Pharmaceutical distribution remuneration in Europe

Results The data show that in Cyprus, Denmark, Finland, the Netherlands, Norway, Sweden and the UK wholesale remuneration is negotiated between manufacturers and wholesalers. In the remaining countries, a maximum allowed wholesale remuneration is regulated on a legal basis, at least for reimbursable medicines. In these countries, wholesale remuneration generally depends on the price of the medicine. Regressive schemes have become more common than linear margins/mark-ups. In 28 of the 30 countries surveyed, pharmacy remuneration is regulated or agreed upon between the pharmacy sector and payers at least for reimbursable medicines, whereas in Cyprus and Malta pharmacy remuneration is not an issue as pharmacies are state-owned and directly belong to public sector. In 16 of these 28 countries, remuneration depends solely on the price of the dispensed medicine, and is usually a regressive scheme. A purely performance-based fee-forservice remuneration is in place in five countries (Croatia, Ireland, the Netherlands, Slovenia and the UK). Pharmacy remuneration that is both price-based and performancebased exists in seven countries (Belgium, Denmark, Finland, France, Germany, Norway and Switzerland).