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2010FACTS AND FIGURES

Pharmacies and Pharmaceuticals in Norway 2010

Apotekforeningen

Facts and figures 2010 3

INDEX

Key figures 2009 4

Pharmacies in Norway 5

About the pharmacy trade 6Numbersofpharmaciesanddevelopment 6Wholesalersandpharmacychains 7Employees,trainingandcompetence 8Healthpersonnelinpharmacies 8

The core activities of pharmacies – Good Pharmacy Practice 9Standardsforpharmacypractice 9Prescriptionsandrequisitions 10Selfcare 10Rationalprescribingandmedicineuse 10Healthpromotionandill-healthprevention 10HealthservicesinNorwegianpharmacies 10PharmacistprescribingogTamifluandRelenza 11

Pharmacy finance 12Pharmacyturnover 12Pharmacyturnoverbycommunitypharmaciesandhospitalpharmacies 12Pharmacymarginaccordingtoprescriptiontype 13

Sales of medicines 14Totalsalesbymaincategoriesinpharmacies 14SalesbyATC-group 15The25mostsoldsubstancesaccordingtovalue 16Salesofnon-prescriptionmedicinesinpharmacies 16Non-prescriptionmedicinesoutsidepharmacies–pharmacyturnover 17

Medicine prices 19Priceregulationforon-patentmedicines 19Pricingsystemsforgenericmedicines 19

Price comparisons with other countries 21

Reimbursement of medicines 24Co-payment 24

About the Norwegian Pharmacy Association 25

Facts and figures 20104

TURNOVER• Pharmacies’totalturnover:NOK22.7billion(+4.4%)• Pharmacies’turnoveronmedicinesales:NOK17.6billion

(+2.5%)• Pharmacies’turnoveronprescriptionmedicines:NOK15.5bil-

lion(+2.5%).88percentofallmedicinesales• Pharmacies’turnoveronnon-prescriptionmedicines:NOK2.1

billion(+2.3%).12percentofallmedicinessales.

MedicinesthataregivenreimbursementbyNationalInsuranceScheme(NIS):NOK8.77billion(NISpaysonaverage87.1%)Averageturnoverperinhabitant:NOK3 658(+NOK43)

ATC-code with highest turnover 1. Medicinesfortreatmentofthenervoussystem–TotalNOK

3.4billion(+1.0%inNOK,+2.1%inDDD)2. Medicinesfortreatmentofantineoplasticandimmunomodu-

latingagents–TotalNOK3.0billion(+3.3%inNOK,+4.2%inDDD)

3. Medicinesforcardiovascularsystem–TotalNOK2.2billion(+0.7%inNOK,+3.7%inDDD)

Medicines with highest turnover1. Etanercept(Enbrel):NOK484.3million(-3.5%inNOK,+1.5%

inDDD)2. Salmeteroleandotherremediesforobstructivelungdiseases

(Seretide):NOK345.9million(+6.5%inNOK,+3.5inDDD)3. Infliximab((Remicade):NOK344.2million(-3.2%inNOK,

+1.2%inDDD)

CONSUMPTIONAllprescriptionmedicines:2 102millionDDD(+3.3%)Prescriptionmedicinessoldonprescription:1 999millionDDD(+3.6%)Prescriptionmedicinessoldtoinstitutions:104millionDDD(-1.9%)

ATC-code with highest consumption1. Medicinesforcardiovascularsystem–Total689.9millionDDD

(+0.7%inNOK,+3.7%inDDD)2. Medicinesforuseintreatmentofalimentarytractandme-

tabolism–Total446.6millionDDD(+2.7%inNOK,-1.0%inDDD)

3. Medicinesfortreatmentofthenervoussystem–Total376.2millionDDD(+1.0%inNOK,+2.1%inDDD)

Medicines with highest consumption 1. Acetylsalicylicacid(Albyl-E):120.3millionDDD(+2.5%in

NOK,+2.3%inDDD)2. Simvastatin(Zocor):114.1millionDDD(+10.4%inNOK,+4.4

%inDDD)3. Sodiumfluoride(Flux):89.0millionDDD(-13.8%inNOK,

-15.2%inDDD)

PRICES ON MEDICINESAllmedicines:NOK/DDD+0.8%Prescriptionmedicine:NOK/DDD-0.7%Non-prescriptionmedicine:NOK/DDD+9.4%

KEYFIGURES2009


PHARMACIESINNORWAYSince2001,Norwayhashadaliberalisedsystemofownershipandestablishment.ThePharmacyActwhichwasputintoforceonMarch1st2001isbasedonthefollowingcriteriaforownershipandestablishment:

• Freeestablishmentofpharmacies-noestablishmentcriteria• Freeownershipofpharmacies–anyonecanownpharmacies,

exceptpharmaceuticalmanufacturersanddoctors• Nolimitofthenumberofpharmaciesthatcanbeownedbyone

pharmacyowner–horizontallyintegratedpharmacychainsareallowed

• Verticalintegrationbetweenwholesalersandpharmacies/pharmacychainsisallowed

Atthesametime,thePharmacyActisstricterontheprofessionalregu-lations,withdetailedregulationsandqualitycriteria.

The primary goals of the Pharmacy Act are:• Correctuseofmedicines,bothmedicallyandfinancially• Accessibilityforallpatientstosafeandeffectivemedicines,inde-

pendentofthepatients’financialsituation• Medicinesshouldhaveaslowpricesaspossible


AsaresultofthechangesinthePharmacyAct,thegeneralpublichasconsiderablybetteraccessibilitytopharmacies,asthenumberofpharmacieshasincreasedfrom399inFebruary2001to667asofJune2010.

Nopharmacyinscarcelypopulatedareashascloseddownsincethepharmacyreform.OnereasonforthisisthatthepharmacychainshavesignedanagreementwiththeMinistryofHealthandCareServ-icestoguaranteepharmacycoverageinalargenumberofscarcelypopulatedareas.

In2001,NorwaywassecondlastintheOECDrankingofnumberofinhabitantsperpharmacy.Evenifthenumberofinhabitantsperpharmacyhasfallensharplyafterthederegulation,NorwaystillhasarelativelylowpharmacycoveragecomparedtomanyEuropeancountries.Seefigure1.

NUMBERSOFPHARMACIESANDDEVELOPMENT

ABOUTTHEPHARMACYTRADE


InNorwaywholesalersaredemandedtodeliveracompleteassortmentofmedicinestopharmaciesalloverthecountryinlessthan24hours.

Threelargeinternationalpharmacychains,eachverticallyintegratedwithapharmaceuticalwholesaler,ownapproximately82percentofthepharmaciesinNorway.Thethreepharmacychainsarelinkedtopharmaceuticalwholesalersandinternationalowners:

WHOLESALERSANDPHARMACYCHAINS

Pharmacy chain Wholesaler Owner

Bootsapotek/Allianceapotek AllianceHealthcareNorge AllianceBootsLimited(English)

Vitusapotek NMDGrossisthandelAS CelesioAG(German)

Apotek1 ApokjedenDistribusjonAS TamroOy(Finnish)/Phoenix(German)

Table 1: Structure of ownership.

Alliance apotek/

Boots apotek, wholly owned

Apokjeden/Apotek 1,

wholly owned

Vitusapotek, wholly owned

Public Hospital pharmacies

Independent pharmacies, no chain

connections

Other independent pharmacies with a chain connection

Total

144 231 169 33 20 70 667

Table 2: Number of pharmacies according to ownership by June 2010.

Figure 1: Number of pharmacies and inhabitants per pharmacy in Norway. (Source: The Norwegian Pharmacy Association and Statistics Norway)

Table2showsthedistributionofthenumberofpharmaciesthatare100%ownedbythepharmacychains,hospitalpharmacieswhicharepubliclyownedandotherpharmacieswhichareindependentor,insomecases,minority[par-tially]ownedbythechains.

ByJune1st2010thereare33hospitalpharmaciesinNorway,31ofthemarepubliclyowned.Thehospitalpharmaciesarepartofthespecialisthealthcareservice.Theseareorganisedasindependenthealthauthorities,ownedbytheregionalhealthauthorities.Twoofthesehospitalpharmaciesareownedbycharitabletrusts,whichhaveagreementswiththehealthauthority.

AllthehospitalpharmaciesandseveralofthepharmacieswhicharenotwhollyownedbyapharmacychainaremembersofDittApotek.DittApotekisanagreementbasedchain(purchasingandrangeco-operation)whichNMDGros-sisthandelASofferstopharmacistswhoownandruntheirownpharmacies.

Befolkningstall pr 01.01.0x i Norge (SSB)År Befolkning (SSB pr 01.01.xx) Antall apotek pr 01.01.xx

1996 4 348 410 3551997 4 369 957 3641998 4 392 714 3731999 4 417 599 3842000 4 445 329 3922001 4 478 497 3972002 4 503 436 4612003 4 524 066 5022004 4 552 252 5202005 4 577 457 5352006 4 606 363 5542007 4 640 219 5732008 4 681 134 6132009 4 737 171 6362010 4 799 252 662

300

350

400

450

500

550

600

650

700

7 000

8 000

9 000

10 000

11 000

12 000

13 000

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

Num

ber o

f pha

rmac

ies

Num

ber o

f inh

abita

nts

per p

harm

acy

Number of inhabitants per pharmacy Number of pharmacies


Thepharmaciesareresourcecentresforknowledgeaboutmedicinesandtheircorrectuse.Rationaluseofmedicinescanprevent,alleviateandcureillnessandtherebycontributetogoodhealth.Providingguidanceregardingtherationaluseofmedicines,bothtocustomersandtohealthpersonnel,isanimportantcontributiontothehealthservice.Thepharmacies’customersaretheentirepopulation.Manyofthecustomersareelderly,andmanyneedspecialconsideration,competenceandhelp.

Theprofessionalstaffinpharmaciesconsistsofapharmacymanager,pharmacists,prescriptionists,pharmacytechniciansandsometimesnurses.Pharmacymanagers,pharmacistsandprescriptionistsareentitledtodispensemedicinesaccordingtoprescriptionsandrequisitions.PharmacymanagersandpharmacistsareeducatedasM.Sc.Pharm,prescriptionistsasB.Sc.Pharm.

Thepharmacymanagers,thepharmacists,prescriptionists,pharmacytechniciansandnursesinpharmaciesareauthorisedhealthpersonnel.Throughthelawconcerninghealthperson-nel,theyaresubjecttothelegalframeworkcommonforallgroupsofhealthpersonnel.Thelawconcerninghealthper-sonnellaysdownanumberofdutiesasreflectedinthelawconcerningpatients’rights.Thislegislationincombinationwiththeauthorisationsystemgivesthepublicqualityassurancefortheprofessionalperformanceinpharmaciesandcontributestostrengthenthepatientsafety.Thelegislationfocusesonrequirementsforproperprofessionalconduct,maintenanceofcompetence,rulesregardingsecrecyanddocumentationofhealthaidwhichisrequiredofhealthpersonnel.

Thepercentageofpharmacistman-labouryearshasincreasedfrom31%in2002to41%in2010.Numberofman-labouryearsbypharmacytechniciansisreducedfrom66%in2002to56%in2010.

EMPLOYEES,TRAININGANDCOMPETENCE

HEALTHPERSONNELINPHARMACIES

Number of man-labour years

Cathegory January 1st 2002 January 1st 2010

M.Sc.pharm(managersandpharmacists) 781(16%) 1286(29%)

B.Sc.Pharm(prescriptionists) 758(15%) 1018(18%)

Pharmacytechnicians 3295(66%) 3092(56%)

Others(nursesetc) 175(3%) 162(3%)

Total 5 009 5 558

Table 3: Number of employees in all pharmacies

ByJune1st201020pharmaciesarenotconnectedtoanychainexceptthroughasupplyagreementwithawholesaler.Suchagree-mentsdonothindersuppliesfromcompetingwholesalers,asthePharmacyActallowsallpharmaciestouseanywholesalertheywant.


THECOREACTIVITIESOFPHARMACIES–GOODPHARMACYPRACTICE

UsingWHO’sguidelinesforGoodPharmacyPractice(GPP)inCommunityandHospitalSettings,tradestandardsforphar-macies(StandardsforPharmacyPractice)inNorwayhavebeendeveloped,definingfourareasasthepharmacies’coreactivities:• Prescriptionsandrequisitions• Selfcare• Rationalprescribingandmedicineuse• Healthpromotionandill-healthprevention

Thestandardsdescribetheroleofthepharmaciesinrelationtocustomers/patients,inthehealthcareserviceandsocietyandexpressthetrade’srequirementsonitselfbymakingqualitydemandsonthepharmacies’activitieswithinthefourcoreareas.

Thetradestandardsarebasedonthecentralprincipleofthecustomers’/patients’needsandrights.Pharmacistsandpharmacytechnicians,asauthorisedhealthpersonnel,offerhealthaidrelatedtomedicinesaccordingtothelegalrequire-mentsforresponsibleprofessionalconduct.Thisislinkedtothepatients’rightsinthelegislation.

STANDARDSFORPHARMACYPRACTICE


Theworkofpreventing,identifyingandsolvingdrug-relatedproblemsforindividualcustomers/patientsiscentral.Thisrequiresextensivecontactwithprescribersandinvolvesconsiderableguidanceandadvicedirectedatcustomers/patients.Theaimofthisistohavethecustomer/patientunderstandthegoalofthetreatmentandempoweringhertocarryitoutcorrectly.Theseaspectsareofimportancefortheeffectofthetreatment.Evaluationandfollow-upofprescriptionmedicinesandtheiruseatcus-tomer/patientlevelcontributestocomplianceandrationalmedicineuse.

Thecustomer/patientshouldbeabletocontributetothepreventionandtreatmentofminorailmentsanddiseases.Thisincludesmaintaininggoodhealth–withorwithoutmedicinesand/orrelatedproducts.

Thepharmaciesgiveadviceandguidancerelatedtosymptomsandotherhealth-relatedneedspresented,andgiveguidanceintheselectionanduseofnon-prescriptionmedicines.Asafirstcontactpointwiththehealthcareservice,pharmaciescancontributetotheefficientuseofotherpartsofthehealthcareservice,byreferringcustomers/patientstophysiciansandotherhealthpersonnel.

Directcontactswithmedicineuserstogetherwithcontactswithprescrib-ersandotherhealthpersonnelgivepharmaciesinsightintothepopula-tion’suseofmedicines.Pharmaciescontributetorationalprescribinganduseby,amongotherthings,communicatingtheirexperiencestotheauthoritiesandotherpartsofthehealthcareservice.

Inco-operationwiththeauthorities,thehealthcareservice,relevantorganisations,userandpatientgroups,pharmaciesareworkingtoenablethepopulationtotakebettercareofitshealth,andtopreventandavoiddisease.Pharmaciestakepartinnationalandlocalhealth-promotingcampaigns,suchascampaignsagainsttheuseoftobacco.Pharmaciespromotehealthylifestylesbydistributinginformation,andgiveadviceandguidanceinthepublichealtharea.

TheNorwegianPharmacyAssociationhassincepublishingthereportHealthServicesinPharmaciesinJanuary2008,beencommittedtoestab-lishnationalhealthservicesinNorwegianpharmacies,andiscurrentlyplanningprojectsonMedicinesUseReviewsandMedicationReviewswithindifferentsettings.

TheNorwegianMinistryofHealthandCareServicescommissionedtheNorwegianDirectorateofHealthtoconsiderHealthServicesinPharma-cies,andinApril2009,theDirectoratepublishedareportcalled“HealthAidinPharmacies”.ThereportadvisedthatMedicinesUseReviewsandSmokingCessationprogramsshouldbeestablishedinNorwegianphar-macies,butdidnotmakeanyrecommendationsonremunerationduetolackofdataoncostefficiency.AprojectmanagedbytheDirectorate,investigatingthecostefficiencyofMedicinesUseReviewsinpharmacies,iscurrentlyunderdevelopment.TheNorwegianPharmacyAssociationisdeeplycommittedtothisproject,whichwillinvolvepharmaciesandpharmacistsintheOsloregion.

InJune2009,TheCoordinationReformwasissuedbytheMinistryofHealthandCareServices.Asaspin-off,theMinistrygatheredagroupofstakeholderstoinvestigateandidentifybreaksinthecourseofmedicaltreatmentandsuggestsolutionstopromotesaferandmoreappropriatemedicationuse.TheNorwegianPharmacyAssociationwasrepresented

SELFCARE

RATIONALPRESCRIBINGANDMEDICINEUSE

HEALTHPROMOTIONANDILL-HEALTHPREVENTION

PRESCRIPTIONSANDREQUISITIONS

HEALTHSERVICESINNORWEGIANPHARMACIES


inthisgroup,andthereportwaspublishedinAugust2009.ThereportsuggestsestablishingnationalcoreElectronicMedicalRecordsasthemostimportanttool,butalsointerdisciplinaryMedicationReviewsandMedicinesUseReviewsatthedifferentlevelsofcareforachievingsaferandmoreappropriatemedicationuse.

TheNorwegianPharmacyAssociationhasinitiatedaprocesstocreateaVisionforCommunityPharmacywithintheHealthServicein2020.SinceJanuary2010,asmallgroupofkeyplayerswithinthepharmacyretailbusinessandtheleadersoftheprofessionalbodieshavehadregularmeetingstodiscussfuturechallengesandhowthepharmaciesshouldmeetthese.Thediscussionshavebeenappliedbothtothedevelop-mentofservicesthatwilladdressfuturehealthchallenges,butalsotothepotentialthreatsandbenefitsofincreasinginternettradeandnewtechnology.Areportisunderproduction,andwillbepublishedbytheendof2010.

OnTuesdaythe3rdofNovember2009,theMinistryofHealthandCareServicesdecidedmakingtheInfluenzaA(H1N1)medicinesTamifluandRelenzamoreeasilyavailabletothepublic.AtthistimetherewasasevereincreaseinInfluenzaAinfections.Thephysiciansreportedheavyworkload,havingmanyflupatientsvisitingtheirofficesandatthistimethemassvaccinationwithPandemrixhadjuststarted.Accordingtothesituation,theMinistryofHealthandCareServicesdecidedtogivepharmaciststherighttoprescribeTamifluandRelenzaoncertainconditions.OnThursdaythe5thofNovember2009at00:01o’clockthefirstTamiflupackagewasprescribedbyapharmacist.ThepharmacistprescribingispracticedaccordingtoguidelinesgivenbytheDirectorateofHealth.FromNovember5thuntilNovember26th,nearly200,000packagesofTamifluandRelenzawereprescribedbypharmacists(populationinNorway:4.9million).TheregulationsonpharmacistsprescribingrightsforTamifluandRelenzalasteduntilthe1stofJuly2010.

PHARMACISTPRESCRIBINGOFTAMIFLUANDRELENZA

Figur 2: Numberofpacksofoseltamivir(Tamiflu)soldperquarterin2009and2010.

År KvartalNumber of packs

2009 1st quarter 904 2nd quarter 16 137 3rd quarter 49 350 4th quarter 314 191

2010 1st quarter 4 195

-50 000

100 000 150 000 200 000 250 000 300 000 350 000

1st quarter

2nd quarter

3rd quarter

4th quarter

1st quarter

2009 2010

Number of packs of oseltamivir

Number of packs


2009 % change 2008-09

Totalpharmacyturnover,excl.VAT 18283 4.5

Averageturnoverperpharmacy,excl.VAT 28.2 0.6

Table 4: Total and average turnover for pharmacies in 2009 (NOK million).

2009 % change % share

mill. NOK 2008-09 of total

Totalturnoverforcommunitypharmacies,excl.VAT 14898 4.3 81.5

Totalturnoverforhospitalpharmacies,excl.VAT 3385 5.5 18.5

Averageturnoverpercommunitypharmacy,excl.VAT 24.2 0.1

Averageturnoverperhospitalpharmacy,excl.VAT 102.6 5.5

Table 5: Total and average turnover in NOK millions by community pharmacies and hospital pharmacies (excl. VAT)

PHARMACYFINANCEPHARMACYTURNOVER

PHARMACYTURNOVERBYCOMMUNITYPHARMACIESANDHOSPITALPHARMACIES

NOK


Norwegianpharmacygrossmark-upforprescription-onlymedicinesisbasedonageneralcalculation.In2009thegrossmark-upforprescription-onlymedicineswaschanged.Basedonthepharmacypurchasingpricethepharmacymark-upiscalculatedby:• thefirstNOK200:7%• therest(aboveNOK200):4%• perpacket:NOK22.00

Fromthismark-up,thepharmacyhastopayaMedicinesSalesTaxtothestate,on0.55%ofthepharmacypurchasingprice.

Prescription type 2009

Reimbursementprescriptions 16.6

Regularprescriptions 30.3

Total 18.4

Table 6: Pharmacy gross margin 2009 - reimbursement and ordinary prescriptions.

PHARMACYMARGINACCOR-DINGTOPRESCRIPTIONTYPE


Supply category2009

mill. NOK incl. VAT2009

mill. NOK excl. VAT%

share% change2008-09

Prescriptionmedicines 15463 12375 88.1 2.5

Non-prescriptionmedicines 2094 1676 11.9 2.3

Total 17557 14051 100.0 2.5

Table 7: SalesincludingVeterinarymedicinesaccordingtosupplycategory(NOKmillion)

SALESOFMEDICINESTOTALSALESBYMAINCATEGORIESINPHARMACIES

ThelowgrowthinsalesinNorwayappliesinparticulartothecom-munitypharmacies.Whilegrowthforthecommunitypharmacieshasbeenbetween0and2percentduringthepastfouryears,thehospitalpharmacieshaveexperiencedagrowthinsalesofover3percenteveryyearsince2003(seefigure3andtable7.).Thisispartlyduetothefactthatfewnewmedicinesareintroducedforuseoutsidethehospitals,whereasmorenewandoftenmoreexpensivemedicinesaretoagreaterextentbroughtintousebythespecialisedhealthservices.Thetotalturnovermeasuredindefineddailydoses(DDDs)roseby2.0percent.


Figure 3: TurnoverTrend(excl.VAT)forprescriptionmedicinesduring2003-2009

SALESBYATC(ANATOMICALTHERAPEUTICCHEMICAL)GROUP

TheATCgroupLAntineoplasticandimmunomodulatingagentshashadan3.3percentincreaseinsalesforhumanuse.Thisisaresultof,amongotherelements,acontinuedstrongincreaseinthesalesoftheTNFinhibitors.

In2009theATCgroupsNNervoussystemandCCardiovascularsystemhadasmallerincreaseinsalebyvaluethantheincreasemeasuredinDDD.Thisisaresultofthe“trinnpris”system’sstrongcontributiontoreducingpricesforseveralmedicineswithlargesales.

ATC 1st level Main groups 2009 mill. NOK,

incl. VAT% change 2008-2009 2009 mill. DDD % change

2008-2009

A Alimentarytractandmetabolism 1934.0 2.7 446.6 -1.0

B Bloodandbloodformingorgans 942.3 5.3 228.2 3.6

C Cardiovascularsystem 2153.9 0.7 689.9 3.7

D Dermatologicals 496.2 2.4 3.2 5.2

G Genitourinarysystemandsexhormones 916.3 0.1 167.3 1.8

H Systemichormonalpreparations,excl.sexhormonesandinsulins 427.5 1.3 75.1 2.2

J Antiinfectivesforsystemicuse 985.4 11.5 36.7 4.6

L Antineoplasticandimmunomodulatingagents 2958.0 3.3 25.4 4.2

M Musculo-skeletalsystem 584.6 1.7 95.6 -0.4

N Nervoussystem 3356.7 1.0 376.7 2.1

P Antiparasiticproducts,insecticidesandrepellents 56.2 -6.6 1.4 -1.0

R Respiratorysystem 1800.9 4.0 287.9 1.9

S Sensoryorgans 436.0 7.1 33.5 -0.3

V Various 179.9 3.0 0.3 4.3

Total 17 228.0 2.8 2 467.8 2.0

Table 8:SalesofmedicinesinrelationtoATCclassification

% vekst % vekst % vekst % vekst % vekstAlle legemidler 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008Total 7,9 3,2 1,6 1,8 2,9Community pharmacy 6,8 1,7 0,9 1,5 0,9Hospital pharmacy 13,7 10,6 4,5 3,1 11,9

2003 2004 2005 2006 2007Total 100,0 107,9 111,3 113,1 115,1Primærapotek 100,0 106,8 108,7 109,7 111,3Sykehusapotek 100,0 113,7 125,8 131,5 135,6

7,9

3,21,6 1,8

2,9 2,5

6,8

1,7 0,9 1,5 0,92,0

13,7

10,6

4,53,1

11,9

4,6

0,02,04,06,08,0

10,012,014,016,0

Per c

ent

Total

Community pharmacy

Hospital pharmacy


THE25MOSTSOLDSUBSTANCESACCORDINGTOVALUE

ATC 5th level Substance (example on brand) 2009 mill. NOK, incl. VAT

% change 2008-09

2009 Mill. DDD

% change 2008-09

1 L04AB01 Etanercept(Enbrel) 484.3 -3.5 1.4 1.5

2 R03AK06 Salmeteroleandotherremediesforobstructivelungdiseases(Seretide) 345.9 6.5 20.3 3.5

3 L04AB02 Infliximab(Remicade) 344.2 -3.2 1.7 1.2

4 L04AB04 Adalimumab(Humira) 306.4 27.0 0.9 36.7

5 N02BE01 Paracetamol(Paracet) 260.5 4.8 39.6 6.1

6 R03AK07 Formoteroleandotherremediesforobstructivelungdiseases(Symbicort) 242.8 8.9 13.8 8.8

7 C10AA01 Simvastatin(Zocor) 232.6 10.4 114.1 4.4

8 A02BC05 Esomeprazole(Nexium) 211.4 -4.5 24.5 7.0

9 M01AE01 Ibuprofen(Ibux) 181.8 5.4 25.1 4.0

10 N06AB10 Escitalopram(Cipralex) 175.1 -0.4 30.9 8.2

11 N07BA01 Nicotine(Nicorette) 172.0 2.1 6.4 1.7

12 C10AA05 Atorvastatin(Lipitor) 168.4 -28.5 51.2 20.7

13 N02AA59 Codein,combinationsexcl.psykoleptics(ParalginForte) 155.4 3.2 21.0 -1.5

14 C09DA01 Losartanogdiuretika(CozaarComp) 154.9 -6.4 21.3 -1.6

15 C09CA06 Kandesartan(Atacand) 153.4 13.2 33.3 13.8

16 H01AC01 Somatropin(Genotropin) 140.4 -2.0 0.7 3.0

17 L01XC02 Rituximab(MabThera) 134.7 13.1 0.0 16.2

18 N06BA04 Metylfenidat(Ritalin) 133.2 6.0 9.9 10.4

19 L03AB07 Interferonbeta-1a(Rebif) 128.3 -3.3 1.0 -1.2

20 C07AB02 Metoprolol(Selo-Zok) 127.1 -0.6 43.7 1.2

21 B01AC06 Acetylsalisylsyre(Albyl-E) 119.2 2.5 120.3 2.3

22 C09DA06 Candesartananddiuretics(Atacandplus) 116.0 14.9 15.1 10.2

23 N05CF01 Zopiclone(Imovane) 114.8 17.0 55.9 1.4

24 A10AC01 Insulin(human)(Insulatard) 114.3 0.0 12.4 -1.4

25 R06AE07 Cetirizine(Zyrtec) 113.4 5.6 59.1 9.9

Sum 25 4 830.6 2.4 723.2 5.5

Combined total 17 228.0 2.8 2 467.8 2.0

SALESOFNON-PRESCRIPTIONMEDICINESINPHARMACIES

Selfcareisoneofthepharmacies’coreworkareas.Pharmacieshaveanimportanttaskinadvisingandguidingintheuseofnon-prescrip-tionmedicines.Non-prescriptionmedicinesaresoldinpharmaciesandinoutletsunderthesupervisionofapharmacy.Aselectionofnon-prescriptionmedicinesisalsosoldoutsidepharmacies.

Intotal,pharmaciessoldnon-prescriptionmedicinesforoverNOK2.0billion.Thisconstituted9.2percentofthetotalturnoverforpharmacies.

Table 9: The25mostsoldactivesubstancesrankedaccordingtovaluein2009(NOKmillion)


Table 10: The10mostsoldactivesubstancesinpharmacies–non-prescriptionmedicines(millionNOKandmillionDDD)*Anon-prescriptionpackofOrlistatcameonthemarketMay2009.

ATC 5th level Substance (example on brand) 2009 mill. NOK, incl. VAT

% change 2008-09

2009 mill. DDD

% change 2008-09

1 N02BE01 Paracetamol(Paracet) 181.9 0.9 15.8 -3.8

2 N07BA01 Nicotine(Nicorette) 172.0 2.1 6.4 1.7

3 M01AE01 Ibuprofen(Ibux) 142.0 4.1 11.3 0.5

4 R01AA07 Xylometazoline(Otrivin) 89.1 -6.2 21.4 -7.9

5 A02BA53 Famotidine.combinations(Pepcid) 62.1 14.2 2.0 13.2

6 R06AE07 Cetirizine(Zyrtec) 58.2 0.0 8.7 1.9

7 A01AA01 Sodiumfluoride(Flux) 47.4 -13.8 89.0 -15.2

8 R05CA10 Combinations(Bergenskbrystbalsam) 43.7 -3.0 3.5 -5.5

9 A08AB01 Orlistat(Alli) 41.4 -* 1.2 -*

10 G01AF02 Clotrimazole(Canesten) 38.1 -0.6 1.5 -4.0

Sum 875.9 5.4 160.7 -9.6

Totalt 2 086.8 3.9 365.3 -5.0

NON-PRESCRIPTIONMEDICINESOUTSIDEPHARMACIES

By1January2010itisallowedtosell44substancesoutsidephar-macies.

Salesoutsidepharmacieswerepermitted1January2003foraselec-tionofnicotinepreparationsforsmokingcessation.On1November2003,therangeofmedicinesthatcouldbesoldoutsidepharmacieswaswidenedwithanumberofothernon-prescriptionmedicines.By1January2009emergencycontraception,aselectionofantihista-mines,antacidsandacidreducers,aswellashydrocortisonetopicalpreparationswereallowedtoselloutsidepharmacies.

Turnoveroutsidepharmacieshasconcentratedonsimplepain-reliev-ingmedicines(paracetamol,ibuprofen,phenazonecombinations),andnosedecongestionsprays(xylometazoline).Theserepresentaminimumlist,whichisarequirementforsalesdefinedbytheNor-wegianMedicinesAgency.


Table 11: Non-prescription medicines sold in the grocery sector and pharmacies combined. Source: Norwegian Institute of Public Health * May be sold outside pharmacies but are not included in the range sold through the grocery retail sector.

ATC 5th level Substance2009

DDD/1000 inh./day

% change in DDD from

2008

1. quarter 2009 2. quarter 2009 3. quarter 2009 4. quarter

2009

M01AE01 Ibuprofen 10.7 -3% 39% 38% 37% 39%

N02BB51 Phenazone+caffeine 2.5 -7% 17% 17% 18% 18%

N02BE01 Paracetamol 17.3 0% 48% 46% 45% 48%

N07BA01 Nicotine 4.8 7% 20% 21% 20% 19%

R01AA05 Oxymetazoline* 1.8 -19% Onlyinpharmacies

Onlyinpharmacies

Onlyinpharmacies

Onlyinpharmacies

R01AA07 Xylometazoline 28.1 0.4% 54% 56% 53% 57%

R05CA10 Combinations 1.6 -3% 10% 9% 8% 9%

R06AE05 Meclozine 0.8 -15% 12% 13% 12% 10%

R06AE07 Cetirizine 5.3 7% 6% 4% 5% 4%

Sum 72.9 0.3 % 42 % 38 % 39 % 43 %

Share of sales in non-pharmacy outlets

AccordingtotheNorwegianInstituteofPublicHealth,salesoutsidepharmaciesduring2009accountedforbetween38and43percentofsalesofmedicinesonthegeneralsaleslist(basicrange),meas-uredinDDDs.

Thegroceryretailsectoralsosellsasmallrangeofothermedicinessuchasantacids,travelsicknessmedicinesandcoughmixtures.Theseaccountforanegligibleshareoftotalmedicinesalesoutsidepharmacies.


Norwegianauthoritiessetamaximumpharmacypurchaseprice(AIP)foreveryprescriptionmedicinegivenamarketauthorisationinNorway.Thisisinadditiontothetraditionalregulationofthepharmacymaximumsalesprice(AUP)andthemaximumpharmacymark-up.

Thesettingofamaximumpriceisatwo-stageprocedure:First,amaximumpurchasepriceforpharmacies(AIP)issetforthemedi-cineinquestion.Thenamaximummark-upfromthepharmacy’ssaleforeachmedicineisset,beforeVATisadded.Intotal,thisfixesthemedicine’smaximumsalepricefromthepharmacy(AUP).

TheNorwegianMedicinesAgencyhasworkedoutguidelinesforsettingthemaximumAIP.ThemainruleisthatthemaximumAIPistheaverageofthethreelowestmarketpricesforthemedicineinthefollowingcoun-tries:Sweden,Finland,Denmark,Germany,GreatBritain,theNetherlands,Austria,BelgiumandIreland.Thistypeofpriceregulationisoftencalled“Internationalreferencepricing”.

TheNorwegianMedicinesAgencysetsamaximumsalepricealsoforgenericmedicines.Thetop-sellingsubstanceswithgenericcompetitionareregulatedbythesocalled“trinnpris”(tiered)pricingsystem.Whenthe“trinnpris”systemwasintroducedon1January2005,itappliedto21substances.ByJuly1st2010,thenumberofsubstanceshadrisento63.

MEDICINEPRICESPRICEREGULATIONFORON-PATENTMEDICINES

PRICINGSYSTEMFORGENERICMEDICINES


Sales last 12 months prior to generic competition* < 100 mill. NOK > 100 mill. NOK

Point of time for price reductions

1.reduction Whentherearegenericalternativesavailableandstablegenericcompetition. 30% 30%

2.reduction 6monthsaftergenericalternativesareavailable 55% 75%

The“trinnpris”-systemensuresthatthepricesformedicinesautomaticallyfallwhenthemedicinesgetstablegenericcompetition.Inthispricingsystem,medicinesforwhichthepatenthasexpiredandwhicharelistedontheNorwegianMedicinesAgency’sexchangelistgetreducedprices.Thepricereductionsaretiered,setable12.

Allpharmacieshavetooffertheircustomersatleastonegenericbrandwithineachgroupontheexchangelistatthisreducedprice.Thispriceisalsothemaximumamountre-fundedbytheNationalInsuranceAdministration.Exceptionsapplywherethedoctorhasfoundmedicalreasonsfordeny-inggenericsubstitution.Insuchcircumstances,theNationalInsuranceAdministrationsystemwillrefundthefullpriceofthemedicine.

Sales at least 12 months after last reduction* > 15 mill. NOK > 30 mill. and < 100 mill. NOK

> 100 mill. NOK

Point of time for price reduction

3.reduction Attheearliest12monthsafterlastordinaryreduction 65% 80% 85%

Table 12: Pricing system for generics – price reductions by January 1st 2008.*Sales for 12 months, Public selling price incl VAT in million NOK.


PRICECOMPARISONSWITHOTHERCOUNTRIES NorwayisamongthecheapestcountriesformedicinesinWesternEurope.

Thisappliesbothformedicinescoveredbypatentsandformedicineswithgenericcompetition.Atthesametime,distributionmarginforNorwegianpharmaciesareamongthelowest.

ThesearethemainfindingsinacomprehensiveanalysisofthepriceofmedicinesevercarriedoutinNorway1.Thereport,publishedinMay2010,wascompiledbytheInstituteforResearchinEconomicsandBusinessAd-ministration(SNF)onbehalfoftheNorwegianPharmacyAssociation.ThereportcomparesthepriceofmedicinesandmarginsinNorwaywiththenineEuropeancountriesselectedbytheNorwegianauthoritiesasbeingthemostcomparable.

Theinvestigationusedseveralmethods,allofwhichplacedNorwayasoneofthecheapestcountries.Thereportalsoestablishesthatthephar-macymarginsinNorwayareamongthelowestinEurope.

Thereportlooksatthe300mostusedsubstances(salesvalue)inNorwayfortheperiodseptember2008toseptember2009.ThereportisbasedondatacollectedbyIMSHealthonprice,volume(packaginganddos-ages),patentstatus,original/generic,packagingsize,presentationform,strength,etcfromSweden,Finland,Denmark,Germany,theUK,theNeth-erlands,Austria,BelgiumandIreland.ItisthepricesfromthesecountriesthatareusedtosetmaximumpricesforprescriptionmedicinesinNorway.

Volume-weightedaveragepricesforeachsubstanceatdoselevelwerecalculatedforthepharmacypurchasepriceandthepharmacies’sellingprice,aswellaspharmacymargin.ThereportthencalculateswhattheNorwegianexpenditureonpharmaceuticalswouldhavebeenifaveragedoseprisesfromothercountriesweretobeimportedtoNorway.ThiswasdonebycalculatingpriceindicesbasedonNorwegianconsumptionweights,aswellasbyregressionanalysisinordertotestwhetherthedif-ferencesinpricewerestatisticallysignificant.

1Thereportisafollow-uponasimilarstudyorderedbytheNorwegianMinistryofHealthandCareServices.ThereportwaspresentedMay28th2008.Afollow-upreportorderedbytheNorwegianPharmacyAssociationwaspresentedinMay2009.


TheinvestigationshowsthatwhentheNorwegianconsumptionofmedicinesisusedasthebasis,NorwayhasthelowestpricesofallthetencomparisoncountriesformedicinesincludedintheNor-wegian“trinnpris”systemandotheroffpatentmedicines,whichincludesthevastmajorityofthehighturnoveroffpatentdrugs.TheNorwegianconsumptiononpatentdrugswouldbecheaperifpricesfromUKweretobeimported.ImportingpricesfromothercountrieswouldincreaseNorwegianexpenditureondrugsinallsegments.

Asthisreportisafollowupofasimilarreportfrom2009,itcontainsananalysisofthedevelopmentinpricesfrom2008to2009,measuredinlocalcurrency(NOK,SEK,DKKandEuro,dependingonthecountry).Everycountryhasexperiencedpricedropsintotal.ThepricedropisbiggestinIreland.Onpatenteddrugs,thepricedropinNorwayishigherthanineveryothercoutryexceptIreland.ThelackofpricedropinNorwayintheoffpatentand“trinnpris”segmentmightbeexplainedbythepricesondrugswithinthissystemdeclineinstantaneously,butthenstayfairlyconstantatthelowerpricelevelafterwards.

All Patented Off patent “Trinnpris”

Norway -1.4% -2.9% 0.2% 0.0%

Sweden -0.1% 0.6% -0.7% -3.7%

Denmark -0.7% 2.6% -4.5% -11.0%

Finland -2.3% -1.4% -3.2% -9.4%

UK -0.2% -0.1% -0.3% 0.2%

Germany -2.1% 0.4% -4.9% -5.8%

Holland -4.9% -1.5% -8.6% -20.6%

Belgium -0.8% 0.3% -2.1% -2.3%

Austria -0.4% 0.2% -1.0% -5.1%

Ireland -14.9% -13.7% -16.1% -19.8%

ACTUALRESULTSAll Patented Off patent Trinnpris

Norway 100.0 100.0 100.0 100.0

Sweden 112.2 116.8 105.1 114.5

Denmark 136.3 145.0 122.8 135.6

Finland 142.4 146.1 136.7 144.0

UK 97.9 88.6 109.9 112.9

Germany 161.8 152.4 176.9 187.0

Holland 141.0 134.3 151.3 167.3

Belgium 215.5 177.3 274.2 244.7

Austria 147.9 137.7 163.2 199.7

Ireland 313.5 195.7 492.9 397.9

Table 13: Bilateralindices(Publicsellingprice)forallsubstances,Norwegianweights,Norway=100

Table 14: Pricechanges


All drugs On patent Off patent

Sweden +* ? ?

Denmark -** ? -***

Finland +*** +*** ?

Holland +*** ? +***

Austria +* +** ?

UK -*** -*** -***

Belgium +*** +*** +**

Germany +*** +*** +***

Ireland +*** +*** +***

Table 15: Resultofregressionanalysis.***:significantat1%level**:significantat5%level*:significantat10%level

Also,theinvestigationshowsthatpharmacymarginislowinNorway.Byusingregressionanalysis,theauthorscomparedthedifferenceinmarginsbetweenNorwayandtherestoftherestofthecountries.Table15showsthatpharmacymarginsinNorwayarestatisticallysignificantlowerthanpharmacymarginsinanyothercountryexceptforUKandDenmark.Lowermarginsaremarkedbya“-“,whereas“+”denoteshighermargins.A“?”indicatesthatthedifferenceisnotstatisticallysignificant,sothattheresultisinconclusive.


AllpersonswhoareeitherresidentsorworkingasemployeesinNorwayoronpermanentormovableinstallationsontheNorwegianContinentalShelfarecompulsorilyinsuredundertheNationalInsuranceScheme,financedbynationaltaxes.AlsocertaincategoriesofNorwegiancitizensworkingabroadarecompulsorilyinsured.

TheNationalInsuranceSchemeoffersreimbursementforcertainmedicinestopatientssufferingfromchronicillnessesaccordingtoalistofdiagnoses(ICPC-2/ICD-10)withasetofcriteriathepatientshavetomeet.Foreachdiagnosisthereisacorrespondinglistofreimbursablemedicines.TheNorwegianMedicinesAgencydecidestheinclusionofmedicinesinthere-imbursementprogramme,uponapplicationfromthepharma-ceuticalindustry.Ahealtheconomicevaluationoftheproductismandatorywhenapplyingforreimbursement.

TheNationalInsuranceSchemefinancedapproximately44percentoftotaldrugsalesinNorwayin2009.Totalturnoverofdrugsin2009was17.6billionNOK.TheNationalInsuranceScheme’sexpenditurefordrugsin2009was7.6billionNOK.

WithintheNationalInsuranceSchemeaco-paymentisrequiredfrommostpatients.Personsreceivingminimumold-agepensionorminimumdisabilitypensionandchildrenbelow12yearsofagedonotpayaco-payment.In2010childrenbelow16yearsofagedonotpayaco-payment.Theco-paymentin2009,asshownintable16,is36%ofsalesvalue,butnomorethan520NOKperprescription.Ifthepatient’stotalcombinedco-paymentonmedicines,visitstophysiciansorpsychotherapycombinedexceeds1780NOKbeforetheendoftheyear,thenthepatientwillreceivea“freecard”anddonothavetopayfurtherco-paymentduringtheyear.

Forgenericmedicinesthereimbursementpricenormallyisequivalenttothepriceofthecheapestgenericalternative,asdefinedbythe“trinnpris”system.Ifthepatientinsistsonhavingthemoreexpensivealternative,thenthepatientwillhavetopaythedifferencebetweentheactualprice,andthepriceofthecheaperalternativeinadditiontothenormalco-payment.Exceptionsapplywhenthephysicianhasfoundmedicalreasonsfordenyingthepharmacytherighttogenericsubstitution.Insuchcases,theNationalInsuranceSchemere-imbursesthepriceoftheproductchosenbythephysician,andthepatientonlyhastopaythenormalco-payment.

2009 2010

36percent,-maximumNOK520perprescription.Co-paymentispaidatthepharmacy.

Maximumtotalco-paymentperyear NOK1780 NOK1840

Table 16: Co-payment in 2009 and 2010

CO-PAYMENT

REIMBURSEMENTOFMEDICINES


TheNorwegianPharmacyAssociation(Apotekforeningen)isthetradeorganisationforpharmaciesinNorwayandtheirowners.Accordingtotheassociation’srules,TheNorwegianPharmacyAssociationshallprimarilyworktosecurethebestpossibleandpredictableframeworktermsforthepharmacies.Inadditiontheassociationshallworktopromotethepharmaciesaclearandvaluablepositionwithinthehealthcaresystem,thepharmacyprofessionandtowardsconsumers.TheNorwegianPharmacyAs-sociationalsofulfilssomejointfunctionsandservicetasksonbehalfofthetrade.

MEMBERS AllNorwegianpharmacies,667intotal,aremembersoftheassociationasof1June2010.Includedinthisfigureare33publiclyownedhospitalpharmacies.

THEBOARDTheboardconsistsofrepresentativesfromindepend-entpharmacies,hospitalpharmaciesandthepharmacychainsApokjedenAS,AllianceBootsLtd.andNMDAS.

ADMINISTRATIONAsof1June2010,TheNorwegianPharmacyAssociationincludingtheorganisationASApotekernesHushad40employees.Theassociation’semployeesareskilledinpharmacy,economy,statistics,ITandteaching.

Forinformationaboutindividuals(names,phonenumberetc)–visitwww.apotek.no

OTHERCOMPANIESAnumberofbusinessactivitiesareorganisedinASApotekernesHus.SpecialmentionshouldbemadeofNAF-gårdeneASandNAF-DataAS.

NAF-gårdeneASprojectspharmacypremisesandownsseveralcommercialbuildingsinNorway,includingsomesmallershoppingcentres.

NAF-DataASsells,maintainsanddevelopsanITsystemwhichisusedbyallpharmacies–calledFarmaPro.

ABOUTTHENORWEGIANPHARMACYASSOCIATION


PHARMACYPOLICYTheframeworktermisthecoreworkingareaforTheNorwegianPharmacyAssociation.Theworkiscarriedoutthroughhearings,dialogueandcontactmeetingswithministries,governmentauthoritiesandpoliticalauthorities,inco-operationwithotherparticipantsinthepharmaceuticalsarea,bydevelopmentofdocumentation,analysisandstatistics,andcontactswithmassmedia.

PUBLICATIONS,ETCTheNorwegianPharmacyAssociationpublishes,amongothers:• ApotekforeningensTidsskrift(TheJournal).Seealso

www.apotektidsskrift.no• Apotekoglegemidler(Pharmaciesandpharmaceu-

ticals)–Tradestatisticsonthepharmacies’operationandsalesofmedicines

• Apotekboka(ThePharmacyBook)–Overviewoflawsandregulationsforthepharmacyandpharmaceuticaltrade

• Handbookforpharmacyoutlets• Aweeklye-mailnewsletter

TRADESTATISTICS TheNorwegianPharmacyAssociationreceivesdatafromthepharmaciesandproducescommontradestatistics.Thepurposeistocreateknowledgeanddocumentationasthebasisforinputtoauthoritiesandforpublicdebate.Thesystemisbasedonallsalesregisteredinthephar-macycomputersystemFarmaPro.Thestatisticssystemincludes,amongotherthings,detailedoverviewsofmedicinesaleswithprices,reimbursementandano-nymisedprescriptioninformation.

PHARMACYSERVICESThePharmacyServiceDepartmentoperatesseveralcom-monservicesforthetradeandassociatedbusinesses:

VAREREGISTERSENTRALEN–VRS(NOR-WEGIANARTICLENUMBERREGISTRY)VRSmaintainsandupdatesthepharmacies’commonar-ticleregisters.VRSco-operateswiththeNorwegianMedi-cinesAgencyandtheNationalInsuranceAdministrationregardinginformationexchange.TheregisterformsthebasisforNorwegianpublicdrugconsumptionstatistics.ItisalsousedinindividualITsystemsforphysicians.

THENORWEGIANPHARMACYASSOCIA-TIONSEDUCATIONALSERVICESTheassociation’seducationalservicescoverproducer-independentcontinuingandpostgraduateeducation,primarilyforpharmacytechnicians.Additionally,specialcoursesforotherprofessionalsarealsoarranged.

SERVICEPRODUCTIONSYSTEMThecentralisedserviceproductionsystemforpharmacyproductshasasitsgoaltosecuregoodavailabilityofmedicineswhicharenotofferedbythepharmaceuti-calindustry.Thesystemisadministeredbythecompany

ServiceProduksjonAS(SPAS).TheNorwegianPharmacyAssociationhastheproductresponsibilityforthesephar-macyproducts.

INTERNATIONALCO-OPERATIONTheNorwegianPharmacyAssociationisamemberofNordiskApoteksforening–NA(TheNordicPharmacyAs-sociation),ajointorganisationforthepharmacyassocia-tionsinDenmark,Finland,NorwayandSweden.

TheNorwegianPharmacyAssociationisalsoamemberofFédérationInternationalePharmaceutique/InternationalPharmaceuticalFederation(FIP),whichisaworld-wideprofessionalorganisationforpharmacists,andEuropharmForum,whichisanetworkofnationalpharmacistorgani-sationsinEurope,linkedtoWHO.

TheNorwegianPharmacyAssociationisanobservertoThePharmaceuticalGroupoftheEuropeanUnion(PGEU),apoliticalorganworkingwithintheEUsystem.Theorganisationfollowsdevelopmentswithinthepharmacistprofessionandthepharmacysector,andproducespolicydocumentsinareasimportanttopharmacies.

2010FACTS AND FIGURES

FACTS AND FIGURES 2010

FACTS AND FIGURES – PHARMACIES AND PHARMACEUTICALS IN NORWAY is a brief presentation of Norwe-gian pharmacies and their trade organisation, The Norwegian Pharmacy Association (Apotekforeningen). The majority of statistics in this publication is based on The Norwegian Pharmacy Association’s trade statistics which includes all sales registered in the pharmacy computer system FarmaPro in 99 per cent of all Norwegian phar-macies.

FACTS AND FIGURES – PHARMACIES AND PHARMACEUTICALS IN NORWAY contains basic facts on pharmacies, sales of medicines, regulation of pharmacies, the Norwegian reimbursement system etc.

THE NORWEGIAN PHARMACY ASSOCIATION is the trade organisation for pharmacies in Norway and their own-ers. According to its rules, the organisation primarily work to secure the best possible and predictable frame-work terms for the pharmacies. The Norwegian Pharmacy Association fulfils some joint functions and service tasks on behalf of the trade. In addition the organisation work to secure the pharmacies a clear and valuable position within the health care system, the pharmacy profession and in the population.

Additional information in English on the Norwegian medicinal market and prices on medicines in Norway is available from The Norwegian Pharmacy Association in print or on our website www.apotek.no

Requests may be sent to:

Apotekforeningen

The Norwegian Pharmacy AssociationPostboks 5070 Majorstuen, NO-0301 Oslo, Norwaytelephone: +47 21 62 02 00, fax: +47 22 60 81 73e-mail: [email protected] 2010

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