
End of pharmacy bonuses looms
German Minister of Health uses sleight of hand to ensure uniform prices for prescription-only medicines.
UM – 08/2019
Germany’s
Minister of Health Jens Spahn wants to protect his domestic pharmacies and make
life difficult for foreign mail-order pharmacies. The Act to Strengthen
Local Pharmacies (which is available in German language only) is intended to ensure that
pharmacy prices for prescription medicines for human use remain fixed. As a
result, mail-order pharmacies based abroad will not be allowed to give their
German customers any bonuses or discounts. The draft law has been submitted ‘informally’
to the European Commission for assessment with regard to competition law. Their
comments will be taken into account. It is not clear what position the
Commission will take.
Fixed prices act like import restrictions
The draft
of the Local Pharmacy Act sees the dictum of fixed pharmacy prices being
transferred to social law. This is the final reaction to an EU infringement
procedure (No. 2013/4075) that has been ongoing since 2013 and a ruling of the
European Court of Justice (ECJ) from October 2016 that has since been issued in
the context of a preliminary ruling procedure (Ruling C-148/15 of 19 October
2016, Deutsche Parkinson Vereinigung). The judgment stated that requiring
mail-order pharmacies located abroad to charge fixed prices was to be regarded
as a quantitative restriction on imports and thus contravened the free movement
of goods. Spahn’s
trick is to abolish the Pharmaceutical Pricing Regulation, which stipulates
that pharmacies must sell medicines at uniform fixed prices, and at the same
time implement a regulation with a comparable effect in Book V of the German Social
Code. The ban on bonuses and discounts would then continue to apply.
Questionable under European law
Even the
ECJ did not consider that is necessary to apply Germany’s fixed pricing system
to foreign pharmacies. On the contrary, forcing pharmacies to charge fixed
prices violates Article 34 of the Treaty on the Functioning of the European
Union (TFEU), as it has a negative effect on the supply of medicines by
pharmacies established in other Member States via mail order. The Internet is an
important means for them to directly access the German market and price
competition can therefore be a more important competitive factor for mail-order
pharmacies than for bricks-and-mortar pharmacies. It is
therefore difficult to imagine that Spahn’s proposed Local Pharmacies Act could
be based on favourable feedback from the Commission. After all, in terms of
European law, the proposed Act is comparable to the Regulation which the ECJ ruled
in October 2016 as infringing the free movement of goods.
Concerns in Germany also
Merkel’s cabinet also has its reservations.
Both the Ministry of Justice and the Ministry of Economic Affairs and Energy,
which is decisive for European coordination, have stated that the Federal
Ministry of Health’s draft Act has ‘significant risks under European law’. The reason
why the draft was nevertheless adopted by the Federal Cabinet on 17 July 2019
must therefore be a political one.
Germany’s statutory health insurance is for healthy competition
Germany’s
statutory health insurance has clearly positioned itself on this issue. Even in
a competitive environment, it advocates healthy competition that results in
better and more affordable care for insured persons and patients. This is a
reflection of the times. The sales volume generated by mail-order pharmacies
abroad is modest and does not justify any measures restricting competition. In
addition, mail-order pharmacies must meet the same quality requirements that apply
to local pharmacies. There are no indications that these requirements would not
be met.