BioPortfolio Limited Pharmaceutical Distribution in Europe The Emergence of Direct-to-Pharmacy Supply

	Pharmaceutical Distribution in Europe The Emergence of Direct-to-Pharmacy Supply
	Executive Summary Chapter 1: The Nature of the European Pharmaceutical Supply Chain The pharmaceutical supply chain Pharmaceutical manufacturers in the EU Pharmacies in the EU Wholesalers in the EU The hospital sector Prewholesaling History of the pharmaceutical supply chain Dynamics in the supply change Relationships within the supply chain Vertical integration New changes in the supply change Outlook for the supply chain Global lessons for the supply chain Case study: Consolidation among Japanese pharmaceutical wholesalers European status of the supply chain Stability of the European supply chain Product shortages in the supply chain Case study: Vaccine shortages and the effect on the supply chain Case study: Supply chain disruption in Latin America Traceability throughout the supply chain Counterfeit products Internet trading and pharmaceuticals Parallel trade The view of pharmaceutical manufacturers The view of parallel importers Legalities of parallel trade Exhaustion of intellectual property rights Repackaging and relabelling of products Consumer views of intellectual property rights The European Union History of the EU The set-up of the EU EU law Primary legislation Secondary legislation Case-law Decision-making in the EU The institutions of the EU The European Economic Area (EEA) The creation of the EEA EU Enlargement and the EEA The Euro The Euro and pharmaceuticals Chapter 2: Challenges for medicine wholesalers in Europe The role of the pharmaceutical wholesaler Channels of distribution Wholsalers and the Single European market Wholesaler opposition to supply quotas Case study: Bayer's Export Policy for Adalat Case study: Syfait versus GlaxoSmithKline Wholesaler views of Direct-to-Phamacy distribution Crossborder mergers and acquisitions Case study: Double acquisition by Phoenix ensures successful market entry into Croatia EU harmonisation and the outlook for pan-European wholesaleing The major players in pan-European wholesaleing Celesio AG The PHOENIX Group OPG Group Alliance Boots European regulations for wholesalers Guidelines on Good Distribution Practice of Medicinal Products for Human Use (94/C 63/03) Lack of harmonisation and the supply chain Wholesaler technology solutions Electronic data interchange Collaborative planning forecasting and replenishment Enterprise resource planning Wholesalers develop value added services Case study: GEHE Pharma Handel chosen as "Best-Practice-Enterprise" for value added services Case study: PHOENIX wins pharmacy partner award Order fulfilment packages Database technology Electronic point-of-sale technology Bar coding Case study: US highlights benefits of bar code and RFID technologies Case study: Pfizer France reviews the RFID system for Viagra Case study: AstraZeneca opts for mass serialisation to prevent counterfeiting European wholesaler opinions on technological solutions Warehouse technology Dispensing technology Techology in the future of pharma distribution Consumers and e-commerce Case study: DocMorris Pharmaceutical distribution in UK Pharmaceutical distribution in France Case study: Industry support of the Masters Degree in Pharmaceutical Distribution at University of Limoges Pharmaceutical distribution in Germany Pharmaceutical distribution in Italy Case study: IBS introduces supply chain management solutions into the Italian pharmaceutical market Pharmaceutical distribution in Spain Pharmaceutical distribution in Switzerland Case study: Galenica expands its service offerings Chapter 3: Manufacturers start to control the ditribution of pharmaceuticals Pharmaceutical manufacturers in Europe The pharmaceutical industry and the supply chain The role of pharmaceuticals Drug development and innovation Cost containment The pharmaceutical market Lack of harmonisation in the EU pharmaceutical market Counterfeiting Pharmaceutical industry efforts to combat counterfeiting Manufacturers exert control over the supply chain The Office of Fair Trading investigation Implications of changes in the supply chain Service standards to patients Rationale behind changes in the supply chain Pfizer's feedback on Direct-to-Pharmacy distribution Case study: Pfizer UK's Direct-to-Pharmacy website Reaction to the Office of Fair Trading enquiry AstraZeneca changes its supply chain arrangements Sanofi-Aventis changes its supply chain arrangements Napp Pharmaceuticals changes its supply chain arrangements Novartis considers changes to supply chain arrangements Eli Lilly considers changes to supply chain arrangements Astellas adopts direct distribution for Transplant Medicines Patients and healthcare Case study: The International Alliance of Patients' Organizations Pharmaceutical manufacturers and the developing countries Collaborations with healthcare providers Case study: Novartis makes agreement with the World Health Organization for distribution of malaria treatment Case study: Diversion of anti-retroviral drugs destined for Africa Anti-diversion tactics Chapter 4: Pharmacy and the Future of Medicines Distribution Pharmacies in Europe Additional pharmacy services Differences in pharmacy regulations Hospital pharmacy in Europe Wholesaler Margins and VAT Rebates and discounts Distribution of OTCs Generics Independent pharmacies Pharmacy chains Wholesaler involvement in pharmacy chains Pharmacy purchasing groups Supermarkets Drugstore chains Mail-order pharmacy Removing restrictions in the European pharmacy sector Case study: European Commission challenges Italian legislation concerning pharmacies Case study: European Commission challenges Spanish legislation concerning pharmacies Case study: European Commission challenges Austrian legislation concerning pharmacies Sale of non-prescription products outside pharmacies Implications of liberalisation in the European pharmacy sector Liberalisation of the pharmacy sector and accessibility Liberalisation of the pharmacy sector and market dominance Liberalisation of the pharmacy sector and quality of service Pharmacies and changes in the supply chain REFERENCES List of Figures Figure 1.1 Outline of the Supply Chain Figure 1.2 Number of pharmacists (per 1000 population) Figure 1.3 Total revenue of European pharmaceutical wholesalers (without VAT) Figure 1.4 Worldwide Vaccine Market Figure 1.5 Share of parallel imports in European pharmacy markets Figure 2.1 Number of Full-line Wholesalers Figure 2.2 Average gross margin of wholesalers in 9 West Europe Countries Figure 2.3 Celesio AG Wholesale Revenue by Market (2006) Figure 2.4 Celesio AG Pharmacy Revenue by Market (2006) Figure 2.5 Phoenix Group Turnover (2002 - 2007) Figure 2.6 Breakdown of OPG Sales (2006) Figure 2.7 Alliance Boots Wholesale Division Revenue (Q1,2,3 2006) Figure 2.8 Percentage of electronic orders from pharmacies to wholesalers Figure 3.1 Pharmaceutical R&D Expenditure in Europe 1195 - 2006 Figure 3.2 Pharmaceutical R&D Expenditure across Europe Figure 3.3 NHS expenditure per person in the UK Figure 3.4 Community prescribing in the UK: Prescriptions Per head Figure 3.5 Patient satisfaction with quality and effectiveness of healthcare received Figure 3.6 Patient satisfaction with ability to access information on new medicines or treatments Figure 4.1 Number of Public Pharmacies (12 European Countries) Figure 4.2 Pharmacy sales per inhabitant Europe (€) Figure 4.3 Number of Hospital Pharmacies in 8 Countries Figure 4.4 VAT rates applied to prescription medicines across Europe Figure 4.5 Share of generics in European pharmaceutical markets Figure 4.6 Percent change in number of pharmacies N, E, N, A, F, S(1995 - 2005) Figure 4.7 UK Pharmacy respondent views on potential costs of setting up a separate Pfizer account for DTP List of Tables Table 1.1: Types of manufacturer medicines Table 1.2: The institutions of the EU Table 1.3: Adoption of the euro Table 2.1: OPG's activities in Europe Table 2.2: Summary of GDP Guidelines Table 2.3: The BAPW's Gold Standard of Good Distribution Practice by Pharmaceutical Wholesalers as endorsed by the MHRA Table 2.4: Process of adoption of IBS supply chain management solution by Itriafarma Table 3.1 Key areas of focus for the International Medicinal Products Anti-Counterfeiting Taskforce (IMPACT) Table 3.2: Overall risks due to DTP identified by OFT Table 3.3: Implications of reduced service standards due to DTP (adapted from OFT, 2007) Table 3.4: Anti-diversion tactics employed by pharmaceutical manufacturers and cited by WHO Table 4.1: Goals of the EAHP Table 4.2: Summary of liberalised pharmacy sector in "case study" countries chosen by ÖBIG Table 4.3: Summary of regulated pharmacy sector in "reference study" countries chosen by ÖBIG