In Frankfurt, Pharmacy Takes a Different Approach

About 8 years ago, readers of this column were introduced to my son, Philip. In the column, I wrote about his attempt to purchase insulin needles, which was denied. His insulin pump failed, and he had a truly bad experience when he appeared at a chain store in Pittsburgh, Pennsylvania. His bushy beard, long hair, and flannel shirt gave the impression that he might not be a diabetic. That column generated the most reader comments I have ever received.

Peter A. Kreckel, RPh

About 6 months ago, Philip sold the family house and moved his wife and 2 beautiful daughters to Frankfurt, Germany. There, he has a great job as a data analyst at a local financial institution, and Philip is settling into his new life as a German citizen. Two years ago, when my wife, Denise, and I began planning a Danube River cruise, my ever-creative wife decided to fly into Frankfurt 3 days before the cruise began to spend time with Philip and his family.

Along with historic buildings and churches, I always love to visit a pharmacy. In Frankfurt, Philip took us to “his” pharmacy. There, we met a bright and warm pharmacist named Ursula Böning. She was glad to visit with Denise and me and to tell us about her profession. There is a world of difference between German pharmacies and their American counterparts.

Over my years of travel through Germany and Europe, I have visited at least a dozen pharmacies. I have yet to meet a male pharmacist. I have also never been to a pharmacy full of the chaos that we see in America at every visit. What truly surprised me on this visit were the prices of medications.

READ MORE: Striking Pharmacists Put Concern for Patients First

I asked Ursula whether semaglutide (Ozempic) is the wonder drug in Germany that it is in the US. She explained that there is a large demand for it but that it is frequently back-ordered. I told her that our price from our wholesaler was $922 per month. She was aghast: Ursula flipped her computer screen around and showed me her warehouse price was €79.00, or US $86.13, per month. “No wonder we can’t get it here; you pay over 10 times as much for it!” she said. The price was the same in Austria and Slovakia.

Ursula shows me her screen, with the warehouse Ozempic price.

Pharmacy in Germany is entirely different than it is in the US. A patient’s data are kept on a cloud, and the patient can go to any pharmacy with their national health insurance card, present it, and make a request for their medication. The pharmacist then pulls down the data and fills the prescription. They wave a prepacked blister pack box in front of a scanner; the bar code verifies it is the right drug, strength, and quantity; the QR code is waved in front of a scanner; and the prescription is billed. The pharmacist handles the transaction, counsels the patient, and sends them on their merry way.

Ursula also shared with me that three-fourths of the pharmacists in Germany are women. I asked her what percentage of graduates enter the retail pharmacy space upon graduation. She guessed around 90% of her class works in a community practice setting and was shocked when I told her my alma mater published the statistic that 16% of graduates were interested in community pharmacy practice. “Then what do they do?” she asked. I answered, “Anything but what you are doing, and what I have done for 42 years.”

Ursula Böning, pharmacist, gave me permission to use her name and photo in this article.

In America, a hodgepodge of practices by drug companies, insurance companies, and pharmacy benefit managers have created a system where pharmacies are losing money on transactions.^1-3 Our pharmacists are overworked, overstressed, and unhappy with the current model. Let’s get rid of all the bureaucracy, the massive stock bottles, the vials, the prior authorizations, and all the other impediments that are keeping our best and brightest out of community pharmacy practice. Let’s follow Germany’s lead in health care—they seem to be pretty good at it. And no wonder: Germany has had national health insurance since Otto von Bismarck in 1883. Let’s use their 140 years of experience to get drug prices, our profession, and our health care back on track.

References

1. Schiller M. Independent Pittsburgh-area pharmacists blame closures on middlemen. CBS News. Updated March 26, 2024. Accessed April 16, 2024. https://www.cbsnews.com/pittsburgh/news/independent-pharmacists-blame-closures-on-middlemen/https://www.cbsnews.com/pittsburgh/news/independent-pharmacists-blame-closures-on-middlemen/ 

2. McIntyre M. Va. pharmacies say low reimbursement rates keep them struggling to stay afloat. Virginia Mercury. November 21, 2023. Accessed April 16, 2024. https://virginiamercury.com/2023/11/21/va-pharmacies-say-low-reimbursement-rates-keep-them-struggling-to-stay-afloat/ 

3. Small Wyoming pharmacies pushed out of business, say industry is like mafia. Cowboy State Daily. April 14, 2024. Accessed April 16, 2024. https://cowboystatedaily.com/2024/04/14/small-wyoming-pharmacies-pushed-out-of-business-say-industry-is-like-mafia/