmacy

» guidelines of the Federal Chamber of Pharmacists and certification

» (chamber certificate, TÜV etc.) as orientation

Standby Duty » proper supply of medicines to the population

» obligation to be permanently on duty with a scheduled exemption

by the chambers of pharmacists

» posting of information about the nearest pharmacy on duty at every pharmacy

Significantly Worse

Significantly Better

Somewhat Better

Unchanged

Somewhat worse




Investment Planning of Pharmacies

0 10 20 30 40 50

44.5 %

45.1 %

43.2 %

50.0 %

27.0 %

25.2 %

30.4 %

32.4 %

25.3 %

25.1 %

24.0 %

13.7 %

13.9 %

20.2 %

16.0 %

14.4 %

7.6 %

5.5 %

6.4 %

5.6 %

No, no investments

are planned.

Yes, the improvement /

expansion of IT

resources.

Yes, the renovation /

modification of

pharmacy spaces or

technical facilities.

Yes, other investments.

Yes, opening or

takeover of a

subsidiary pharmacy.

2020

2019

2018

2017


Owners’ Assessment of how Many Interested Parties Could Be Expected in the Event of Selling their Pharmacy

0 10 20 30 40 50

13.6 %

16.1 %

19.8 %

19.0 %

21.0 %

19.4 %

25.0 %

26.8 %

46.3 %

44.4 %

43.4 %

42.2 %

20.8 %

18.4 %

11.8 %

12.0 %

No interested parties

One interested party

2–4 interested parties

5 and more

interested parties

2020

2019

2018

2017



Supplementary,

pharmacy-typical

products

5.03 billion euros

Pharmacy Sales Revenue 2020 (without VAT) 56.71 billion euros = 100 %

MEASURED IN SALES FIGURES

8.9 %

Pharmaceuticals

51.68 billion euros

Volume of pharmaceuticals covered by SHI,

private insurance and other

48.20 billion euros

Self-medication

3.49 billion euros

not prescribed

3.20 billion euros

prescribed

1.03 billion

euros

Prescription-only pharmaceuticals

47.17 billion euros

Pharmacy-only

pharmaceuticals

(non-prescription)

4.23 billion euros

Unrestricted

OTC pharma-

ceuticals

0.29 billion

euros

83.2 % 7.5 %

1.8 %

85.0 % 6.2 %

5.6 %

0.5 %

91.1 %

SALES STRUCTURE AND DISPENSED PACKAGES

Dispensed pharmaceuticals account for 91 percent of revenue in pharmacies with supplementary products

commonly found in pharmacies accounting for the remainder. Roughly 83 percent of sales resulted from

prescription-only pharmaceuticals prescribed by a doctor or dentist.

Note: Mail order sales are not taken into account.

Source: Insight Health GmbH & Co. KG, ABDA statistics

MEASURED IN NUMBER OF PACKAGES



Volume of pharmaceuticals covered by SHI,

private insurance and other

849 million packages

Self-medication


65.5 % 34.5 %

not prescribed

407 million

packages

prescribed

100 million

packages

7.7 % 31.4 %

Prescription-only pharmaceuticals


Pharmacy-only

pharmaceuticals

(non-prescription)


Unrestricted OTC

pharmaceuticals

40 million packages

57.8 % 39.1 % 3.1 %

Pharmaceuticals 20201,296 million packages = 100 %



in billions euros 2018 2019 2020

Pharmacy Sales Revenue (without VAT) 50.70 54.10 56.71

Prescription-only Pharmaceuticals 41.03 44.23 47.17

Pharmacy-only Pharmaceuticals (Non-prescription) 4.59 4.64 4.23

Prescribed 1.14 1.14 1.03

not Prescribed 3.46 3.50 3.20

Unrestricted OTC Pharmaceuticals 0.27 0.27 0.29

Volume of Pharmaceuticals Covered by SHI, Private Insurance and Other 42.16 45.37 48.20

Self-medication 3.72 3.77 3.49

Supplementary, Pharmacy-typical Products 4.82 4.96 5.03

in millions packages 2018 2019 2020

Pharmaceuticals 1,363 1,376 1,296

Prescription-only Pharmaceuticals 739 760 749

Pharmacy-only Pharmaceuticals (Non-prescription) 584 577 507

Prescribed 121 118 100

not Prescribed 463 458 407

Unrestricted OTC Pharmaceuticals 40 39 40

Volume of Pharmaceuticals Covered by SHI, Private Insurance and Other 861 878 849

Self-medication 503 497 447



Sales Revenue and Volume

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. This includes certain therapeutic aids, dietary supplements, vitamins and minerals or

blood sugar test strips as well as cosmetics and sunscreen. They account for 8,9 percent of the total revenue.

* when not classified as a pharmaceutical


0.99 billion euros

0.63

billi

on e

uros

0.79 billion euros

0.69 billion euros

0.96

bill

ion

euro

s

euro

s

0.32

billi

on 0.18 billion euros

0.13 billion euros

0.08 billion euros

euros0.26 billionMedical-technical Aids and Supplies

Eye-related Products *

Gastrointestinal *

Foodstuffs Commonly Sold in Pharmacies

(e. g., Cough Drops and Teas)

Other

Nutritional Supplements

* (e. g., Vitamins and

Minerals)

Diet Aids and

Dietetics

Diagnostics and Measurement

Devices (e. g., Blood Sugar Test Strips)

Bandaging and Plasters

Personal Hygiene and Body Care *

(e. g., Skin Products, Cosmetics,

Sunscreen and Disinfectant)

Total: 5.03 billion euros

Sales Revenue 2020 (without VAT)



31 %

69 %

31 %

69 %

18 %

82 %

Other EU Countries

Czech Republic

Hungary

Bulgaria

Poland

Croatia

Greece

Spain

Italy

Romania 2

2

2

1

4

7

5

9

18

15

9

6

4

6

22

11

5

27 29

25

19

14

11

7

7

6

6

31

Other countries

Jordan

Ukraine

North Macedonia

Tunisia

Albania

Bosnia and Herzegovina

Egypt

Syria 165

3

4

8

10

58

5

35

24

17

3

6

46 70

6 14

9

319154

93

34

22

20

12

11

10

116

Source: Federal Chamber of Pharmacists (BAK) Source: Federal Chamber of Pharmacists (BAK)

PROFESSIONAL LANGUAGE PROFICIENCY EXAM FOR FOREIGN PHARMACISTS

There is also labour migration in the field of pharmaceutical supplies. 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 necessary for their profession. This is done using three-part proficiency exams based on the

Common European Framework of Reference of Languages (CEFR). In almost all federal states, the chamber

of pharmacists has been assigned this responsibility by their state authorities.

Number of Examinations and Success Rates

Number of Exam Candidates, Gender Ratios and Countries of Origin 2020

Passed on the First Attempt

Non-EU States

European Union (EU, EEA, Switzerland)

Passed on Subsequent Attempts

Men

Women

337

455

792 total from 65 countries

2018903 Professional

Language Proficiency

Exams

31 %

69 %

31 %

69 %

18 %

82 %

31 %

69 %

31 %

69 %

18 %

82 %

20191,060 Professional


Exams

2020936 Professional


Exams


PHARMACIES AND EUROPE PHARMACIES AND EUROPE

APOTHEKEN UND EUROPA

PHARMACY-RELATED LEGAL STIPULATIONS IN EUROPE

The organisational structures of the multiple healthcare systems within the European Union vary. Accordingly,

the regulative demands and laws concerning the supply and provision of pharmaceuticals also differ from

country to country. Only a minority of states have allowed mail order sales of prescription-only medicines;

in some countries, pharmacies can be owned by third parties (through non-pharmacists, corporations).

Source: Pharmaceutical Group of the European Union (PGEU) Source: Pharmaceutical Group of the European Union (PGEU)

Ban of mail order trade with Prescripion-only Pharmaceuticals

Ban on Third-Party Ownership

Yes

No

No information

Yes

No

No information

Country Rx Mail order Trade Ban Ban on Third-party Ownership

Belgium ✓ ×

Bulgaria ✓ ×

Denmark × ✓

Germany × ✓

Estonia × ✓

Finland × ✓

France ✓ ✓

Greece ✓ ×

Ireland ✓ ×

Italy ✓ ×

Croatia ✓ ×

Latvia N / A N / A

Lithuania N / A N / A

Luxembourg N / A ✓

Malta × ×

Netherlands × ×

Austria ✓ ✓

Poland ✓ ✓

Portugal ✓ ×

Romania ✓ ×

Sweden × ×

Slovakia ✓ ×

Slovenia ✓ ✓

Spain ✓ ✓

Czech Republic ✓ ×

Hungary ✓ ✓

Cyprus ✓ ✓



VALUE-ADDED TAX ON PHARMACEUTICALS

Value-added tax (VAT) on pharmaceuticals varies greatly among the 27 member states of the European Union.

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

Ireland and Sweden have all made certain pharmaceuticals exempt from the tax.

The European Commission’s publication for 2021 was not available by the editorial deadline.

* The VAT rate was temporarily reduced to 16 % in the second half of 2020

Source: European Commission (EC)

Tax Rate for

Pharmaceuticals

in 2020

General VAT tax

rate in 2020

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

Netherlands 9.0 21.0

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

Hungary 5.0 27.0

Croatia pharmaceuticals covered by the SHI;


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

Malta 0.0 18.0

PHARMACY DENSITY IN EUROPE

With 23 pharmacies per 100,000 inhabitants, Germany is in the bottom third of the European comparison

field. The 27 member states of the European Union have an average pharmacy density of 32 pharmacies per

100,000 inhabitants.

* Last available year

** France métropolitaine (excluding overseas territories)

Source: ABDA statistics, Pharmaceutical Group of the European Union (PGEU), national pharmaceutical associations, European Commission (EC)

Greece 88

3,282

840

9Denmark

12Netherlands

14Sweden

15Finland

15Luxembourg

16Austria

16Slovenia

23Germany

23Hungary

24Czech Republic

28Croatia

28Portugal

32France **

36Poland

37Slovakia

38Estonia

38Ireland

43Latvia

42Belgium

46Bulgaria

47Lithuania

49Malta

62Cyprus

32Italy

9,500

Number of Pharmacies *

Pharmacies per 100,000 Residents

22,102

524

221

4,841

8,620

1,317

13,497

ca. 143,000

1,994

498

1,894

2,304

2,547

1,181

2,923

20,736

19,331

819

97

1,397

340

18,753

506

2,000

1,433

47Spain

44Romania

32EU average



COMPARISON OF COUNTRIES: VACCINATION IN PHARMACIES

Worldwide, pharmacists are allowed to vaccinate against influenza in pharmacies in at least 20 countries, including

France, Great Britain and the USA. The aim is to increase the vaccination rate and to ensure basic services in

regions with weak healthcare infrastructure. In Germany, pilot projects for influenza vaccination in pharmacies

have been permitted since 1 March 2020.

Countries where Pharmacists May Vaccinate Against Influenza in Community Pharmacies

Vaccination Permit

Pilot Project

Note: In Switzerland, the vaccination permit is valid in 21 of the 26 cantons.

Source: Pharmaceutical Group of the European Union (PGEU), International Pharmaceutical Federation (FIP), ABDA

Non-European

Countries with

Vaccination Permits

Argentina

Australia

Brazil

Costa Rica

Hong Kong, China

Israel

Canada

Kenya

Lebanon

New Zealand

Paraguay

Philippines

South Africa

USA

Publisher

ABDA – Federal Union of German

Associations of Pharmacists

Heidestrasse 7

10557 Berlin, Germany

www.abda.de

Design

Cyrano Kommunikation GmbH

Hohenzollernring 49 – 51

48145 Muenster, Germany

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