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“We should realize that the pharmacy is a healthcare institution, not a point of purchase”

Head of the Board of All-Ukrainian Pharmaceutical Chamber, member of the International Pharmaceutical Federation (FIP) Oleg Klimov opened the dark side of the Ukrainian pharmacy business in a sharp as a needle interview for LDaily  

Externally it seems that the pharmaceutical business in Ukraine is doing well. The number of pharmacies is growing and they become more modern and functional. You can buy almost everything there… only the prices are very high. This is how an ordinary citizen sees a modern Ukrainian pharmacy. Mr. Klimov knows about it a bit more. He sees the things, which are hidden behind the beautiful store window and it makes him scared. Lack of self-government of pharmacists and admission to the profession, amateurs in white coats, non-prescription medicine, failure of the reimbursement program, very high extra charges, marketing orders for the sale of specific brands. Meanwhile, everything can be different as it is in the countries of a sustainable economy and in the European Union countries.

: What was the purpose of creation of All-Ukrainian Pharmaceutical Chamber? 

O. Klimov: Me and my like-minded people have been dreaming about creating a Chamber, based on the ideology of the International Federation of Pharmacists for years. Now there are about 60 different public organizations in Ukraine that are aimed to care about the health of the population. However, most of them are tools for lobbying business of manufacturers, distributors or pharmacy networks. All-Ukrainian Pharmaceutical Chamber public organization is the only one, dare I say it, professional public organization, which is created to lobby the interests of the patient and the pharmaceutical worker.

Before creating our public organization, we negotiated the approval of the draft of Statute of the International Pharmaceutical Federation. It had to correspond with the principles of the Federation, which was a fundamental thing for us. In 2015 we signed up, getting an approval from the International Pharmaceutical Federation.

The global history of public organizations influencing the policy of state in the pharmaceutical sector is quite old. Such an organization, and in 1834 it was founded in Poland. In Ukraine the pharmaceutical Chamber has been working for three years and so far it has no analogues.

: Who has the right to be a member of the Chamber?

O. Klimov: Our organization accepts only private individuals with pharmaceutical education. The presence of legal entities is strictly prohibited by the Statute, because they may cause the conflict of interests. Businessmen unite with each other in order to defend themselves from the state, tax service, etc., but they are all situational associations that do not aim to lobby for the interests of citizens.

: What is the role of the Chamber before the state and does the state listen to it?

O. Klimov: We managed to establish professional relations with the Ministry of Health, we discuss all documents of the Ministry in the working group. Cabinet of Ministers has also heard us, as we manage to regulate the implementation of resonance bills. At the moment, there are many unsolved issues. We see the strong opposition among the pharmacy network owners regarding the adoption of the draft law “On Pharmaceutical Self-Government”, which clearly describes the state and professional community relations. It foresees the creation of an institution of admission to a profession that exists in the whole world.

In the US, UK, Germany, Poland after getting a university diploma a young specialist should pass a test in a professional organization and only after a successful examination he will receive a work permit in the form of “PERSONAL LICENSE FOR PROVIDING PHARMACEUTICAL SERVICES”

There are national registries of pharmaceutical workers in these countries, which are the only source, which can confirm your professional level. My colleagues from the MORION, LLC have also created a similar register in Ukraine, where you can look at the place of study, the term of employment, and the period of time, when he completed his postgraduate courses.  It is not a surprise that the registry has caused such a resistance among the participants in the pharmaceutical market as the initiative of the self-government legislation.

: Why did it happen?

O. Klimov: Because now you need to show down- who is working on you, specialist or not? I am sure that not all Ukrainian citizens know that a person with the secondary level of medical education does not have the right to dispose prescription medicine. Like mushrooms after the rain, our pharmacies grow and I have to say that there are many white coats` workers, who even do not have a pharmaceutical education. That`s a horror!

In Ukraine the place of medicine sale is gaining popularity now. They have nothing to do with pharmacies. A prescription is not required here, and it completely ignores the ethics of patient treatment.

There is a government program “Available medicines” in Ukraine now. How do you think, how many pharmacies do support it? About 5 thousand pharmacies declare their participation, but in fact, no more than 1600 business entities, including communal enterprises that have no other way out, and a small number of private owners. Where are the others 17 thousands??? 90% of medicine sale places do not support government initiatives, and not because they are good or bad, but because it is a loss for business. Participation in the state program means a significant reduction of the markup, a thousand reports to various agencies and the return of money in 30-40 days. So the state promised our citizens to give the available medicines and “forgot” to emphasize that they would get them at the expense of pharmacies. Reimbursement successfully works all over the world, but it is not submitted under a political flag and is not realized at the expense of business.

: What to do if there is no pharmaceutical service, everything is done due to the business purpose. What steps would you recommend to make in order to get out of this situation?

O. Klimov: The main steps are the following three.

  • The first step is the training of personnel. Every worker should have a license to provide the pharmaceutical services, because it is not the pharmacy, which releases the medicine, but a specific person-specialist, who should be responsible for his actions.·
  • The second step is postgraduate education. Without it a person can not work in the pharmaceutical area. In the UK you have to confirm the license every year, making a huge number of online tests. That’s the only way to be sure that only highly qualified specialists work in our pharmacies. We are following the standards in all areas- the plant (GMP), the laboratory (GLP), the distributor (GDP), registration, quality control standards. And only the last and most important area, which is pharmacy, has no world standards. Under the pressure of business prohibition a pharmacy moratorium, aimed to check the medical establishments for has been introduced for the third year by the State Service of Ukraine on Medicines and Drugs Control. It is a state service that must guarantee Ukrainian citizens, according to its status, that the medication in the pharmacy and the personnel meet all the requirements. Therefore, all preliminary expenses are leveled up by the pharmacies to zero.
  • The third step is the liquidation of the markups on the medicines of the prescription group. Each package must indicate the retail price, which includes the distributor’s markups. The price of the pharmaceutical service has to be also added to it; in Europe (Germany) it is approximately 8.98 euro cents. The pharmacy has to build its business success not at the expense of the number of medicine sales places, but due to the quantity and quality of pharmaceutical services provided to the patient.

Taking into account the global experience, it becomes clear that all these reforms work. Thus, in Germany, France, Poland, Hungary and other countries, an ordinary citizen does not even have the right to be the owner of a pharmacy without a pharmaceutical education. In France, if the pharmacy owner dies, and there are no qualified pharmacists among his heirs, the local pharmaceutical organization gives his worker in a term of 5 years. If during this time nobody from the family get a pharmaceutical education, the pharmacy will be sold at auction.

In Ukraine it just looks very nice a beautiful picture has now been built – modern rooms, neat personnel, nice shelves and stands. But it does not even smell like a pharmacy. Just a business that neglects pharmaceutical ethics

: How much time do we need to radically change the situation so that we have it like, for example, in Poland?

O. Klimov: If it were my will, then I would start with the prices for medicines. 50% of price lowering only took time to prepare the resolution of Cabinet of Ministers. This is the first step. The second is the adoption of the laws on “Pharmaceutical self-government”, medical products and pharmaceutical activities. It offers 5 years of transition, so that pharmacists can obtain pharmaceutical education. The extramural form of study is not accepted in this area. This diploma is not recognized abroad as an education document. And 8 years for the development and implementation of Good Pharmacy Practice (GPP) standards, they are the accreditation standards of a pharmacist and a pharmacy as a health care institution.

During this period everything will be back in its places. The pharmaceutical self-government authorities start working. Not the corrupt state ones, which influence both business and pharmaceutical workers, but professional public organizations. There will be an accreditation of each employee, who will join a Unified register.

Leaving everything as it stands nationally threatens, as it is about the most valuable thing in the life of every person – the health. We have the right to require from the State to fulfill its constitutional duty – to guarantee every citizen accessible, high-quality and highly effective medicines.

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