“We need to strengthen pharmacies in the supply chain,” says Montag. Particularly in view of demographic change and the overwork of doctors, pharmacies are becoming increasingly important as the first point of contact: “The less time doctors have available, the more crucial pharmacies become,” he explains.
However, the ApoRG does not adequately take these needs into account, criticizes the politician. “We need to strengthen pharmacies – that starts with strengthening them financially.” He points out that there has been no fee adjustment since 2013. In the ApoRG, Health Minister Karl Lauterbach (SPD) is now even planning to further reduce the variable part of the remuneration. This would further weaken the already financially troubled industry, warns Montag.
Pre-financing for pharmaceuticals
The state wants to ensure a comprehensive supply of medicines and to do so is relying on the private capital of pharmacists, who have to pre-finance the medicines, said Montag. In some cases, pharmacies even have to take out loans. There is a significant risk to operations, particularly with high-priced medicines. The 3 percent trade component is not only a compensation, but also a hedge against this risk. In addition, these 3 percent are also used to finance advisory services and application instructions, which are necessary in the outpatient care of seriously ill patients in order to ensure the quality of care.
The already limited commercial freedom of pharmacies is far from sufficient to cover the exploding costs. “The population cannot eat so many cough drops that the pharmacy could offset the increase in costs through the commercial component,” says Montag.
“The state could not provide what the pharmacy network does, either in the same quality or at a lower cost,” he stressed. There is therefore a legal mandate, which can also be derived from Section 79 of the Medicines Act (AMG), to maintain the economic viability of the supply structures.
With the discount ruling, the Federal Court of Justice (BGH) also confirmed that profitability must be ensured by the core competence of dispensing medicines and not by discounts from wholesalers. Lauterbach’s reform contradicts the principle of fairness between the state and the pharmacists, Monday ruled.
At an SPD election campaign event in Chemnitz, Lauterbach himself recently addressed the strained financial situation of pharmacies: “He admits that there is a lack of money, but at the same time continues to cut important economic components,” criticizes Montag. “Either the man has no idea or he doesn’t know what his law says.” Even if closures mean that more patients are spread across fewer pharmacies, this does not improve the situation. Sales do not equal profit, emphasizes Montag.
Pharmacies are not dispensing points
The dispensing process involves much more than just handing over a package over the counter. A considerable amount of effort is required before a drug can be safely dispensed. This includes consulting services, instructions for use, managing supply bottlenecks and, if necessary, telephone consultations with doctors. The health minister does not seem to understand the effort required to dispense drugs. “Lauterbach should not just show up at the pharmacy for a photo shoot, but get to know the entire process,” criticizes Montag.
Lauterbach makes suggestions from the ivory tower without being aware of the actual consequences. Reforms, however, must be based on the reality of care. “There are many areas in which we could make things easier – where is the law to reduce bureaucracy?” Montag asks. In his view, Lauterbach is nothing more than a minister who makes announcements: “Lauterbach understands neither the economic figures nor the problems facing pharmacies.”
Instead of continuing to turn off the tap to pharmacies, it is necessary to examine which services can be financed and where there are reserves for efficiency in the system. “That is the job of a health minister,” said Montag. But Lauterbach has not said anything of the sort.
No “pharmacy light”
Like FDP leader Christian Lindner (FDP) recently, Montag rejects the concept of a “pharmacy light”. The pharmacy’s competence lies not in the mere dispensing of medication, but in advising and supporting patients, he stresses. “The patient leaves the pharmacy wiser than when he entered,” says Montag. Only pharmacies with a pharmacist on site can offer this quality.
Monday will accompany an emergency service in a pharmacy this Friday. The politician believes that increasing the emergency service fee makes sense, but an increase in the emergency service remuneration would not be enough to ensure the profitability of pharmacies. “You would have to do emergency service every day,” he says.
