The front page of today's Tages Anzeiger carries a story about a proposal, which has the support of the federal governement, to allow pharmacists to write their own prescriptions for a limited number of situations.

The proposal is naturally opposed by the doctors, and also the insurance companies.

Let's examine the present situation. Right now (at least in Zurich) doctors have the ability to sell medications directly to patients. Doctors naturally argue that this is more convenient for the customers, but those opposed would argue that allowing a doctor to both prescribe and sell the same medication represents a serious conflict of interest, especially when they get a lot of "marketing assistance" from the drug companies.

Pharmacists are naturally up in arms about the present situation since it eats into their income (they also seem slow to adjust to changes - compare a traditional Swiss pharmacist to something like boots in the UK).

With this in mind, are the pharmacists well within their rights to call for such a proposal if not just to redress the imbalance?

My own opinion is that it may have certain advantages. For example patients could save the health insurance a bit of money and the doctor some time by taking care of routine cases. Then why do the health insurance companies oppose it? Is it because they feel pharmacists may overprescribe medication due to the same sort of conflict of interest that exists for the doctors?

I think the only workable solution is that doctors don't sell drugs, and pharmacists don't prescribe them. That's the only way to reduce the conflict of interest.

What do you think?

Hi,
i understand what you are saying, but here in the UK both pharmacists and nurses can prescribe if they have done the relevant courses. In this situation ie. the NHS I think this is a good thing, relieving some of the strain on the doctors. many nurses and pharmacists run their own clinics ( they do in my field anyway - CHD). If I am already seeing a patient at my clinic & can prescribe a drug ,I feel I am providing a better service for the patient, preventing duplicating of services and time wasting.

It's all 'beating about the bush' - the nub of the matter is the pharmacists / chemists shops have a monopoly here.

Migros made an attempt to sell non-prescription drugs a few years ago, they failed. You can't even buy an aspirin in a Swiss supermarket.

The results is that we pay more for drugs. But at least they keep employment up. We have two chemist's* shops in Thalwil (population 17,000) with a well-manned (and womaned) teams at both...


[* I feel that although the shops are plural, the concept of 'chemist's shop' in this instance is singular.]

Personally I disagree with the idea of Pharmacists handing out prescriptions. I have had a couple of instances where I went to buy cough mixture of some flu medicine, clearly stated that I am allergic to aspirin and have still walked out of the shop with a product containing aspirin, from a pharmacists! So simply put no I don't want them handing out prescriptions.

I used to disagree with Doctors selling you the medication that they have just prescribed. But due to change of personal circumstances, I am incredibly grateful that my doctor is able to give me the meds directly and save me the trip...

Interesting, I hadn't considered that and hadn't even noticed that non-prescription drugs were missing from the supermarket shelves here (shows how often I buy these things).

Well I guess the answer is either for the pharmacists to move inside the supermarkets (i.e. Migros hires one and gives them a counter inside the supermarket) or the pharmacies expand and start selling a much larger range of other products (like Boots) with longer opening hours.

Oops, I just described the way market forces have already changed things in other countries

No, no!change can only be disastrous, result in loads of lost jobs and flood the country with foreigners. Must ..... resist .... change

In the UK there was also a huge ruckus when pharmacists were allowed to sell certain drugs without a doctor's prescription. But that must have been something like 15 years ago now. As it stands, some stuff still needs a doctor's prescription, some can be prescibed by a pharmacist and other drugs can only be bought in a pharmacy but don't need a prescription. The range of pharma products that you can buy in a supermarket is still pretty small.

(FYI, you can now buy viagra without presciption in a pharmacy if you are over 35 and meet some other criteria )

Gav

I am really opposed to doctors selling the meds they prescribe. I had seen one doctor who did this- she refused to ever write a prescription. This meant I had to come back and see her to pick up drugs she prescribed on the last visit but didn't have in stock. This happened more than once. And one time I called to get a repeat on a prescription and she insisted I come in (she's close to where I work, not to where I live) to get it and refused to call it in to a pharmacy - not for an exam, but because she didn't "do that".

Then again, I had a lot of complaints about this woman (whom expat women in Basel seem to love...I don't understand why...)

For many drugs its simply commercial distribution. How much is the margin on a product and and who gets it ? Traditionally, the doctor does the specification, the pharmacy does the distribution. This setup should separate the specification from the selling.

To be honest my pruchase of pharma is limited to what in UK would be over the counter products.

Go into the pharmacy at the end of Bahnhofstrasse. I can tell the difference between one brand of paracetemol and another, simply by reading the label. But no, everything is kept out of reach, in formal-looking wooden drawers where none but the enlightened can look.

Another area of retailing that is ripe for a shakeup. Bring on the generics.

dave

Did you speak to the actual Pharmacist (qualified professional), or just some person who was working in the store?

I just want to say that conflicts of interests between "health operators (i.e. physicians and pharmacists)" and pharmaceutical firms must be avoided in any case. Thus doctors shouldn't sell medicines and pharmacists shouldn't be able to make prescriptions.

It would be interesting to compare consumption, substance abuse and addiction rates to stuff like painkillers in the UK and Switzerland, the two countries being at both end of the spectrum when it comes to availability of medicines.

Note that by interesting I really mean that, I'm not being a smart arse and I'm not implying anything, I just wonder if the restrictions in Switzerland do really help in that matter (which is the thinking behind the lack of freely available painkillers rather than a "job for the boys" mentality although there is probably a fair dose of that too...)

sorry for resurrecting old thread, but i'm intrested how it ended up. any news about this proposition? was it approved finally ?

Still in discussion.

I think everyone should be able to prescribe anything, as long as the prescription can be taken elsewhere (eg to a cheap pharmacy) to fill.

It's regulated differently in each canton.

• 13 cantons, mostly in central and Eastern Switzerland, allow doctors to sell medication.
• 4 cantons partially allow this, usually in rural regions but not in the cities. Canton Zurich falls in this category until the end of 2009 but the Zurich people have voted that doctors in Zurich and the Winterthur district are allowed to sell starting next year, too.
• In 9 cantons the doctors always give prescriptions and the patient buys at the pharmacy.

Mandatory health insurances have accumulated a big budget imbalance and significant premium increases loom for 2010. Because of this the federal council Couchepin suggested several ways how to get the expenses under control in May. In early June, he added another measure to the bundle that will be discussed in parliemant. He wants to disallow doctors to hand out medication.

Also, on 1.7.09 the Federal Department of Home Affairs decided to lower the margins on medication and to limit the price of generic medicaments.