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ABOUT THE ABDA
» The ABDA – Federal Union of German Associations of Pharmacists is the foremost organisation for phar-
macists in Germany. The ABDA represents the interests of the pharmaceutical healthcare professions in
politics and society while promoting high-quality, comprehensive pharmaceutical care in Germany.
» The ABDA has 34 members: 17 regional chambers of pharmacists and 17 regional associations of
pharmacists – one from each of Germany’s 16 federal states plus an additional representative from
North Rhine-Westphalia which has been divided into North Rhine and Westphalia-Lippe due to its size.
» The 17 chambers of the Federal Chamber of Pharmacists (BAK) and the 17 associations in the German
Pharmacists’ Association (DAV) are combined under one roof in ABDA. Membership in the Chamber of
Pharmacists is mandatory for all pharmacists while membership in associations for pharmacy owners,
on the other hand, is voluntary.
» ABDA’s Executive Board is composed of 13 members: the president, the vice president, an employed
pharmacist from a community pharmacy along with five members each from the BAK and DAV
executive boards.
» The annual general assembly for pharmacists takes place once per year as part of German Pharmacist Day.
The annual general assembly is used to form political positions. Its resolutions are binding for the ABDA
committees’ actions.
» The offices of ABDA, BAK and DAV are in Berlin and are run by the general manager. In addition to the
four business areas, a) pharmacy, b) pharmaceuticals, c) economics and d) law, there are staff positions
for a) finances, personnel and administration, b) communications and c) European affairs.
» European representation for ABDA is headquartered in Brussels (Belgium) and is responsible for represent-
ing its interests in European Union (EU) institutions.
» The ABDA is a member of the German Federation of Independent Professionals (BFB), the Pharmaceutical
Group of the European Union (PGEU), and the International Pharmaceutical Federation (FIP).
» The ABDA receives professional support from many institutions, including the Drug Commission of German
Pharmacists (AMK), the German Institute for Drug Use Evaluation (DAPI) as well as the Central Laboratory of
German Pharmacists (ZL).
GERMAN PHARMACIES – FIGURES, DATA, FACTS 20182
PHARMACIES IN GERMANY
» The red pharmacy A (with chalice and snake) is the identifying symbol for community pharmacies in Germany.
This registered trademark of the German Pharmacists Association (DAV) enjoys special legal protection
throughout Germany and Europe.
» In order to work as a pharmacist in Germany, one must study for 5 years at university: 2 years each of basic
and main studies and 1 year of practical training. Each course of study ends with a state examination. Upon
successful completion, one must apply for a license to practice pharmacy, which is authorisation to exercise
the profession.
» Pharmacists with a foreign pharmaceutical diploma or certificate need to have it recognised prior to starting
to work. There is a responsible authority for the recognition in every federal state. The responsible authority
will check the equivalency level of the qualification. If there are significant divergences in the qualification,
the responsible authority might propose measures to compensate the gaps. Moreover, applicants need to
give proof of their language skills in German. Additionally, citizens from outside the European Union (EU) or
the European Economic Area (EEA) will need a work and residence permit and eventually a visa for entry,
residence and employment in Germany.
» Pharmacists in Germany are not only part of the healthcare professions (like doctors) and freelance pro-
fessions (such as architects), but also pharmacy owners which means they are also merchants who are
therefore required to pay business taxes.
» Freedom of establishment has been created for pharmacists in Germany. According to this principle, a
pharmacist may establish a pharmacy anywhere and anytime, provided that he complies with the law.
This also means that no pharmacist is protected from unwanted competition in the vicinity.
» In Germany, the owner / operator of a pharmacy must always be a pharmacist. This third-party ownership
ban emphasises a pharmacist’s personal responsibility and liability – and decouples the provisioning of
pharmaceuticals from corporate profit goals.
» The ownership of multiple pharmacies is forbidden in Germany. However, a pharmacist may, in addition to
the main pharmacy, operate up to three subsidiary pharmacies in the nearby local vicinity. Each of these
locations must also have a pharmacist in place as subsidiary manager. There are no pharmacy chains in
Germany.
» Selling pharmaceuticals via mail order is allowed in Germany. Approved mail-order pharmacies are “normal”
community pharmacies with a special mail-order permit. According to a list from the Federal Ministry of
Health, the mail-order trade is also allowed from a few other European countries.
» Prices for prescription-only pharmaceuticals are uniform nationwide; this is stipulated by the Drug Price
Ordinance to protect patients and pharmacists. However the European Court of Justice undermined this
law in 2016 when it ruled that foreign mailorder pharmacies may grant discounts on nationwide fixed
prices. In contrast, all pharmacies are free to set their own price for non-prescription medications.
» The pharmacist’s fee for consultation on a prescription medication is regulated by the Drug Price Ordinance.
Broadly speaking, this is a fixed fee of 8.35 euros per package. Each pharmacist may calculate their own
fee for non-prescription pharmaceuticals.
» Pharmacists in Germany assume an obligation for the common good of society. This is not individually
remunerated but, rather, it is individually subsidised. This includes creating formulations, dispensing
narcotic substances and performing comprehensive evening and emergency services.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 3
LOWER SAXONY
BREMEN
WESTPHALIA-LIPPE
NORTH RHINE
Düsseldorf
HanoverMünster
Bremen
Hamburg
Kiel
Schwerin
Berlin
Potsdam
Dresden
Erfurt
Munich
Stuttgart
Saarbrücken
Wiesbaden
Mainz
Magdeburg
RHINELAND-PALATINATE
SAARLAND
BADEN-WUERTTEMBERG
BAVARIA
THURINGIAHESSE
SAXONY
BRANDENBURG
MECKLENBURG-WESTERN POMERANIA
SCHLESWIG- HOLSTEIN
NORTH SEA
THE NETHERLANDS
BELGIUM
LUXEM-BOURG
FRANCE
SWITZERLAND
AUSTRIA
CZECH REPUBLIC
POLAND
DENMARKBALTIC SEA
HAMBURG
SAXONY-ANHALT
BERLIN
MAP OF GERMANY
GERMAN PHARMACIES – FIGURES, DATA, FACTS 20184
“APOTHEKE 2030” PERSPECTIVE PAPER
» The policy paper “Pharmacy 2030 – Perspectives on provision of pharmacy services in
Germany” (“Apotheke 2030”), was adopted by a vast majority on German Pharmacist Day
2014 in Munich. This was preceded by an opinion-forming process in which several
thousand pharmacists participated over the course of an entire year.
» The preamble reads as follows: “Pharmacists in Germany are experts in pharmaceuticals.
Based on this core competency, they make an indispensable contribution to patients’
well-being in outpatient care. As freelance health professionals, they carry out their legal
mandate of comprehensive pharmaceutical provisioning to the German public via public,
owner-operated pharmacies.”
» The healthcare system in Germany faces great challenges such as demography, a lack of
professionals and financial pressure on resources. Therefore, for the benefit of our patients,
the healthcare role of the pharmacy must be actively defined so that healthcare may
maintain a key role in the future as well.
» “Apotheke 2030” describes how the pharmacy’s role and range of services should be
advanced as a pillar of the healthcare system. Essentially, it concerns ways in which phar-
macies may strengthen their role in healthcare while collaborating as part of a network with
doctors and other specialised professionals thus making true medication management for
patients possible.
» Three issues are at the forefront when strategically implementing the document: First,
pharmacists must define the correct way in which to systematically implement medication
management. Secondly, provisioning frameworks must be adapted for the future. Thirdly,
pharmacists must determine what the future holds regarding pharmacist qualification
(education, advanced and continuing education).
» Pharmacies in Germany wish to continue offering medication management as a crucial
instrument for safe, effective and economical pharmaceutical therapy in the future. In so
doing, all of a patient’s medication, including self-medication, will be continually analysed.
The goal is to avoid, detect, and solve problems related to pharmaceuticals and, in so
doing, increase the effectiveness and efficiency of pharmaceutical therapy.
» Pharmacists wish to collaborate collegially both among each other and with other health-
care professions as part of a healthcare network. Pharmacies will actively co-design the
healthcare network with clearly defined competencies and interfaces. As an integral com-
ponent of the network, they will assume responsibility for pharmaceuticals, the safety of
pharmaceutical therapy and the optimization of practices.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 5
CONTENTS
PHARMACIES’ PROVISION, SUPPLY AND SERVICES
Overview of Patient Care and Services ....................................................................................................................9
Night-time and Emergency Service .......................................................................................................................10
Formulations .........................................................................................................................................................12
Standard Formulations ..........................................................................................................................................13
PHARMACY LANDSCAPE
Number of Pharmacies ..........................................................................................................................................14
Pharmacy Numbers by German Federal State ......................................................................................................15
Geographical Coverage .........................................................................................................................................16
Pharmacy Density in Europe .................................................................................................................................17
Subsidiary Structure ..............................................................................................................................................18
Specific Types of Pharmacies ................................................................................................................................19
Mail Order Trade ................................................................................................................................................... 20
EMPLOYMENT IN PHARMACY
Number and Age of Pharmacists ...........................................................................................................................21
Jobs in Pharmacies .............................................................................................................................................. 22
Trainee Positions in Pharmacies ............................................................................................................................23
Pharmacy Students and Approbations ..................................................................................................................24
Professional Language Proficiency Exams for Foreign Pharmacists ..................................................................... 26
Continuing Professional Education and Postgraduate Specialisation .....................................................................27
PHARMACEUTICALS IN GERMANY
Pharmaceuticals Approved in Germany ................................................................................................................ 28
Pharmaceutical Price Index .................................................................................................................................. 29
Value-Added Tax on Pharmaceuticals .................................................................................................................. 30
Pharmaceuticals Pricing ........................................................................................................................................31
Pricing for Standard Formulations .........................................................................................................................32
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
Breakdown of Total SHI Expenditures .................................................................................................................. 33
Miscellaneous Health Insurance Fund Expenditures ............................................................................................. 34
SHI Expenditures for Pharmaceuticals ................................................................................................................. 35
Pharmaceuticals by Price Classes ........................................................................................................................ 36
Pharmacy and Manufacturer Markdowns ..............................................................................................................37
Rebate Pharmaceuticals....................................................................................................................................... 38
Patient Co-Payments ............................................................................................................................................39
Co-Payment Exemptions .......................................................................................................................................40
QUALITY ASSURANCE
Guidelines and Working Aids .................................................................................................................................41
AMK: Reporting of Pharmaceutical Risks ..............................................................................................................42
Quality Assurance of Formulations ....................................................................................................................... 44
Challenges Involving Polymedication .................................................................................................................... 45
Risks Involving Pharmaceutical Misuse ..................................................................................................................46
SPECIFIC COVERAGE AREAS
Pharmaceuticals for Serious Illnesses ................................................................................................................... 48
Medical Cannabis ..................................................................................................................................................49
Antibiotics ............................................................................................................................................................ 50
Antidiabetics ..........................................................................................................................................................51
Blood Sugar Testing Strips ....................................................................................................................................52
Consultation-Intensive Pharmaceuticals ............................................................................................................... 53
Pharmaceuticals with Specific Requirements ....................................................................................................... 54
OTC Pharmaceuticals: Leading Indication Areas .................................................................................................. 55
Non-Prescription Pharmaceuticals: Special Treatment Services and Therapies .................................................... 56
Green Prescriptions ...............................................................................................................................................57
Dispensing of Emergency Contraceptives ............................................................................................................ 58
Provision of Medical Aids.......................................................................................................................................59
Vaccines ............................................................................................................................................................... 60
OPERATING RESULTS
Prerequisites for the Operation of a Pharmacy .......................................................................................................62
Operating Results for the Average Pharmacy ........................................................................................................63
Development of Pharmacy Remuneration .............................................................................................................64
Pharmacies by Sales Volume Categories ..............................................................................................................65
Sales Structure and Dispensed Packages ........................................................................................................... 66
Supplementary Products Commonly Found in Pharmacies .................................................................................. 69
Pharmacy Climate Index 2017 ...............................................................................................................................70
LEGAL NOTICE
The following may contain variations in totals due to the rounding of figures.
OVERVIEW OF PATIENT CARE AND SERVICES
Pharmacies have the legal mandate to ensure the provision of pharmaceuticals to the population. This applies
to each individual pharmacy as well as to a comprehensive distribution of pharmacies throughout Germany.
As well as providing pre-packaged medications, pharmacies fulfil obligations to the common good, such as,
night-time and emergency services or the preparation of formulations.
Source: ABDA-Statistik, Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH, infas Institut für angewandte Sozialwissenschaft GmbH
19,748 community pharmacies provide medication to the population in
Germany. (as of 31st December 2017)
1 billion patient interactions in community pharmacies every year.
3.6 million patients are served in community pharmacies each day.
250,000 delivery services are performed daily.
6 million industrially manufactured pharmaceuticals inspected
by pharmacists annually.
88 % of patients who regularly take three or more medications usually
patronize the same pharmacy.
83 % of German citizens have faith and trust in pharmacists.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 9
PHARMACIES’ PROVISION, SUPPLY AND SERVICES
VERSORGUNGSLEISTUNGEN DER APOTHEKEN
Night-time and Emergency Services in 2017 470,000
of these full shift (8 P.M.– 6 A.M.) 410,000
partial shift 60,000
Open Pharmacies per Night-time and Emergency Shift 1,300
Patients Served per Night-time and Emergency Shift 20,000
The number of emergency shifts performed by each pharmacy varies. An example taken from the state
of Bavaria: a pharmacy in the city of Munich has 14 shifts annually. During the same period, one in the
comparatively rural community of Rothenburg performs these services 74 times.
NIGHT-TIME AND EMERGENCY SERVICE
Night-time and emergency services are one of the most important services performed for the common good of
society. The chamber of pharmacists responsible for each region regularly defines and assigns these service
duties to each pharmacy according to need. Pharmacies receive additional remuneration for the performance
of these services. This is paid for out of the Emergency Service Fund of the German Pharmacists’ Association.
Apothekenfinder 22 8 33 is a service for assisting patients in quickly and easily finding the nearest available
(emergency-) pharmacy.
Sources: Nacht- und Notdienstfonds, aponet.de, Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
Prescriptions without Emergency Service Fees for SHI Insured 2017
Many patients visit pharmacies during night-time and emergency service hours because of urgent self-medi-
cation needs (e. g. “morning after pill”) or to fill prescriptions. These include, for instance, private prescriptions
or pink prescriptions charged to the SHI. If a doctor performing emergency services has marked the “noctu”
(lat. night) field on the pink prescription, the patient is not required to pay the emergency service fee of 2.50
euros and the fee is, in these cases, covered by their insurance fund. In 2017, this service provision was utilized
by patients when filling prescriptions for nearly two million packages.
prescription-only pharmaceuticals
1,370,000
non-prescription pharmaceuticals
540,000
Total
1,910,000 Packages
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201810
PHARMACIES’ PROVISION, SUPPLY AND SERVICES
Sources: aponet.de, Nacht- und Notdienstfonds
Emergency service fee per full shift performed in euros
Apothekenfinder 22 8 33service for assisting patients in finding the nearest available (emergency-) pharmacy
0
100
200
300
4th Quarter3rd Quarter2nd Quarter1st Quarter
275.
13
286.
51
278.
15
273.
96
267.
33
268.
07
279.
47
280.
12
2016
Average: 275 euros
2017
Average: 277 euros
www.aponet.de (12.2 million)
Smartphone App Use
(580,000)
Telephone, Text Message and Mobile (350,000)
Visits in 2017
13.1 million
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 11
PHARMACIES’ PROVISION, SUPPLY AND SERVICES
FORMULATIONS
In many cases, there are no ready-made pharmaceuticals for a patient’s specific pharmaceutical needs.
Pharmacies fill this gap by providing extemporaneous preparations as per a doctor’s prescription. In 2016,
a total of 13.3 million formulations were prepared for those insured under statutory health insurance (SHI).
Sources: Wissenschaftliches Institut der AOK (WIdO)
0
3
6
9
12
15
2016 20152014
1.1
2.4
7.8
2.6
13.913.5
1.2
2.4
7.3
2.4
1.1
2.4
7.4
2.6
13.3
Individually prepared parenteral solutions
Cytostatic preparations
Methadone preparations
Standard formulations
in millions
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201812
PHARMACIES’ PROVISION, SUPPLY AND SERVICES
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
STANDARD FORMULATIONS
Each year pharmacies prepare more than seven million standard formulations according to doctors’ prescrip-
tions for SHI-insured patients. Whether it be skin cream or fever suppositories, all pharmacies are able to prepare
these individually according to the patient’s needs. Children, in particular, benefit from this; for instance, when
a medication is not available as a pre-packaged pharmaceutical at a certain dosage. Many pensioners and
seniors also require “special preparations”.
Standard Formulations by Age Groups number per 1,000 SHI insured
0
40
80
120
160
136
13313
7
82
73
79
76
72
78
140
133
144
98
93
100
Children
(under 15 years)
Youth
(15 to under 20 years)
Adults
(20 to under 65 years)
Seniors
(65 years and older)
ø All SHI insured
(average)
2015 2016 2017
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 13
PHARMACIES’ PROVISION, SUPPLY AND SERVICES
NUMBER OF PHARMACIES
The number of community pharmacies in Germany has been in decline since 2009 (highest level 2008: 21,602).
At the end of 2017, it reached 19,748, its lowest point since the late 1980s. The causes of this include healthcare-
related political conditions as well as competition among individual pharmacies. Comprehensive pharmaceutical
care for the population remains, however, unthreatened.
1990 1995 2000 2005 2010 2015 2016 2017
Number of Pharmacies
(incl. subsidiaries) 19,898 21,119 21,592 21,476 21,441 20,249 20,023 19,748
of which are
Main / Individual
Pharmacies * 19,898 21,119 21,592 20,248 17,963 15,968 15,607 15,236
Subsidiaries — — — 1,228 3,478 4,281 4,416 4,512
New Openings — 372 187 326 263 154 123 120
Closings — 156 185 242 370 346 349 395
Development / Change — +216 +2 +84 −107 −192 −226 −275
year-end statistics
* Pharmacies with an operating licence pursuant to Section 2 of the German Pharmacies Act [Apothekengesetz]
Source: ABDA-Statistik
1990 1995 2000 2005 2010 2015
20,000
21,000
22,000
21,1
19
19,8
98 20,1
08 20,3
50
20,6
48 20,9
03
21,2
90 21,4
57
21,5
56
21,5
90
21,5
92
21,5
69
21,3
05
21,4
65
21,3
92
21,4
76
21,5
51
21,5
70
21,6
02
21,5
48
21,4
41
21,2
38
20,9
21
20,6
62
20,4
41
20,2
49
20,0
23
19,7
48
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201814
PHARMACY LANDSCAPE
APOTHEKENLANDSCHAFT
PHARMACY NUMBERS BY GERMAN FEDERAL STATE
The number of community pharmacies in the individual federal states depends, among other things, on the
number of inhabitants, the population’s demographic structure and the physical area. The most populous
state, North Rhine-Westphalia, has been divided into the two chamber districts of North Rhine and Westphalia-
Lippe and accounts for the highest number of pharmacies with more than 4,000 in total.
Federal State Community Pharmacies of these main / individual
pharmacies *
of these subsidiaries
Number Pharmacy Density **
Baden-Wuerttemberg 2,506 23 1,891 615
Bavaria 3,179 25 2,480 699
Berlin 812 23 642 170
Brandenburg 576 23 431 145
Bremen 145 21 103 42
Hamburg 404 22 307 97
Hesse 1,485 24 1,150 335
Mecklenburg-Western Pomerania 404 25 320 84
Lower Saxony 1,935 24 1,496 439
North Rhine-Westphalia 4,210 24 3,236 974
North Rhine 2,237 23 1,751 486
Westphalia-Lippe 1,973 24 1,485 488
Rhineland-Palatinate 1,008 25 779 229
Saarland 301 30 255 46
Saxony 982 24 758 224
Saxony-Anhalt 597 27 458 139
Schleswig-Holstein 658 23 517 141
Thuringia 546 25 413 133
Total 19,748 24 15,236 4,512
year-end statistics 2017
* Pharmacies with an operating licence pursuant to Section 2 of the German Pharmacies Act [Apothekengesetz]
** Pharmacies per 100,000 residents
Source: ABDA-Statistik
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 15
PHARMACY LANDSCAPE
Source: ABDA-Statistik
GEOGRAPHICAL COVERAGE
On average, there are 24 pharmacies for every 100,000 residents in Germany. There are, however, regional
differences to be found across the country: pharmacy density varies greatly according to the number of
residents or area and structure of cities and districts. At present comprehensive pharmaceutical care for
the population remains guaranteed nationwide.
22 or less
(125 districts)
23 – 25
(137 districts)
26 or more
(139 districts)
Pharmacy Density in Administrative Districts 2017
Pharmacies per
100,000 residents
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201816
PHARMACY LANDSCAPE
PHARMACY DENSITY IN EUROPE
Germany, with 24 pharmacies per 100,000 inhabitants, lies below the European average.
On average, the 28 European Union member states have a density of 31 pharmacies per 100,000 inhabitants:
* last available year
Sources: ABDA-Statistik, Zusammenschluss der Apotheker in der Europäischen Union (ZAEU), nationale Apothekerverbände, Europäische Kommission (EC)
Greece 87
22,046
871
8Denmark
12The Netherlands
14Sweden
15Finland
16Austria
16Slovenia
16Luxembourg
22United Kingdom
23Hungary
24Germany
24Czech Republic
26Croatia
28Slovakia
28Portugal
31Italy
31EU Average
32France
37Estonia
38Poland
39Ireland
44Latvia
43Romania
47Spain
47Lithuania
51Bulgaria
55Cyprus
9,500
Number of Pharmacies *Pharmacies per 100,000 residents
210
477
3,714
8,673
4,929
1,387
21,403
—
490
14,584
1,854
19,748
2,559
1,114
1,516
2,935
18,549
1,352
331
95
14,000
2,315
452
1,994
1,392
812
51Malta
44Belgium
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 17
PHARMACY LANDSCAPE
SUBSIDIARY STRUCTURE
Of the combined 19,748 pharmacies, exactly 15,236 were individual or main pharmacies with subsidiaries as of
the end of 2017. Subsidiary expansion is on the rise. Introduction of the SHI (statutory health insurance) Mod-
ernisation Act of 2004 means that a pharmacist is now allowed to have up to three subsidiaries. Each subsidi-
ary must have a pharmacist acting as the subsidiary manager and all (main and subsidiary pharmacies) must be
physically located in close proximity to one another.
2005 2010 2015 2016 2017
Pharmacies without subsidiaries
(individual pharmacies) 19,148 15,277 12,851 12,399 11,989
Main pharmacies
with one subsidiary 989 2,057 2,229 2,290 2,282
Main pharmacies
with two subsidiaries 94 466 612 628 665
Main pharmacies
with three subsidiaries 17 163 276 290 300
Main / Individual Pharmacies 20,248 17,963 15,968 15,607 15,236
Source: ABDA-Statistik
year-end statistics
0
4,000
8,000
12,000
16,000
20,000
20172016201520102005
19,148
1,100
15,277
2,686
12,851
3,117
20,248
17,963
15,968
12,399
3,208
15,607
11,989
3,247
15,236
Pharmacies without subsidiaries Pharmacies with at least one subsidiary
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201818
PHARMACY LANDSCAPE
SPECIFIC TYPES OF PHARMACIES
Hospital pharmacies do not belong to “community pharmacies”. All community pharmacies are owner- operated
with some pharmacies legally operated by several pharmacists as a general partnership (German: OHG).
Leased pharmacies do exist on a temporary basis. This occurs, for example, when an owner has passed
away. To ensure service and coverage at a local level, so-called prescription collection containers may also
be established. Prescriptions are collected (sometimes digitally) and filled by an authorised pharmacy.
* German: Apothekengesetz / ** German: Apothekenbetriebsordnung
Sources: ABDA-Statistik, IQVIA Commercial GmbH & Co. OHG
2015 2016 2017
Hospital pharmacies (Section 14 German Pharmacies Act *) 390 384 379
Pharmacies supplying hospitals (Section 1a Para. 1 Ordinance
on the Operation of Pharmacies **)183 178 171
OHG pharmacies (Section 8 German Pharmacies Act) 662 689 709
Leased pharmacies (Section 9 German Pharmacies Act) 880 832 774
Branch pharmacies (Section 16 German Pharmacies Act) 11 12 12
Emergency pharmacies (Section 17 German Pharmacies Act) 0 0 0
Prescription Collection Containers § 24 Ordinance on the Operation of Pharmacies
Baden-Wuerttemberg 110
Bavaria 132
Berlin –
Brandenburg 77
Bremen –
Hamburg –
Hesse 173
Mecklenburg-Western Pomerania 112
Lower Saxony 107
North Rhine-Westphalia 35
North Rhine 3
Westphalia-Lippe 32
Rhineland-Palatinate 66
Saarland 10
Saxony 124
Saxony-Anhalt 139
Schleswig-Holstein 46
Thuringia 77
Total 1,208
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 19
PHARMACY LANDSCAPE
MAIL ORDER TRADE
Mail order trade of prescription and OTC medications has been allowed in Germany since 2004. Mail order
trade already accounts for a double-digit market share in self-medication. As concerns prescription pharma-
ceuticals, this share is considerably lower. However, sales of mail order, prescription-only pharmaceuticals
have risen considerably since the European Court ruled, in October 2016, that foreign (non-German) mail order
traders are no longer bound to mandatory German price structures for prescription pharmaceuticals.
Changed source: the quality of the currently available data regarding mail order trade of prescription-only pharmaceuticals is limited.
* values at manufacturer sales price (ApU) minus manufacturer markdowns
** professional web-shop and listing with price search engines
Sources: IQVIA Commercial GmbH & Co. OHG, ABDA-Statistik, own calculations
Sales Volume 2017
Sales Volume 2017
Pharmacies with a Mail Order License (Section 11a German Pharmacies Act)
2,958Pharmacies with a
Mail Order License
(§ 11a German
Pharmacies Act)
of which approx. 150 are actively engaged in mail order trade **
Prescription-only Pharmaceuticals
8 million packages (1.1 %)
Change from previous year (5.8 %)
112 million packages (13.2 %)
Change from previous year (6.3 %)
842 million euros (17.0 %)
Change from previous year (9.8 %)
305 million euros (1.0 %)
Change from previous year (4.0 %)
730 million packages (98.9 %)
Change from previous year (−0.3 %)
736 million packages
(86.8 %)
Change from previous year
(−1.0 %)
4,118 million euros
(83.0 %)
Change from previous year
(0.8 %)
28,849 million euros (99.0 %)
Change from previous year (5.0 %)
OTC Pharmaceuticals and Non-Pharmaceutical Products
Community Pharmacies Mail Order Trade
Sales * 2017(without VAT)
Sales * 2017(without VAT)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201820
PHARMACY LANDSCAPE
NUMBER AND AGE OF PHARMACISTS
At the end of 2017, there were more than 64,000 active pharmacists in Germany and this number has been
growing. The overwhelming majority work in community pharmacies yet pharmacists are also employed in the
pharmaceutical industry, in hospital pharmacies, universities and government agencies. More than two-thirds
of all licensed pharmacists are women.
Active Pharmacists in: 2015 2016 2017 Percentage of
Women 2017
Community Pharmacies 50,356 50,123 51,098 72.6 %
of which are owner managed 15,968 15,607 15,236 48.4 %
Hospital Pharmacies 2,212 2,307 2,382 70.4 %
Industry, Administration, Associations,
Science 10,189 10,518 10,899 60.4 %
Pharmaceutical Industry 5,867 6,136 6,530 60.8 %
Federal Armed Forces 229 243 241 35.7 %
Government Agencies and
Statutory Corporations 937 907 954 61.6 %
Universities 1,187 1,169 1,219 50.8 %
Educational Institutions and
Vocational Schools 465 465 482 79.5 %
Other 1,504 1,598 1,473 63.7 %
Total 62,757 62,948 64,379 70.5 %
Age of Occupationally Active Pharmacists: total female male
Community Pharmacies 47.2 45.7 51.2
of which are pharmacy owners 51.5 50.0 53.0
of which are licensed staff 44.7 44.2 47.4
Hospital Pharmacies 43.0 40.5 48.1
Industry, Administration, Associations, Science 41.5 39.8 44.1
All Areas of Activity (as of 31st December 2014) * 46.2 44.8 49.5
* data collection performed every four years.
Source: ABDA-Statistik
Average Age of Pharmacists
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 21
EMPLOYMENT IN PHARMACY
BESCHÄFTIGUNG IN DER PHARMAZIE
JOBS IN PHARMACIES
The number of people working in community pharmacies grew to 157,000 in 2017. About one-third of these
are approbated (licensed) pharmacists: Two-thirds work as pharmaceutical technical assistants (PTA) or
pharmaceutical commercial employees (PCE).
2015 2016 2017 Percentage of
Women 2017
Pharmacists 50,356 50,123 51,098 72.6 %
Pre-approbation Trainee Pharmacists
(PhiP) 1,608 1,651 1,693 73.7 %
Pharmacist’s Assistants;
Pharmaceutical Engineers 6,145 5,803 5,591 96.8 %
Pharmaceutical Technical Assistants PTA
(incl. interns) 63,660 65,658 65,823 97.2 %
Pharmaceutical Commercial Employees
(PCE) / Assistants 32,759 33,193 33,079 98.4 %
Total Number of Positions 154,528 156,428 157,284 89.2 %
year-end statistics
Source: ABDA-Statistik
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201822
EMPLOYMENT IN PHARMACY
TRAINEE POSITIONS IN PHARMACIES
Pharmacies offer apprenticeships for about 7,400 young people. These trainees complete their practical
training period at a pharmacy. This year is completed either as part of dual training to become a pharma-
ceutical commercial employee (PCE), the programme to become a pharmaceutical technical assistant (PTA),
or as the final, practical stage of their pharmacy studies at university.
2015 2016 2017
Pharmaceutical Commercial Employees (PCE)
in Training 3,724 3,805 3,626
Pharmaceutical Technical Assistants (PTA) in Training2,117 2,085 2,076
Pre-approbation Trainee Pharmacists (PhiP) 1,608 1,651 1,693
Total Number of Trainee Positions 7,449 7,541 7,395
year-end statistics
Source: ABDA-Statistik
3,626
1,693
2,076
Pharmaceutical Commercial
Employees (PCE) in TrainingPharmaceutical Technical Assistants
(PTA) in Training
Pre-approbation Trainee Pharmacists (PhiP)
Trainee Positions 2017
7,395 total
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 23
EMPLOYMENT IN PHARMACY
PHARMACY STUDENTS AND APPROBATIONS
The number of pharmacy students and newly-approbated pharmacists in Germany is increasing as is the
demand for pharmacists across the job marketplace in general, e. g. in industry and hospitals. 22 universities
in 14 federal states offer pharmacy programmes. The programme is structured into three sections: basic
studies (2 years), main studies (2 years) and practical training (1 year).
Academic Year Students New Students Approbations Promotions
2016 / 2017 15,682 2,766 2,202 415
2015 / 2016 15,548 2,752 2,025 385
2014 / 2015 15,268 2,748 2,079 407
2013 / 2014 14,632 2,708 1,947 350
2012 / 2013 14,183 2,754 1,929 329
Source: Statistisches Bundesamt (Destatis), Landesbehörden
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201824
EMPLOYMENT IN PHARMACY
Places of Study
Federal State UniversityRegistrations 2016 / 2017
Winter Semester
Registrations 2017
Summer Semester
Baden-Wuerttemberg
Freiburg 90 0
Heidelberg 45 0
Tübingen 140 0
Bavaria
Erlangen-Nurnberg 127 0
Munich U 108 100
Regensburg 134 0
Würzburg 47 47
Berlin Berlin FU 69 62
Brandenburg — — —
Bremen — — —
Hamburg Hamburg 58 0
HesseFrankfurt / Main 90 90
Marburg 145 95
Mecklenburg-Western
Pomerania Greifswald 67 66
Lower Saxony Braunschweig 80 69
North Rhine-Westphalia
Bonn 86 89
Düsseldorf 65 67
Münster 78 78
Rhineland-Palatinate Mainz 49 43
Saarland Saarbrucken 32 28
Saxony Leipzig 36 0
Saxony-Anhalt Halle-Wittenberg 179 0
Schleswig-Holstein Kiel 62 62
Thuringia Jena 77 0
Total 1,864 896
Source: Stiftung für Hochschulzulassung (ZVS)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 25
EMPLOYMENT IN PHARMACY
PROFESSIONAL LANGUAGE PROFICIENCY EXAM FOR FOREIGN PHARMACISTS
Pharmacists with a mother tongue other than German who apply for approbation in Germany are required to
provide proof of German language skills specific to and required for their profession. This is done by means of
three-part proficiency exams based on the Common European Framework of Reference of Languages (CEFR).
Almost all chambers of pharmacists have been charged with the execution of these tests by the competent
authorities at the state level and the number of tests carried out nearly doubled in the last year.
Number of Professional Language Examinations and Success Rates
Source: Bundesapothekerkammer (BAK)
Number of Exam Candidates, Gender Ratios and Countries of Origin
passed on first attempt
Men
passed on further attempts
Women
Non-EU StatesEuropean Union (EU, EEA, Switzerland)
22 %
78 %
20 %
80 %
22 %
78 %
20 %
80 %
2017769 Professional
Language Proficiency
Exams
2016345 Professional
Language Proficiency
Exams
Iraq
Bosnia and Herzegovina
Ukraine
Other
Syria
Egypt
234 109 343
73932
21 3413
82315
713
6
41 54 95Croatia
Bulgaria
Spain
Greece
Poland
Romania
Hungary
Italy
3710 27
3214 18
2310 13
233 20
84 4
66
55
86 2
Other
308 22
346
373
719 total from 60 countries
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201826
EMPLOYMENT IN PHARMACY
2015 2016 2017
Events 3,494 3,458 3,339
Participants 161,905 159,266 166,869
Area Field
General Pharmacy 11,574 Nutritional Consultation 2,234
Clinical Pharmacy 1,739 Naturopathy Treatment and Homeopathy 2,205
Pharmaceutical Analysis 807 Geriatric Pharmacy 800
Medication Information 690 Prevention and Health Promotion 583
Pharmaceutical Technology 534 Oncological Pharmacy 226
Theoretical and Practical Education 157 Infectiology 111
Public Health Care 123 Care Services 69
Toxicology and Ecology 93
Specialised Pharmacist Titles – Total 15,717 Field Designations – Total 6,228
2015 2016 2017
Number of Educational Programmes Completed 423 486 523
Source: Bundesapothekerkammer (BAK)
CPE Events Held by the State Chambers of Pharmacists (LAK) and State Pharmacists’ Associations (LAV)
Postgraduate Specialisation Completions per Year(in area and field of pharmacy)
Pharmacists Completing / Postgraduate Specialisation 2017
CONTINUING PROFESSIONAL EDUCATION AND POSTGRADUATE SPECIALISATION
Continuing professional education (CPE) serves to refresh and expand upon existing knowledge. Postgraduate
specialisation refers to the acquisition of specialised knowledge and skills in a specific field or area of pharmacy.
A three-year training programme in one of these areas entitles a pharmacist to the right to call themselves a
specialised pharmacist. Following a one-year programme in one of these fields, the corresponding identifying
designation may be used.
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 27
EMPLOYMENT IN PHARMACY
Prescription-only Narcotic Pharmaceuticals * 1,854
Pharmaceuticals Requiring a Special Prescription
(T-prescription) ** 16
Other Prescription-only Pharmaceuticals 48,281
Pharmacy-only Pharmaceuticals 19,423
Unrestricted OTC Pharmaceuticals 34,123
Total Number of Marketable Pharmaceuticals 103,697
PHARMACEUTICALS APPROVED IN GERMANY
More than 100,000 different pharmaceuticals have been governmentally approved in Germany. Each pack-
aging size, potency or dosage form is considered an individual pharmaceutical even if the brand name is
the same. About half of all pharmaceuticals are prescription-only. Governmental approval for nationwide
use may be granted at either the federal level in accordance with the Medicinal Products Act (AMG) or
at the European level.
* pharmaceuticals subject to prescription regulations for narcotics in Germany e. g. strong painkillers
** pharmaceuticals which may be utilized only in very specific situations due to their hazardous potential e. g., the active ingredient Thalidomide
As of: January 2018
Source: Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM)
prescription-only pharmaceuticals
50,151
non-prescription pharmaceuticals
53,546
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201828
PHARMACEUTICALS IN GERMANY
ARZNEIMITTEL IN DEUTSCHLAND
PHARMACEUTICAL PRICE INDEX
The pharmaceutical price index describes the average price development (incl. VAT) of pharmaceuticals
which are prescribed at the expense of statutory health insurance (SHI). Pharmaceutical prices have sharply
decreased over the past decade, while consumer prices have risen continually.
* Pharmacy markdowns, manufacturer markdowns, savings resulting from rebate contracts and patient co-payments are not taken into account.
Sources: Wissenschaftliches Institut der AOK (WIdO), Statistisches Bundesamt (Destatis)
2008 2011 2014 20172005
70
0
140
100.
0
101.
6
103.
2
105.
6
108.
4
108.
7
109.
9
112.
2
114.
4
116.
2
117.
1
117.
5
118.
1
120.
2
100.
0
99.5
97.2
95.9
94.5
94.9
94.8
92.6
91.4
91.7
90.6
88.5
87.1
85.9
Pharmaceutical Price Index * Consumer Price Index
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 29
PHARMACEUTICALS IN GERMANY
VALUE-ADDED TAX ON PHARMACEUTICALS
Value-added tax (VAT) on pharmaceuticals varies greatly among the 28 member states of the European Union.
Germany has one of the highest VAT rates on pharmaceuticals – behind only Denmark and Bulgaria. In contrast,
Malta, the United Kingdom, Ireland and Sweden have all made certain pharmaceuticals exempt from the tax.
Source: Europäische Kommission (EC)
Tax Rate for
Pharmaceuticals
in 2018
General VAT
tax rate in 2018
Denmark 25.0 25.0
Bulgaria 20.0 20.0
Germany 19.0 19.0
Latvia 12.0 21.0
Finland 10.0 24.0
Italy 10.0 22.0
Czech Republic 10.0 21.0
Austria 10.0 20.0
Slovakia 10.0 20.0
Slovenia 9.5 22.0
Estonia 9.0 20.0
Romania 9.0 19.0
Poland 8.0 23.0
Greece 6.0 24.0
Portugal 6.0 23.0
Belgium 6.0 21.0
The Netherlands 6.0 21.0
Hungary 5.0 27.0
Croatia pharmaceuticals covered by the NHS
non-prescription pharmaceuticals
5.0
25.0
25.0
Lithuania reimbursable pharmaceuticals
non-reimbursable pharmaceuticals
5.0
21.0
21.0
Cyprus 5.0 19.0
Spain 4.0 21.0
Luxembourg 3.0 17.0
France reimbursable pharmaceuticals
non-reimbursable pharmaceuticals
2.1
10.0
20.0
Sweden prescription-only pharmaceuticals
non-prescription pharmaceuticals
0.0
25.0
25.0
Ireland pharmaceuticals for oral use
pharmaceuticals for non-oral use
0.0
23.0
23.0
United Kingdom pharmaceuticals covered by the NHS
non-prescription pharmaceuticals
0.0
20.0
20.0
Malta 0.0 18.0
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201830
PHARMACEUTICALS IN GERMANY
PHARMACEUTICALS PRICING
The selling prices for prescription pharmaceuticals and the pharmacy fee are determined according to legal
stipulations laid out in the Drug Price Ordinance [AMPreisV]. To ease the financial burden on health insurance
funds, lawmakers have stipulated markdowns and discounts along with co-payments from insured individuals.
Example of a Prescription-only, Pre-packaged Medication
Manufacturer sales price (ApU) 50.00 Euro
+ maximum wholesale mark-up (3.15 % of the ApU + 0.70 euros) 2.28 Euro
= pharmacy purchase price (AEP) 52.28 Euro
+ pharmacy mark-up (3 % of the AEP + 8.35 euros) 9.92 Euro
+ emergency services mark-up (0.16 euros) 0.16 Euro
= Net Pharmacy Sales Price (net AVP) 62.36 Euro
+ value-added tax (19 % of the net AVP) 11.85 Euro
= Gross Pharmacy Sales Price (AVP) 74.21 Euro
− statutory co-payment from the insured individual (10 % of gross AVP) 7.42 Euro
− statutory pharmacy markdown (1.77 euros) 1.77 Euro
− statutory manufacturer markdown * (7 % of ApU) 3.50 Euro
= Effective Expenditures for Statutory Health Insurance (SHI) ** 61.52 Euro
* The manufacturer markdown for pharmaceuticals which are not bound to fixed prices amounts to 7 percent for patent-protected originals and 16 % for generics.
The amount for generic medication that is bound to fixed prices is, however, 10 percent. The manufacturer markdown is waived if the pharmaceutical price lies 30
percent under the fixed price. (§ 130a SGB V).
** does not take into consideration any rebate contracts which reduce costs for statutory health insurance (SHI)
Source: ABDA-Statistik
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 31
PHARMACEUTICALS IN GERMANY
PRICING FOR STANDARD FORMULATIONS
The sales pricing for standard formulations is determined according to legal stipulations laid out in the Drug
Price Ordinance [AMPreisV] in a fashion similar to industrially produced, prescription medications. Discounts
and mark-ups are precisely defined therein. The rules governing remuneration for standard formulations were
adjusted in 2017.
Example for a Prescription-only Ointment (100 g)
Pharmacy purchase price (AEP) for an active ingredient (1 g powder),
base (99 g ointment base) and container (1 dispenser for 100 g) 5.00 Euro
+ fixed mark-up (90 % of AEP) 4.50 Euro
+ formulation mark-up for production
(6.00 euros for preparation of ointments up to 200 g) 6.00 Euro
+ fixed fee 8.35 Euro
= Net Pharmacy Sales Price (net AVP) 23.85 Euro
+ value-added tax (19 % of the net AVP) 4.53 Euro
= Gross Pharmacy Sales Price (AVP) 28.38 Euro
− statutory co-payment from the insured individual
(10 % of AVP, minimum 5 euros) 5.00 Euro
− statutory pharmacy markdown (1.77 euros) 1.77 Euro
= Effective Expenditures for for Statutory Health Insurance (SHI) 21.61 Euro
Source: ABDA-Statistik
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201832
PHARMACEUTICALS IN GERMANY
BREAKDOWN OF TOTAL SHI EXPENDITURES
Of the more than 230 billion euros that the statutory health insurance (SHI) spent in 2017, the largest percentage
went to hospitals and doctors. Pharmaceutical expenditures (incl. pharmacies) ranked third with 14.6 percent.
2.2 percent of this were accounted for by pharmacies and their services. This is less than half of that spent on
SHI administration (4.7 percent).
* from pharmacies
Notice: “Medical Aids from Pharmacies” are, in contrast to the previous year’s publication,
no longer grouped with pharmaceuticals but, rather, with remedies and medical aids.
Sources: Bundesministerium für Gesundheit (BMG), ABDA-Statistik
2017 230.56 16.3 6.1 6.3 32.2 4.7 19.8 14.6 2.2
2016 222.73 16.1 6.2 6.4 32.1 4.9 19.8 14.5 2.3
2015 213.67 16.1 6.3 6.4 32.2 4.9 19.6 14.6 2.3
2014 205.54 16.0 6.3 6.4 32.7 4.9 19.2 14.5 2.3
2013 194.49 16.2 6.5 6.2 33.0 5.1 19.1 13.9 2.4
2012 184.25 15.3 6.4 6.2 33.5 5.2 19.1 14.3 2.3
2011 179.61 15.4 6.5 6.2 33.4 5.3 18.7 14.6 2.3
2010 175.99 15.4 6.5 6.0 33.0 5.4 18.1 15.6 2.5
2009 170.78 15.5 6.6 6.0 32.5 5.2 18.2 16.0 2.6
2008 160.94 15.2 6.8 6.1 32.4 5.1 18.3 16.1 2.6
2007 153.93 15.1 6.9 6.1 32.8 5.3 17.6 16.1 2.6
Total SHI Expenditures 2017: 230.56 billion euros
Miscellaneous Expenditures 19.8 %
Administration 4.7 %
Remedies and Medical Aids 6.3 %
Dentists (incl. dentures) 6.1 % Hospitals 32.2 %
Pharmaceuticals from Pharmacies 14.6 %
of which is pharmacy added-value
share as per Drug Price Ordinance
(AMPreisV) 2.2 %
Doctors 16.3 %
Tota
l SH
I Exp
endi
ture
s
(bill
ion
euro
s)
Doc
tors
of w
hich
in %
Den
tists
(inc
l. de
ntur
es)
Rem
edie
s an
d M
edic
al A
ids
Hos
pita
ls
Adm
inis
trat
ion
Mis
cella
neou
s Ex
pens
esP
harm
aceu
tical
s *
of w
hich
is p
harm
acy
adde
d-
valu
e sh
are
as p
er D
rug
Pric
e
Ord
inan
ce (A
MP
reis
V)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 33
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
ARZNEIMITTELVERSORGUNG IN DER GKV
MISCELLANEOUS HEALTH INSURANCE FUND EXPENDITURES
Miscellaneous health insurance fund expenditures include, among other things, sick pay, home nursing and travel
expenses as well as “vaccinations incl. doctor’s fees”. “Pharmaceuticals from Others / Mail Order” refers to overseas
mail order pharmacies or health authorities.
Sources: Bundesministerium für Gesundheit (BMG), ABDA-Statistik
5.3 % Sick Pay
2.6 % Home Nursing
2.4 % Travel Expenses
1.0 % Early Diagnosis
0.9 % Dialysis Material Costs in
Doctor’s Offices
0.8 % Integrated Care
0.6 % Vaccinations
(incl. doctor’s fees)
0.6 % Pregnancy, Maternity
0.3 % Services Abroad
2.2 % Other
1.5 % Outpatient & Inpatient Benefits
and Rehab Services
1.6 % Pharmaceuticals from
Others / Mail Order
Total Miscellaneous Expenditures 2017:
19.8 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201834
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
SHI EXPENDITURES FOR PHARMACEUTICALS
Approximately two-thirds of statutory health insurance’s (SHI) pharmaceutical expenditures went to the
pharmaceutical industry. In 2017, expenditures for the 19 percent value-added tax on pharmaceuticals
exceeded those for pharmacy services.
* provisional
** formulations, pre-packaged pharmaceuticals and surgical dressings from pharmacies
(in contrast to the previous year’s publication, medical aids are no longer included)
Sources: Bundesministerium für Gesundheit (BMG), ABDA-Statistik
2015 2016 2017 *
in billion
euros
in billion
euros
in billion
euros
Pharmaceutical Industry and
Advance Services
(such as raw materials) 20.28 65.0 % 21.06 65.1 % 22.01 65.3 %
Pharmaceutical Wholesaling 1.05 3.4 % 1.07 3.3 % 1.11 3.3 %
VAT (state) 4.98 16.0 % 5.17 16.0 % 5.37 16.0 %
Pharmacies 4.86 15.6 % 5.05 15.6 % 5.17 15.4 %
Total SHI Expenditures
for Pharmaceuticals **
31.17 100.0 % 32.35 100.0 % 33.66 100.0 %
Pharmacies 15.4 %
VAT (state) 16.0 %
Pharmaceutical Industry
and Advance Services
(such as raw materials) 65.3 %
Pharmaceutical
Wholesaling 3.3 %
SHI Expenditures for Pharmaceuticals 2017: 33.66 billion euros
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 35
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
PHARMACEUTICALS BY PRICE CLASSES
The pharmacy sales price (AVP) for every prescription-only medication is legally regulated by the Drug Price
Ordinance (AMPreisV) and based on the manufacturer sales price (ApU). For nine out of ten medications,
this amounts to 100 euros or less. Despite a lower number of actual packages, higher priced, innovative
medications account for a growing percentage of the total sum spent.
Price Classes * 2015 2016 2017
to 100.00 euros 91.1 % 90.9 % 90.5 %
100.01– 500.00 euros 7.8 % 8.0 % 8.4 %
500.01–1,500.00 euros 0.6 % 0.6 % 0.6 %
more than 1,500.00 euros 0.4 % 0.4 % 0.5 %
Price Classes * 2015 2016 2017
to 100.00 euros 37.7 % 36.6 % 35.1 %
100.01– 500.00 euros 25.0 % 25.3 % 25.6 %
500.01–1,500.00 euros 9.1 % 9.0 % 9.1 %
more than 1,500.00 euros 28.3 % 29.1 % 30.3 %
Sales Volume Percentage SHI of Prescription-only Pre-packaged Medications
Sales Revenue Percentage of SHI Prescription-only Pre-packaged Medications
* at pharmacy sales prices
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201836
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
PHARMACY AND MANUFACTURER MARKDOWNS
Over the years, lawmakers have introduced various instruments to limit statutory health insurance (SHI) expendi-
tures for pharmaceuticals. Pharmacies as well as pharmaceutical manufacturers must grant markdowns to
the SHI when dispensing prescription-only pharmaceuticals. The pharmacy markdown is currently set at 1.77
euros (incl. VAT). This amount must be reimbursed to the health insurance fund from the pharmacist’s fees for
each package dispensed at the expense of the SHI. This amounts to more than one billion euros per year.
Source: Deutscher Apothekerverband e. V. (DAV)
0
300
600
900
1,200
1,500
1,800
201720162015
1,533
1,081
1,562
1,096
1,563
1,090
in million euros
Pharmacy Markdowns Manufacturer Markdowns
(without rebate contracts)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 37
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
Rebate Pharmaceuticals: Agreements and SHI Savings
REBATE PHARMACEUTICALS
Since 2007, health insurance funds have been able to enter into rebate contracts with manufacturers to dispense
pharmaceuticals at a lower cost. There are currently more than 27,000 fund-specific rebate contracts stipulating
which insured person can receive which pharmaceutical from which manufacturer. Compliance with these
manifold agreements as part of patient care has resulted in a drastic increase in administrative effort for
the pharmacies.
Sources: ABDATA, Pro Generika e. V., Bundesministerium für Gesundheit (BMG), IQVIA Commercial GmbH & Co. OHG
27,300 number of rebate contracts at the end of 2017
4.0 billion euros in savings from rebate contracts in the year 2017
112 health insurance funds and companies involved at the end of 2017
178 pharmaceutical companies involved at the end of 2017
16,500 number of rebate pharmaceuticals (central registration numbers) at the end of 2017
25 % percentage of rebated, prescription-only pharmaceuticals either exempt from or having reduced co-payments at the end of 2017
409 million packages of prescription medication with rebate contracts dispensed in 2017
11.9 million data sets used in pharmacy computer systems at the end of 2017
2015 2016 2017
Number of rebate contracts at year’s end 21,100 24,600 27,300
SHI savings in year 3.7 billion euros 3.9 billion euros 4.0 billion euros
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201838
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
PATIENT CO-PAYMENTS
SHI (statutory health insurance) insured patients must make co-payments to their health insurance funds for
certain services. This amounts to ten percent of a pharmaceutical’s price for prescribed medications and must
lie between a minimum of five but no more than ten euros. There is a 2.90 euro average due to co-payment
exemptions for some medications and insured persons. The co-payments, which community pharmacies are
legally required to collect from patients, have saved health insurers two billion euros annually.
Source: Deutscher Apothekerverband e. V. (DAV)
1,200
1,400
1,600
1,800
2,000
2,200
2,400
201720162015201420132012
2.5
3.0
201720162015201420132012
1,862
1,9782,027
2,0842,143 2,149
2.60 2.60
2.70
2.80 2.80
2.90
Patient Co-payments for Pharmaceuticals in Million Euros
Average Co-payment per Package in Euros
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 39
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
CO-PAYMENT EXEMPTIONS
A hardship provision in Section 62 of the Social Insurance Code (SGB V) stipulates that SHI insured persons
need only make co-payments amounting to two percent of their yearly gross income. This limit is reduced
to one percent for chronically ill persons. One in eleven of the approximately 72 million SHI insured people
in Germany are exempt from additional co-payments. This ratio has been in decline for years.
Co-Payment Exemptions 2011 2012 2013 2014 2015 2016
Chronically Ill Patients in millions 6.9 7.0 6.5 6.4 6.2 6.0
Other Patients in millions 0.5 0.5 0.4 0.4 0.3 0.3
Total Number of Co-payment
Exempt Persons in millions 7.4 7.5 6.9 6.8 6.5 6.3
Percentage of SHI Insured Persons
Exempt from Co-payments 10.7 % 10.7 % 9.9 % 9.6 % 9.2 % 8.8 %
Source: Bundesministerium für Gesundheit (BMG)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201840
PHARMACEUTICALS IN STATUTORY HEALTH INSURANCE (SHI)
GUIDELINES AND WORKING AIDS
The Federal Chamber of Pharmacists’ guidelines, including commentary and working aids, are recommendations
addressing common situations and designed to ensure a high quality of service and skills in pharmacies. They
consider applicable laws and regulations as well as the current state of the art in science and technology. They
do not, however, relieve individuals of the responsibilities which come along with their health care profession.
Materials are available for the following pharmacy related topics and activities:
1. Pharmaceutical Information
2. Pharmaceutical Risks
3. Asthma
4. Blood Pressure Measurement
5. Blood Testing
6. Dosage Forms
7. Diabetes
8. Nutritional Consultation
9. Supply to Care Homes and Centres
10. Provision of Medical Aids
11. Hygiene Management
12. Hospital Supply
13. Manual Repackaging
14. Medication Analysis
15. Opiate Substitution
16. Production of Parenterals
17. Inspection of Source Materials / Primary Packaging
18. Inspection of Proprietary Medicinal Products
19. Prescription Delivery
20. Preparations / Formulas
21. Self-medication
22. Mail Order Trade
Materials available at: www.abda.de/themen/apotheke/qualitaetssicherung0/leitlinien/leitlinien0
Source: Bundesapothekerkammer (BAK)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 41
QUALITY ASSURANCE
QUALITÄTSSICHERUNG
AMK: REPORTING OF PHARMACEUTICAL RISKS
Pharmacists check the quality of pharmaceuticals and report any quality deficiencies to the Drug Commission
of German Pharmacists (AMK). The AMK collects and evaluates reported drug safety issues and, when
nece ssary, issues warnings, helping greatly to protect consumers and ensure their safety.
Issues Reported to the Drug Commission of German Pharmacists (AMK)
* reported suspicious cases (pharmaceuticals and other product groups)
** manufacturer defect / technological errors
Source: Arzneimittelkommission der Deutschen Apotheker (AMK)
2015 2016 2017
Absolute Absolute Absolute Percentage
Change from
Previous Year
Packaging Errors 2,446 2,640 2,780 30.6 % 5.3 %
Undesired Pharmaceutical Reactions *
and Other Reported Issues 2,676 2,640 2,702 29.7 % 2.3 %
Galenic Deficiencies ** 1,413 1,547 1,494 16.4 % −3.4 %
Mechanical Errors 788 1,060 1,095 12.1 % 3.3 %
Declaration Errors 699 725 623 6.9 % −14.1 %
Other 387 279 390 4.3 % 39.8 %
Total 8,409 8,891 9,084 100.0 % 2.2 %
30.6 %4.3 %
6.9 %
12.1
%
16.4 %
29.7 %
Other
Undesired Pharmaceutical Reactions *
and Other Reported Issues
Galenic Deficiencies **
Mechanical Errors
Declaration ErrorsPackaging Errors
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201842
QUALITY ASSURANCE
Risks by Pharmaceutical Group
* OTC = Over the Counter
Source: Arzneimittelkommission der Deutschen Apotheker (AMK)
1,990 OTC
Pharmaceuticals *
332 Non-Pharmaceuticals
6,762 Prescription-only
Pharmaceuticals
3.7 %
21.9
%
74.4 %
2017 Absolute Percentage
Prescription-only Pharmaceuticals 6,762 74.4 %
OTC Pharmaceuticals* 1,990 21.9 %
Non-Pharmaceuticals 332 3.7 %
Total 9,084 100.0 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 43
QUALITY ASSURANCE
QUALITY ASSURANCE OF FORMULATIONS
The Central Laboratory of German Pharmacists (ZL) in Eschborn contributes, by means of ring trials, to ensuring
the quality of formulations. Any pharmacy may participate by preparing and submitting a formulation specified
by the ZL. This is then tested for the identity, quantity and distribution of the active ingredient as well as other
testing parameters such as pH values, particle size, density, etc. The number of participating pharmacies has
been growing for years with nearly every third pharmacy voluntarily having their formulations tested at least
once a year.
* number of participants includes multiple participations by individual pharmacies
** figures for 2017 were not available at the time of publication
Source: Zentrallaboratorium Deutscher Apotheker e. V. (ZL)
Year Number of Participants
(formulations examined)
Number of
Pharmacies *
Participation Percentage
(of total number of pharmacies)
2016 ** 7,619 6,036 29.3
2015 7,674 6,099 29.3
2014 7,343 5,706 27.3
2013 6,502 4,952 23.5
2012 5,720 4,452 20.9
2011 4,982 3,835 17.7
2010 4,814 3,644 16.7
2009 3,876 2,901 13.2
2008 3,437 2,488 11.3
2007 2,685 1,886 8.6
2006 2,081 1,515 6.7
Ring Trials of the Central Laboratory of German Pharmacists (ZL)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201844
QUALITY ASSURANCE
Patients with Polymedication
Source: Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH (data collection 2015)
CHALLENGES INVOLVING POLYMEDICATION
Polymedication (or “multi-medication”) is defined as the situation in which a patient regularly takes several
different medications for a prolonged period. Leading definitions require a minimum of three to five such medi-
cations. Approximately every fourth German regularly takes three or more medications. Several initiatives for
medication management such as ARMIN (“Pharmaceutical Initiative Saxony – Thuringia”) or PRIMA (Primary
System Integration of Medication Plans with Acceptance Examination) exist to address the risks involved in
polymedication.
9%
5%
9%
47%
9%
5%
9%
30%
no medications
1– 2 medications
3 medications
4 medications
5 or more
medications
One Person in Four is Affected by Polymedication23 % of all adult German citizens (15 million) take three or more medications on a regular basis.
Problems with Polymedication Type of Medications
Yes 40 % only prescription medications 71 %
No 60 % also non-prescription medications 29 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 45
QUALITY ASSURANCE
RISKS INVOLVING PHARMACEUTICAL MISUSE
Approximately 4 to 5 percent of all prescribed pharmaceuticals in Germany are associated with abuse, misuse
or potential for dependency. The total number of those affected is estimated at 1.4 to 1.5 million. Dependency
on sleeping aids and sedatives is most common. A differentiation must be made, for substances which lead
to a physical dependency, between addiction (dependence) and misuse. For substances which do not lead to
physical dependence, only misuse is possible. In terms of the entire range of products, 10 to 12 percent of all
self-medication packages contain ingredients with a potential for misuse. 1 percent of the population and 5 to
8 percent of those suffering from headaches misuse analgesics (painkillers) by taking them too often or taking
dosages which are too high. Taking these medications too often can lead to painkiller-induced headaches.
Experience with Consumption of Prescription-only Medicationswithout Medical Necessity *
56 %
1 %
26 %
17 %
43 %
2 %
25 %
30 %
Willingness to Consume Prescription-only Medicationswithout Medical Necessity *
0 5 10 15 20 25 30 35
13 % 20 %
5 % 22 %
3 % 10 %
2 % 9 %
0 5 10 15 20 25 30 35 40
13 % 26 %
19 %19 %
9 % 11 %
5 % 11 %
to improve mood or to reduce
fear / nervousness
to improve mental performance
to improve physical appearance
to improve physical performance
no, but it is possible /
imaginable
yes
don’t know
no, not imaginable
no, but it is possible /
imaginable
yes
* Survey of 5008 Germans aged between 16 and 70 performed by Forsa for ABDA. The survey was conducted between December 15,
2017 and January 5, 2018.
Sources: Bundesapothekerkammer, Deutsche Hauptstelle für Suchtfragen (DHS), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201846
QUALITY ASSURANCE
Experience with Consumption of Non-prescription medications without Medical Necessity *
56 %
1 %
26 %
17 %
43 %
2 %25
%
30 %
no, but it is possible /
imaginable
yes
don’t know
no, not imaginable
0 5 10 15 20 25 30 35
13 % 20 %
5 % 22 %
3 % 10 %
2 % 9 %
0 5 10 15 20 25 30 35 40
13 % 26 %
19 %19 %
9 % 11 %
5 % 11 %
to improve mood or to reduce
fear / nervousness
to improve mental performance
to improve physical appearance
to improve physical performance
Willingness to Consume Non-prescription medications without Medical Necessity *
no, but it is possible / imaginableyes
* Survey of 5008 Germans aged between 16 and 70 performed by Forsa for ABDA. The survey was conducted between December 15,
2017 and January 5, 2018.
Sources: Bundesapothekerkammer, Deutsche Hauptstelle für Suchtfragen (DHS), Forsa Gesellschaft für Sozialforschung und statistische Analyse mbH
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 47
QUALITY ASSURANCE
PHARMACEUTICALS FOR SERIOUS ILLNESSES
Recently, innovative pre-packaged pharmaceuticals have played an increasingly important role in treating
illnesses such as cancer (oncology) or autoimmune disorders (immuno suppressive drugs) The costs are
presented alongside their respective therapeutic uses. Specially formulated, individually prepared formulations
(cytostatics) are used in oncology treatments alongside pre-packaged pharmaceuticals. In addition, there
are also parenteral solutions; some of which with monoclonal antibodies. The manufacture of these special
formulations is subject to special technical requirements. The stipulations of section 35a of the Ordinance on
the Operation of Pharmacists (ApBetrO) are met, across Germany, by roughly 300 pharmacies by means of
a special clean room laboratory.
0
1,000
2,000
3,000
201720162015
2,53
12,
497 2,82
9
2,57
9
3,18
52,
696
0
1,000
2,000
3,000
4,000
201720162015
3,29
12,
966
3,76
8
3,07
5
4,38
8
3,64
7
Immuno Suppressive
Cytostatic Agents
Oncology
Dispensed in community pharmacies at the expense of SHI: Special Formulations
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI), Arzneiverordnungsreport (AVR)
Volume in thousands of packagesSales in million euros
2014 2015 2016
Prescriptions
(millions)
Sales
(million euros)
Prescriptions
(millions)
Sales
(million euros)
Prescriptions
(millions)
Sales
(million euros)
Cytostatic Preparations 2.4 1,255 2.4 1,232 2.4 1,245
Parenteral Solutions 1.1 1,812 1.1 1,966 1.2 2,388
of which:
with monoclonal
antibodies 0.6 1,620 0.6 1,776 0.8 2,199
Dispensed in community pharmacies at the expense of SHI: Pre-packaged Pharmaceuticals
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201848
SPECIFIC COVERAGE AREAS
SPEZIFISCHE VERSORGUNGSBEREICHE
MEDICAL CANNABIS
Doctors have been allowed, since March 10, 2017, to prescribe medical cannabis in individual cases as part of
their therapeutic freedom. All pharmacies are allowed to create and dispense corresponding medications on
prescription. Cannabis can be prescribed in various forms. These include the plants’ flowers or as an isolated
main ingredient Dronabinol, also known as “THC”. The doctor decides the form and dosage. Pharmacists provide
their patients with appropriate direction when dispensing the prescribed medication. When authorisation has
been granted, health insurance funds cover the costs of the medication as prescribed by doctors.
Number of
Prescriptions
Number of Units
Dispensed
Preparations containing cannabis and unprocessed
cannabis flowers 26,718 44,224
Pre-packaged pharmaceuticals containing cannabis 34,154 35,821
Total 60,872 80,045
Cannabis Prescriptions for SHI Insured 2017
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 49
SPECIFIC COVERAGE AREAS
ANTIBIOTICS
Antibiotics are essential in treating bacterial infections. Incorrect or excessive use leads, however, to the
develop ment of resistant bacterial strains. Certain antibiotics have no effect on these resistant varieties.
The proper handling of antibiotics includes using them only when and as prescribed by a doctor. The use
of antibiotics in Germany has been on the decline since 2013.
Oral Antibiotics
Oral antibiotics dispensed in community pharmacies at the expense of SHI. Prescriptions from dentists are not taken into account.
Source: Insight Health GmbH & Co. KG
Defined Daily Doses per 1,000 insured (DDD)
0
3
6
9
12
15
12.612.812.814.113.1
20162015201420132012
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201850
SPECIFIC COVERAGE AREAS
ANTIDIABETICS
Approximately 6.7 million people are currently living with diabetes mellitus in Germany. About 95 percent suffer
from type 2 diabetes. The progression and prognosis of diabetes is significantly dependent upon the actions
of the individual patient. Diabetic patients receive medication from community pharmacies and, upon request,
provided consultation and monitoring while using the pharmaceuticals.
Active Ingredients Used Mainly in the Treatment of Diabetes
2017 (rounded)
Volume per 1,000
SHI Insured
Sales per 1,000
GKV Insured
Biguanide 124 1,900 €
Fast working insulin and analogues 82 9,400 €
Slow working insulin and analogues 53 6,900 €
DPP-4 inhibitors 32 3,600 €
Combinations of oral antidiabetics 32 4,300 €
Sulphonylureas 20 400 €
Combination of fast working and intermediate or slow
working insulins and analogues 17 1,600 €
SGLT2 inhibitors 14 2,000 €
Intermediately working insulin and analogues 14 1,100 €
GLP-1 receptor agonists 9 2,700 €
Other 4 200 €
All Antidiabetics 400 34,000 €
Antidiabetics dispensed in community pharmacies at the expense of SHI.
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI), Deutscher Gesundheitsbericht Diabetes 2018
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 51
SPECIFIC COVERAGE AREAS
2015 2016 2017
Packages dispensed in millions 25.1 25.2 23.8
Quantity in millions 1,311 1,314 1,235
Sales in million euros (incl. VAT) 705.3 695.2 630.5
BLOOD SUGAR TESTING STRIPS
Several million patients live with Diabetes in Germany. Pharmacies play a role in the care and supply of these
patients’ needs. This includes not only dispensing pharmaceuticals, but also the supply of blood-sugar testing
devices and the accompanying testing strips. The pharmacists’ associations have, accordingly, concluded
state and nation-wide supply contracts with the health funds and insurers.
Blood-sugar testing strips dispensed in community pharmacies at the expense of SHI (excluding in-office / consultation needs).
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201852
SPECIFIC COVERAGE AREAS
CONSULTATION-INTENSIVE PHARMACEUTICALS
In 2017, pharmacies dispensed more than 190 million pharmaceuticals which, independent of their active
ingredients, required high levels of consultation due to their dosage form. This represents about 30 percent of
all pre-packaged pharmaceuticals dispensed at the expense of statutory health insurance funds. One example
of complex, intensive consultation can be seen in the case of an asthma spray where the inhaler’s proper use
must be demonstrated.
3.6 % Pharmaceuticals for injection
13.9 % Pharmaceuticals, which may not be separated / split *
3.4 % Pharmaceuticals for inhalation
2.0 % Other
0.9 % Pharmaceuticals for rectal application
1.5 % Pharmaceuticals for nasal application
1.6 % Pharmaceuticals which must be prepared
(e. g. dry syrups)
2.6 % Pharmaceuticals for application
at the eyes
All SHI Pre-packaged Pharmaceuticals 2017 (648.4 sales volume in millions of packages)
* Dosage forms such as medications which are enteric coated or retard-pharmaceuticals
which should not be split / separated without consulting a doctor or pharmacist
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
All dosage forms requiring complex, intensive consultation: 29.5 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 53
SPECIFIC COVERAGE AREAS
PHARMACEUTICALS WITH SPECIFIC REQUIREMENTS
Certain pharmaceuticals are subject to special requirements. For instance, narcotics (strong painkillers) require
a special prescription and documentation in order to avoid misuse or undesired effects. The same is true of
pharmaceuticals containing Thalidomide (T-Prescription). There are also special regulations in place to ensure
the safety and quality of temperature sensitive pharmaceuticals.
Sales Volume in Packages 2015 2016 2017
Narcotics (Pre-packaged Pharmaceuticals) 10.2 million 10.5 million 10.5 million
Narcotics (Formulations) — — 6.8 million
Pharmaceuticals prescribed on a T-prescription basis 44,000 53,000 62,000
Refrigerated articles (storage temp. max. 8° C) 19.0 million 19.3 million 19.5 million
Temperature sensitive pharmaceuticals * 8.2 million 8.4 million 8.2 million
* must be cooled to between 2° C and 8° C, without interruption, during the entire delivery and storage chain process (e. g. vaccines)
Pre-packaged pharmaceuticals and vaccines dispensed in community pharmacies at the expense of SHI.
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201854
SPECIFIC COVERAGE AREAS
* inter alia respiratory illnesses
** mainly gastrointestinal illnesses
*** skin-related illness remedies
Source: Insight Health GmbH & Co. KG
OTC PHARMACEUTICALS: LEADING INDICATION AREAS
OTC (over the counter) medications are non-prescription, freely saleable medications sold mainly for use in
self-medication. Consultations are, in these situations, particularly important as they allow for the opportunity
to re-examine the patient’s diagnosis of their own ailment. Large variations in demand are common due to
seasonal fluctuations in cold and flu viruses or pollen allergies.
25.2 %
23.8 %
12.7 %
10.7 %
7.0
%
20.7 %
31.7 %
18.1%17.9 %
10
.4 %
4.7
%
17.2 %
25.2 %
23.8 %
12.7 %
10.7 %
7.0
%
20.7 %
31.7 %
18.1%17.9 %
10
.4 %
4.7
%
17.2 %
Alimentary System
+ Metabolism **
1.1 billion euros (without VAT)
Alimentary System
+ Metabolism **
114 million packages
Sales 2017total 4.8 billion euros
(without VAT)
Sales 2017total 632 million
packages
Respiratory System *
1.2 billion euros (without VAT)
Respiratory System *
201 million packages
All Other Indication Areas
1.0 billion euros (without VAT)
All Other Indication Areas
108 million packages
Muscular and Skeletal Systems
0.3 billion euros (without VAT)
Muscular and Skeletal Systems
33 million packages
Dermatology ***
0.5 billion euros (without VAT)
Dermatology ***
66 million packages
Nervous System
0.6 billion euros (without VAT)
Nervous System
113 million packages
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 55
SPECIFIC COVERAGE AREAS
Sales Development
Sales Volume Development
Source: Insight Health GmbH & Co. KG
NON-PRESCRIPTION PHARMACEUTICALS SPECIAL TREATMENT SERVICES AND THERAPIES
Extra-ordinary types of therapies covered by the Medicinal Products Act (AMG) include herbal, homeopathic and
anthroposophical medications. The non-prescription medications (incl. healthcare products) are popular and in
high demand in pharmacies.
2015 2016 2017
Herbal Medicines 966 961 974
Homeopathic Medicines 412 405 392
Anthroposophical Medicines 92 89 87
2015 2016 2017
Herbal Medicines 102 99 99
Homeopathic Medicines 43 41 37
Anthroposophical Medicines 9 9 9
in million euros (without VAT)
in millions of packages
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201856
SPECIFIC COVERAGE AREAS
GREEN PRESCRIPTIONS
A green prescription is a way for a patient’s doctor to recommend a non-prescription medication. The patient
must pay for the medication themselves in the pharmacy, but the prescription contains a notification that it may
be submitted to many health insurance funds for reimbursement as part of their coverage programme. On all
accounts, the green prescription serves patients as a good reminder of the doctor’s recommendation, active
ingredient and dosage form.
Dispensing of Non-prescription Medications 2017
Distribution of Green Prescriptions Doctor Type 2017 *
45.7
%
31.6 %22.7 %
2017148.6 million
packages
Green Prescription
Private Prescription
SHI Prescription
All Physician Groups
Ear, Nose, and Throat Specialists
Dermatologists
General Practitioners **
Gynaecologists
Paediatricians
Urologists
Orthopaedists
Internists Pneumology
Specialisations ***
Neurologists / Psychiatrists
68 %
84 %
77 %
76 %
73 %
72 %
66 %
54 %
42 %
38 %
23 %
* percentage of per specialist type for doctors which prescribed at least one green prescription in the 4th quarter of 2017
** general practitioners, internal specialists and doctors working as GPs
*** cardiologists, gastroenterologists, rheumatologists
Sources: IQVIA Commercial GmbH & Co. OHG (IMS VIP®), Bundesverband der Arzneimittelhersteller e. V. (BAH)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 57
SPECIFIC COVERAGE AREAS
DISPENSING OF EMERGENCY CONTRACEPTIVES
Emergency contraception (“the morning after pill”) has been available without prescription in German pharma-
cies since March 15, 2015. Lawmakers wanted to make this form of contraceptive more readily available to
women. Accordingly, sales figures have risen (as self-medication) while there has been a fall in the number of
doctor’s prescriptions. As is the case with other contraceptives, women have the legal right, until their 21st
birthday, to financial reimbursement by the statutory health funds. In order to claim this, though, they must
have the medication prescribed by a doctor (pink prescription).
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
2017201620152014
96,000
379,000
475,000
49,000
467,000
146,000
662,000
27,000
665,000
65,000
757,000 23,000
732,000
53,000
808,000
Emergency Contraceptive Sales in Community PharmaciesSales in packages (rounded)
Source: Insight Health GmbH & Co. KG
without prescription with private prescription with SHI prescription
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201858
SPECIFIC COVERAGE AREAS
PROVISION OF MEDICAL AIDS
Pharmacies are, alongside health care supply stores, allowed to supply SHI insured with therapeutic or medical
aids. This usually requires the pharmacy’s participation in a supply agreement between the health insurance
fund and the pharmacists’ association. A requirement for participation is a so-called pre-qualification which
confirms all the necessary conditions for sale of particular types of aids in advance. Approximately 18,000
pharmacies have at least one product-group specific pre-qualification.
Application Aids (e. g. insulin pens) 258
Incontinence Aids (e. g. urine bags) 120
Aids for Compression Therapy (e. g. compression stockings) 98
Measuring Instruments: Bodily Function and Condition (e. g. Lancets and Blood
Pressure Devices) 47
Inhalation and Respiratory Therapy Devices (e. g. nebulisers) 42
Aids for Caregiver Use (e. g. gloves and face masks) 24
Extraction Units (e. g. breast pumps) 20
Vision Aids (e. g. eye pads) 18
Bandages 11
Stoma Articles 9
Orthoses / Splints 6
Other Product Groups 18
Total 671 million euros (incl. VAT)
* individual prescriptions and consultation overhead at pharmacy sales prices
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
SHI Medical Aid Sales * in Community Pharmacies 2017 in million euros
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 59
SPECIFIC COVERAGE AREAS
VACCINES
Statutory health insurance (SHI) spends over one billion euros per year (incl. VAT) on vaccines. These are generally
prescribed on a pink prescription slip by doctors during consultation hours. Flu epidemics and recommendations
from the standing vaccine commission account for seasonal or annual fluctuation.
1 incl. combination vaccines with diphtheria, tetanus etc. 2 incl. combination vaccines with mumps, rubella, chickenpox
Figures reflect only vaccines dispensed by community pharmacies.
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
0 5 10 15 20 25 30 35
2016
1,2500 250 500 750 1,000
2016
2015
2017
34.5
35.2
12.4 7.3 3.3 3.2 1.90.9 0.8
2.51.3 0.9
12.4 7.8 3.4 3.4 2.00.9 0.7
2.41.3 0.9
34.9
1,170
12.7 7.2 3.3 3.2 2.30.8 0.8
2.51.2 0.9
121 304 192 107 142 30 118 5255 49
2017
1,200
1,229
152 308 191 113 122 32 122 5159 50
151 334 186 122 130 33 109 5361 50
2015
0 5 10 15 20 25 30 35
2016
1,2500 250 500 750 1,000
2016
2015
2017
34.5
35.2
12.4 7.3 3.3 3.2 1.90.9 0.8
2.51.3 0.9
12.4 7.8 3.4 3.4 2.00.9 0.7
2.41.3 0.9
34.9
1,170
12.7 7.2 3.3 3.2 2.30.8 0.8
2.51.2 0.9
121 304 192 107 142 30 118 5255 49
2017
1,200
1,229
152 308 191 113 122 32 122 5159 50
151 334 186 122 130 33 109 5361 50
2015
Influenza
Pertussis (Whooping Cough)¹
Pneumococcus
TBE Meningoencephalitis
Measles²
Rotavirus
Meningococcus
Hepatitis
Human Papilloma Virus (HPV)
Other
Volume in millions of vaccine doses
Sales in million euros (incl. VAT)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201860
SPECIFIC COVERAGE AREAS
There are regional as well as seasonal differences found in vaccination numbers. The higher figures found in the
former East German states are mainly a result of the higher amount of influenza vaccination coverage. Specific
individual states in both the east and west see a higher number of measles vaccinations. The high number of TBE
(Tick-borne Encephalitis) vaccinations in southern Germany can be explained by the spread of the disease there
in the summer months.
* incl. combination vaccines with mumps, rubella, chickenpox
Figures reflect only vaccines dispensed by community pharmacies.
Source: Deutsches Arzneiprüfungsinstitut e. V. (DAPI)
501
447
387
420
403
418
424
466
445
473570
678
688
566584
583
443
133
150
124
163
151
140
157
162
160
153222
344
305
222289
290
124
27
28
26
23
24
31
25
32
29
3424
25
29
3724
22
25
93
50
27
38
14
15
1612
23
19 78
47
60
2125
20
91
Doses of Vaccine Issued at the Expense of SHI per 1,000 SHI Insured in 2017
Measles Vaccine *national average:
25
TBE Vaccine *national average:
45
Vaccine Doses Totalnational average:
462
Influenza Vaccine *national average:
170
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 61
SPECIFIC COVERAGE AREAS
PREREQUISITES FOR THE OPERATION OF A PHARMACY
Several requirements must be met to legally operate a pharmacy. These are laid out in the German Pharmacies
Act (ApoG) and the Ordinance on the Operation of Pharmacies (ApBetrO). Many pharmacies far exceed these
minimal requirements to ensure high quality product and customer service as well as general good business
practice.
Source: ABDA – Bundesvereinigung Deutscher Apothekerverbände e. V.
Operating License » licensed pharmacist
» personal management
» 1st hand responsibility
Operational Spaces » min. 110 square meters of floor space
» offices, laboratory, storage, night-time service room
Pharmaceuticals » prescription and pharmacy-only pharmaceuticals as special goods
» pre-packaged pharmaceuticals, formulations and narcotics
» reserves covering at least one week of average demand
Quality Management » pharmaceutical staff incl. technical assistants (PTA), pharmacists,
pharmaceutical engineers
» compulsory QMS system for pharmacy processes
» guidelines of the Federal Chamber of Pharmacists (BAK) and certification
(chamber certificate, TÜV etc.) as orientation
Standby Duty » proper supply of pharmaceuticals to the population
» obligation of constant duty, regular exemption by the pharmacists’ chambers
» notification – at every pharmacy – informing of the nearest, open and operating
pharmacy
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201862
OPERATING RESULTS
OPERATING RESULTS FOR THE AVERAGE PHARMACY
Three-fourths of a pharmacy’s average revenue of 2.31 million euros per year are spent on the cost of sales
operations. Payroll and other expenses must be deducted from the remaining gross revenue. Pre-tax earnings
averaged 144,000 euros in 2017. However, this amount does not translate directly into a gross income because
pharmacy owners, as self-employed freelancers, not only deduct from this amount to pay taxes, but also to
make investments and cover their own retirement plans fully.
2015 2016 2017
Net Revenue * in thousands of euros 2,110 2,220 2,315
− Cost of Sales 1,593 1,683 1,760
= Gross Revenue 517 537 555
− Staff / Payroll 225 235 247
− Other Tax-Deductible Expenses 161 165 170
= Fiscal Operating Result (pre-tax profit) ** 136 143 144
of which partial operating result for the SHI *** 80 83 84
of which, subsidies from DAV Night-time and Emergency
Service Fund 5 5 6
* excluding sales tax and SHI markdowns
** incl. subsidies from the night-time and emergency service fund
*** Cost allocation was performed using the 50-50 sales / revenue method.
Source: Treuhand Hannover GmbH (ABDA-Datenpanel)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 63
OPERATING RESULTS
DEVELOPMENT OF PHARMACY REMUNERATION
In 2004, the pharmacy fee was set at 8.10 euros per prescription-only pharmaceutical. In 2013, it was raised,
for the first time in ten years, to 8.35 euros. There is also a 3 percent mark-up on the pharmacy purchase price
as well as a charge of 0.16 euros to support the night-time and emergency services fund. The effective pharma-
cists’ remuneration is reduced by the pharmacy markdown for pharmaceuticals dispensed at the expense of
SHI. This markdown is currently set at 1.77 euros (incl. VAT). Material costs (e. g. energy costs) and personnel
costs (e. g. standard wages) have risen significantly more than remuneration.
Index (2004 = 100)
* pharmacy remuneration per prescription-only pharmaceutical package as per Section 1 of the German Drug Price Ordinance (AMPreisV)
in conjunction with Section 130 of the Social Insurance Code (SGB V)
** provisional
Sources: Bundesministerium für Gesundheit (BMG), Statistisches Bundesamt (Destatis), ADEXA, ABDA-Statistik
90
100
110
120
130
140
150
160
170
2018**20172016201520142013201220112010200920082007200620052004
SHI Revenues167.8
Gross Domestic Product149.1
Negotiated (standard) Wages in Pharmacies128.9
In�ation Rate (CPI)122.2
Pharmacy Remuneration*114.3
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201864
OPERATING RESULTS
PHARMACIES BY SALES VOLUME CATEGORIES
Average sales for a pharmacy in Germany amount to roughly 2.31 million euros annually (without VAT). There
are, however, large differences found when comparing individual pharmacies. About 60 percent of pharmacies
do not reach the average sales amount with individual, large pharmacies greatly exceeding it.
Percentage of Pharmacies in %
Sales in million euros (without VAT)
Source: Treuhand Hannover GmbH (ABDA-Datenpanel)
0
3
6
9
12
15
> 5
.00
< 5
.00
< 4
.75
< 4
.50
< 4
.25
< 4
.00
< 3
.75
< 3
.50
< 3
.25
< 3
.00
< 2
.75
< 2
.50
< 2
.25
< 2
.00
< 1
.75
< 1
.50
< 1
.25
< 1
.00
< 0
.75
2.3
5.8
8.9
10.7
10.9
10.6
10.4
8.9
6.8
5.2
4.0
2.8 3.0
1.7
1.5
3.8
1.1
1.2
0.5
Average sales:
2.31 million euros
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 65
OPERATING RESULTS
BETRIEBSWIRTSCHAFTLICHE DATEN
supplementary,
pharmacy-typical
products
4.88 billion euros
Pharmacy Sales 2017 (without VAT)49.05 billion euros = 100 %
MEASURED IN SALES FIGURES
9.9 %
pharmaceuticals44.17 billion euros
volume of pharmaceuticals covered by SHI,
private insurance or other
40.48 billion euros
self-medication
3.69 billion euros
not prescribed
3.43 billion
euros
prescribed
1.11 billion
euros
prescription-only pharmaceuticals
39.36 billion euros
pharmacy-only
pharmaceuticals
(non-prescription)
4.54 billion euros
unrestricted
OTC pharma-
ceuticals
0.26 billion
euros
80.3 % 9.3 %
2.3 %
82.5 % 7.5 %
7.0 %
0.5 %
90.1 %
SALES STRUCTURE AND DISPENSED PACKAGES
Dispensed pharmaceuticals account for more than 90 percent of revenue in pharmacies with supplementary
products commonly found in pharmacies accounting for the remainder. More than 80 percent of sales resulted
from prescription-only pharmaceuticals prescribed by a doctor or dentist.
Sources: Insight Health GmbH & Co. KG, ABDA-Statistik
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201866
OPERATING RESULTS
MEASURED IN NUMBER OF PACKAGES
Sources: Insight Health GmbH & Co. KG, ABDA-Statistik
pharmaceuticals 20171,373 million packages = 100 %
prescription-only pharmaceuticals
741 million packages
volume of pharmaceuticals covered by SHI,
private insurance or other
864 million packages
pharmacy-only
pharmaceuticals
(non-prescription)
591 million packages
self-medication
509 million packages
not prescribed
468 million
packages
prescribed
123 million
packages
unrestricted OTC
pharmaceuticals
41 million packages
54.0 % 43.0 %
8.9 %
62.9 % 37.1 %
34.1 %
3.0 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 67
OPERATING RESULTS
in billion euros 2015 2016 2017
Pharmacy sales (without VAT) 47.19 48.15 49.05
Prescription-only pharmaceuticals 37.57 38.46 39.36
Pharmacy-only pharmaceuticals (non-prescription) 4.59 4.59 4.54
Prescribed 1.13 1.13 1.11
Not prescribed 3.46 3.46 3.43
Unrestricted OTC pharmaceuticals 0.28 0.28 0.26
Volume of pharmaceuticals covered by SHI, private insurance or other 38.71 39.59 40.48
Self-medication 3.74 3.73 3.69
Supplementary, pharmacy-typical products 4.74 4.83 4.88
in million packages 2015 2016 2017
Pharmaceuticals 1,412 1,408 1,373
Prescription-only pharmaceuticals 748 754 741
Pharmacy-only pharmaceuticals (non-prescription) 620 610 591
Prescribed 128 127 123
Not prescribed 492 483 468
Unrestricted OTC pharmaceuticals 45 43 41
Volume of pharmaceuticals covered by SHI, private insurance or other 876 881 864
Self-medication 536 527 509
Sources: Insight Health GmbH & Co. KG, ABDA-Statistik
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201868
OPERATING RESULTS
SUPPLEMENTARY PRODUCTS COMMONLY FOUND IN PHARMACIES
The supplementary pharmacy-typical range of products is made up of all non-pharmaceuticals dispensed and
sold in the pharmacy and includes certain therapeutic aids, dietary supplements, vitamins and minerals or blood
sugar testing strips as well as cosmetics and sunscreen. They account for 9.9 percent of total revenue.
* when not classified as a pharmaceutical
Source: Insight Health GmbH & Co. KG
Medical-technical aids and supplies
Eye-related products *
Gastrointestinal *
Other
Vitamins and
minerals
Diet aids and dietetics
Bandaging and
dressings
Diagnostic and measurement devices
(e. g. blood sugar test strips)
Dermatology *
(incl. hygiene products,
cosmetics, sunscreen)
Total: 4.88 billion
euros
Sales 2017 (without VAT)in billion euros
1.05
0.43
0.51
0.
27
0.81
0.65
0.92
0.14
0.10
Total:4.88 billion euros
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 69
OPERATING RESULTS
PHARMACY CLIMATE INDEX 2017
Since 2016, pharmacists’ expectations, outlook and planning for the short-term future have also been
collected alongside their quantifiable, commercial results. The survey at hand was conducted prior to
the European court’s October 2016 ruling that foreign mail order traders need not adhere to the Drug
Price Ordinance (AMPreisV) and indicates that small pharmacies and those with low sales volumes
hold particularly pessimistic views of the future.
Do you plan to hire employees in the next two to three years?
Do you plan to dismiss employees in the next two to three years?
0 10 20 30 40 50 60
56.4 %
41.4 %
5.5 %
0 20 40 60 80 100
89.3 %
7.4 %
5.1 %
No, no hiring planned
No, no dismissals planned
Yes, the hiring of
pharmaceutical staff is planned.
Yes, the dismissal of
pharmaceutical staff
is planned.
Yes, the hiring of
non-pharmaceutical
staff is planned.
Yes, the dismissal of
non-pharmaceutical
staff is planned.
Source: TNS infratest / bonsai GmbH
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201870
OPERATING RESULTS
0 10 20 30 40 50
23.3 %
30.3 %
37.2 %
34.2 %
32.2 %
53.8 %
19.5 %
20.7 %
14.8 %
11.6 %
0
Do you currently train / educate in your main pharmacy?
No, I am not currently
training / educating anyone.
Yes, one or more
pre-approbation, trainee
pharmacists (PhiPs)
Yes, one or more
pharmaceutical technical
trainees (PTA)
Yes, one or more
pharmaceutical commercial
trainees (PKA)
Yes, other apprenticeships
e. g. student interns or in
other occupations
Source: TNS infratest / bonsai GmbH
Total Larger Pharmacies (11 or more employees)
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 71
OPERATING RESULTS
APOTHEKENKLIMA-INDEX 2016
If you were planning to sell your (main-) pharmacy or look for a replacement to take over for you in the next two to three years, how many seriously interested parties would you expect to have?
20.8 %
13.6 %
46.3 %
19
.4 %
0.0 %
51.1 %
27.0
%
21.9 %
20.8 %
13.6 %
46.3 %
19
.4 %
0.0 %
51.1 %
27.0
%
21.9 %
Total
Smaller Pharmacies<1 million euros
in sales turnover
0 interested parties
1 interested party
2 – 4 interested parties
5 or more interested parties
Source: TNS infratest / bonsai GmbH
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201872
OPERATING RESULTS
Do you plan investments in the next two to three years?
0 10 20 30 40 50 60 70
44.5 %
51.9 %
25.3 %
21.7 %
25.2 %
22.6%
13.7 %
9.1%
3.9 %
7.6 %
No, no investments
are planned.
Yes, the renovation /
modification of
pharmacy spaces or
technical facilities.
Yes, the improvement /
expansion of IT
resources.
Yes, other
investments
Yes, opening or
takeover of a
subsidiary pharmacy.
Source: TNS infratest / bonsai GmbH
Total Pharmacy owners 50 years of age
and older
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 73
OPERATING RESULTS
Which type of economical / business development do you expect for your own (main-) pharmacy in the next two to three years?
32.1
%
3.3 % 22.6 %
8.8 %
33.2 %
3.3 %
10.2 %
18.3 %
26.4
%
41.7 %
32.1
%
3.3 % 22.6 %
8.8 %
33.2 %
3.3 %
10.2 %
18.3 %
26.4
%
41.7 %
Total
Smaller Pharmacies
(4 to 5 employees)
significantly better
somewhat better
unchanged
somewhat worse
significantly worse
Source: TNS infratest / bonsai GmbH
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201874
OPERATING RESULTS
Which type of economical / business development do you expect for “Pharmacies in general” in the next two to three years?
significantly better
somewhat better
unchanged
somewhat worse
significantly worse
0
25
50
75
100
20172016
37.2 %
39.0 %
11.8 %
11.6 %
44.7 %
19.7 %
25.6 %
9.5 %
0.5 %0.4 %
Source: TNS infratest / bonsai GmbH
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 75
OPERATING RESULTS
Source: TNS infratest / bonsai GmbH
Has the European court’s October 2016 ruling that foreign mail order traders are no longer bound to the Drug Price Ordinance (AMPreisV) influenced your commercial or operative decisions in a negative fashion?
Total
small communities
(less than 5,000
residents)
investments 56.3 % 61.2 %
staff 33.9 % 37.0 %
training 18.9 % 32.7 %
none of the above named 37.1 % 29.0 %
GERMAN PHARMACIES – FIGURES, DATA, FACTS 201876
OPERATING RESULTS
Which of the following healthcare-related, political topics do you believe to be most important for the coming two to three years?
Source: TNS infratest / bonsai GmbH
0 17 34 51 68 85
83.7 %
73.6 %
72.1 %
75.6 %
67.8 %
67.1 %
38.0 %
40.5 %
29.2 %
28.3 %
24.0 %
22.3 %
23.7 %
27.0 %
23.2 %
24.7 %
1.3 %
1.6 %
planning security (i. e. stable
legal frameworks such as
retention of the Drug Price
Ordinance (AMPreisV)
stable / improved commercial
framework conditions
bureaucracy reduction
recruitment and fostering of
trainees / apprentices
introduction of “medication
management” and other
remunerated pharmaceutical
services
improved cooperation
with doctors
improved cooperation with
insurers and healthcare funds
more flexibility and leeway
regarding patient care / supply
other than the aforementioned
2017 2016
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 77
OPERATING RESULTS
LEGAL NOTICE
Publisher
ABDA – Federal Union of German
Associations of Pharmacists
Unter den Linden 19–23
10117 Berlin, Germany
www.abda.de
Design
Cyrano Kommunikation GmbH
Hohenzollernring 49–51
48145 Münster, Germany
Production
Köllen Druck + Verlag GmbH
Hessische Straße 11
10115 Berlin, Germany
October 2018
GERMAN PHARMACIES – FIGURES, DATA, FACTS 2018 79