Medication in Germany

Got an excruciating headache? Need an aspirin lickety-split? Well, if you're in Germany and it's a Sunday, forget about grabbing a bottle of over-the-counter painkillers at the grocery store.

Not only are German grocery stores not open Sundays, you won't find aspirin there anyway. Unless you have friends or neighbors with aspirin on hand, you'll just have to wrestle with the hellish mindgrip unless you're willing to shlep around town to find the emergency pharmacy on duty.

Limited access, high prices

For decades, Germany's restrictive laws have limited the selling of medications only to pharmacies, which must be personally run by registered pharmacy owners.

Though European countries have been deregulating everything from telecommunications to postal services and railways, German lawmakers have been reluctant to tamper with the pill market, resulting in protection against competition among pharmacies and continued high prices.

As of 2004, however, pharmacists are now allowed to own not just one, but up to three of their own stores.

Risky business

Pharmacists generally support limited access to medication, saying that it ensures public safety.

"Even minor painkillers contain risks and should only be sold by pharmacists who provide information on them and who sell them only in limited amounts," said Ursula Sellerberg, a spokeswoman for the Federation of German Pharmacists' Associations (ABDA).

Still, "liberalization of who sells medication would mean greater competition and pharmacies would be forced to lower prices," said Kai Vogel, a spokesman for the North Rhine-Westphalia Consumer Protection Agency.

Vogel said German consumer protection agencies, however, are advocating that pharmacies should still be required to provide information about medication risk.

Sellerberg, for her part, pointed out that stomach problems from mere aspirin can occur when taken in high doses.

"We're encouraging pharmacists to advise even for 'lighter' medications," she added.

Gaining ground

Chain drug stores where consumers can buy inexpensive over-the-counter medication or prescription drugs provided by a trained pharmacist have been non-existent in Germany. There's no RiteAid, no CVS, no Duane Read -- to name some of the US's largest retailers.

That has begun to change over the past few months. In July, former software engineer Ralf Däinghaus opened a DocMorris -- Europe's largest mail-order medication firm based in the Netherlands -- pharmacy in Saarbrücken. Thus ensued a debate over whether Germany should permit retail drug chains.

On the one hand, German pharmacists say DocMorris was violating German law, which forbids corporations from owning pharmacies.

On the other hand, Saarland's Health Minister Josef Hecken, who permitted the Dutch DocMorris to open shop in Saarbrücken, said that EU law entitling any European citizen to set up business anywhere in the Union "takes precedence over national law."

Penny-pinchers

Some customers in Saarbrücken were delighted, saying they could save up to 30 percent on prescription and over-the counter drugs at DocMorris. And they're not cheap at traditional pharmacies: There a package of 20 brand-name aspirin tablets costs just under five euros (around $6.50), though a generic version of 30 tablets costs around half that.

Ralph Däinghaus was proud to announce double the number of sales in the first month of opening the Saarbrücken store, as compared to sales by the former pharmacy store he took over there.

He "expected success," he told Germany's tageszeitung (taz) daily, because medication costs in Germany are "scandalous" compared to France and Belgium, where the same drugs cost half the price, taz wrote.

German pharmacists were less than thrilled, however, and began worrying that their livelihoods were at stake and patients at risk.

Däinghaus has also been in and out of court since July, with three Saarbrücken pharmacists and two German pharmacy associations -- who contested DocMorris -- eventually chalking up a victory when the Saarland district court ordered the DocMorris store in Germany to be closed.

"The decision was right based on German law," said Vogel, "but it is very likely that DocMorris will go all the way to the European Court of Justice with countersuits and that the ban will be reversed and drug prices will eventually change in Germany."

Reform headaches

In Berlin, lawmakers plan to install a price cap on prescription drugs; pharmacies could lower prices, but not raise them. And, since only pharmacies are permitted to supply hospitals with drugs, politicians believe cheaper medication could also mean drastic savings in Germany's flailing public health care system.

"But pharmacy costs make up only 2.7 percent of all the expenses of the public health care system," said ABDA's Sellerberg. "That's only half of what the public insurance schemes need for their administrative tasks."

Traditional pharmacists have been up-in-arms. Throughout November, thousands of them have staged protests across Germany against health care reforms which they say threaten their existence.

Reform plans include a clause in which pharmacists would be expected to negotiate rebates between insurance groups and pharmaceutical manufacturers. Should they fail, pharmacists would have to contribute 500 millions euros ($640 million) from their own pockets to the government.

ABDA maintains this is unfair since costs for insurance companies have risen not because pharmacists maintain high prices, but because 80 percent of what public health insurers pay for patients' medications goes to pharmaceutical manufacturers and taxes.

Kai Vogel believes it's only a matter of time until Germany changes its ways and starts allowing more competition. For now, he suggests that when shopping in pharmacies, consumers should request drug prices and ask for less expensive generic varieties.

They should also make sure they don't get a headache on Sunday.