Pharmacy Mapping Results 2008 Apr3 En

EUROPEAN SEMINAR

CO-OPERATIVE ENTERPRISES IN THE PHARMACY SECTOR OPPORTUNITIES & CHALLENGES ROME, 30-31 MARCH 2009

MAPPING EXERCISE CO-OPERATIVES WORKING IN THE PHARMACY SECTOR IN EUROPE

Version 1.3

This mapping exercise is realised with the support of

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TABLE OF CONTENTS TABLE OF CONTENTS

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METHODOLOGICAL FOREWORD

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1. CO-OPERATIVES WORKING IN THE PHARMACY SECTOR IN EUROPE: WHERE & HOW

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2. COUNTRY ANALYSIS

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2.1. Belgium

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2.2. France

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2.3. Germany

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2.4. Greece

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2.5. Italy

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2.6. Netherlands

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2.7. Poland

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2.8. Portugal

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2.9. Spain

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2.10. Switzerland

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2.11. Turkey

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2.12. UK

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3. CO-OPERATIVES WORKING IN THE PHARMACY SECTOR IN EUROPE: KEY FIGURES

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FIRST OUTCOMES

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ANNEX 1: QUESTIONNAIRE

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ANNEX 2: COUNTRY SHEETS

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METHODOLOGICAL FOREWORD COOPERATIVES EUROPE, the Europe region of ICA, represents a force for economic growth and social change of 163 million member co-operators owning 250 000 cooperative enterprises and giving jobs to 5,4 million European citizens. It gathers together 171 national cooperative organisations from 37 countries of the European region and 6 European sector-based Organisations. Its vision is the promotion of the co-operative model of enterprise for sustainable economic progress with social objectives. Taking advantage of its great representativeness and of its several contacts with national and sectoral organisations in all European countries, COOPSEUROPE carries out mapping exercises to help organisations in sharing experiences, establishing contacts and networks as well as creating synergies. Therefore, although the surveys are implemented with the highest possible precision level and following the basic scientific criteria, COOPERATIVES EUROPE does not pretend to be considered a research centre. Mappings’ results are to be considered indicative, in the sense that they give the idea of the dimensions and the potential of a determined phenomenon or sector.

The analysis and mapping of co-operatives working in the pharmacy sector in Europe, is a completely new subject for COOPERATIVES EUROPE. At the beginning of the study COOPSEUROPE disposed of no data about this sector, neither for the European nor for the national levels. This was due to two main reasons. Firstly, among ICA members there is only one national organisation representing co-operative pharmacies in Europe – OPHACO, Office des pharmacies coopératives de Belgique. Secondly, there is no European organisation representing co-operative enterprises working in the pharmacy sector as the sector-based European organisation, EUSP, represents social pharmacies in general, which do not necessarily have a co-operative form. Three were the main reasons for which the data collection was not easy. First of all, as already stated, for the lack of a European structure, and, in many cases (Germany, The Netherlands, France, Poland, Switzerland), even of a national structure. Second, in countries like Spain and Greece, where cooperatives have a long-standing tradition, the representative structures do not have regular relations with COOPSEUROPE’s members, which makes the contact difficult. Finally, in particular with those organisations with which COOPERATIVES EUROPE had no direct relation, it was difficult to persuade them to take part in the survey.

The mapping was carried out in three phases. The first stage was meant to be a general recognition of the overall situation in the different European countries. A set of general questions was sent to contact-points in 22 countries: Bulgaria, Cyprus, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Luxembourg, Norway, Netherlands, Poland, Portugal, Spain, Slovakia, Sweden, Switzerland, Turkey and UK. On the basis of the results of the first enquiry and of discussions with experts of the sector, a questionnaire was prepared (see annexe 1) and sent to the contacts in the countries where cooperatives work also in the pharmacy sector. In the questionnaire, co-operatives are classified into three categories according to their activity:

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-

Co-operative of professional pharmacists, which function as buying groups/ wholesalers, provide logistic services and training; - Co-operative pharmacies: consumers coming together in retail co-operatives; - Workers joining in a co-operative to produce drugs. Besides, a forth category was created for those corporate enterprises working in the pharmacy sector which are controlled by co-operatives (50% at least). In the final stage, fulfilled questionnaires were collected. For those countries which did not take part into the survey, but whose co-operative movement is active in the pharmacy sector, web researches have been carried out to at least get a general overview of the phenomenon. Unfortunately, not all data are available and, though scientifically not correct, sometimes we will have to add together quantities (such as the turnover or number of employees) referring to different years.

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1. COOPERATIVES WORKING IN THE PHARMACY SECTOR IN EUROPE: WHERE & HOW Before analysing the European countries where co-operatives work also in the pharmacy sector, an overview is provided. In at least 12 of the 22 countries which were contacted for this mapping, the presence of cooperatives in the pharmacy sector is signalled: - Belgium - France - Germany - Greece - Italy - Netherlands - Poland - Portugal - Spain - Switzerland - Turkey - UK A national federation representing co-operatives working in the pharmacy sector is present in: Belgium (OPHACO), Greece (OSFE), Italy (Federfarma Servizi), Portugal (Fecofar), Spain (Acofarma), Turkey (TEKB), UK (The Co-operative Pharmacy). The following chart summarizes the categories which are present in each of the countries and signals where a national federation has already been created.

Belgium France Germany Greece Italy Netherlands Poland Portugal Spain Switzerland Turkey UK

Y

Y Y Y Y Y Y

Y

National Federation

Corp controlled by co-ops

Drug producers

Co-op Pharmacies

Wholesaler/ Buying Co-ops

Co-operatives in the pharmacy sector

Y Y Y Y Y

Y Y

Y Y

Y Y Y

Y

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Y Y

2. COUNTRY ANALYSIS 2.1. Belgium In the Belgian pharmacy sector co-operatives are present under various forms: co-operative pharmacies, buying groups, distributors and “offices de tarification”. OPHACO is constituted by 15 consumer co-operatives companies, specifically active in the intermediary distribution (8 wholesalers, 600 pharmacies, 50 Health Product shops) of medicines (human and animal) and health products: medical devices, medical nutrition or cosmetics. According to the data published on the website of OPHACO, co-operative pharmacies represent about 20% of the Belgian pharmaceutical product market, they have a turnover of 600 millions Euro and employ 3 500 people (1 000 pharmacists)1.

Belgium: Co-operative pharmacies

Points of sale Employees Employees (pharmacists) Members Turnover (year?)

Co-operative pharmacies 600 3 500 1 000

Other pharmacies

Total

4 700

5 3002

XXXXXXXXXXXXX 600 000 000 €

2.2. France In the French pharmacy sector, co-operatives are present as buying groups (groupements de repartition). In particular the co-operative network CERP, is the third main actor in France: - O.C.P. Group 37% - CERP Network 29% - Alliance Healthcare France 28% - Phoenix Pharma 4% - Others 2% Unfortunately, it was not possible to find data about all the members of the CERP network.

France: Wholesaler/ Buying co-operatives in the pharmacy sector

Cerp-Rouen* Cerp-Rhin-RhôneMéditerranée Cerp-BretagneNord 1 2

Served Pharmacies 5 300 3 000

Employees 2 735 995

Turnover (2007) 3 315 000 000 € 1 543 000 000 €

Market share 14,5 % 8% 2,5 %

http://ophaco.nexenservices.com/index.php?pageID=1 http://girp.eu/membersprofiles.php?urlxx=BELGIUM

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Cerp-Lorraine** Total

1 700 10 000

1 750 5 480

800 300 000 € 5 658 300 000 €

4% 29 %

* Cerp-Rouen together with the German company Sanacorp (corporate enterprise partly controlled by a co-operative), founded in 2007 the new holding Millennium s.p.a. based in Bologna (Italy). ** Cerp-Lorraine has recently undergone a deep reorganisation process: the repartition pharmaceutique activity was sold to Phenix, which has allowed the new company, since 30th September 2008 named Welcoop Group, to concentrate on the service activities.

However, CERP is not the only co-operative entity in the pharmacy sector in France. There are at least two other actors to mention: Sogiphar and the Coopérative des Pharmaciens, which has recently changed its name into Central des Pharmaciens. Unfortunately, no data is available for these two cooperatives, unless for the fact that 600 pharmacies are members of the Coopérative des Pharmaciens. Therefore, on a total of about 23 000 pharmacies in France3, at least 10 600 of them work with/are members of a co-operative.

2.3. Germany Sixteen are the full-line wholesalers of pharmaceutical products in Germany4. Among the biggest, Noweda and Sanacorp are linked to the co-operative movement. Sanacorp used to be a co-operative, and it was transformed into a joint company in 1995 – Sanacorp Pharmaholding AG and Sanacorp Pharmahandel GmbH - which remains, however, controlled by the co-operative Sanacorp eG Pharmazeutische Groβhandlung (100 % of the votes, 73,2 % of the capital). In 2007, together with the French co-operative CERP-Rouen, Sanacorp created Millennium S.p.a, a stock company based in Bologna (Italy).

Germany: other (non co-operative) enterprises in the pharmacy sector, owned by cooperatives (50% minimum)

Millenium spa (Sanacorp Pharmahandel GmbH)

Served Pharmacies 8 000

Employees 2 554

Turnover (2007) 2 728 577 000 €

On the other hand, Noweda is still an Apothekergenossenschaft, a co-operative of pharmacists, which counts 6553 members.

Germany: wholesaler/ buying co-operatives in the pharmacy sector Wholesaler/ Buying co-ops Number Members 3 4 5

Other buying groups (Ankaufsgruppe)

1 (Noweda) 6 553

XXXXXXXXXXXX

http://girp.eu/membersprofiles.php?urlxx=FRANCE http://girp.eu/membersprofiles.php?urlxx=GERMANY http://girp.eu/membersprofiles.php?urlxx=GERMANY

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Total

165 XXXXXXXXXXXXXX

Served pharmacies Employees Turnover (2006/2007)

5 000

16 551

21 551

1 540 2 456 000 000 €

10 697 19 944 000 000 €

12 237 22 400 000 000 €

Noweda eG and Sanacorp AG have therefore a turnover of more than 5 billion €, which is about 25% of the whole German market and they totally employ more than 4 000 people.

2.4. Greece Also in Greece pharmaceutical product wholesaler co-operatives have gathered together to create a common platform: in 1988 OSFE, Cooperative Federation Farmakopoion Greece, was created.

Greece: wholesaler/ buying co-operatives in the pharmacy sector

Number Members Served Pharmacies Employees Turnover (2001)

Wholesaler/ Buying co-ops 27 5 1007

Other buying groups 115 XXXXXXXXXXXX 4 400

Total 1426 XXXXXXXXXXXXXX 9 5008

8009 750 000 000 €10

€

€

According to the data published on the website of OSFE, the federation of co-operatives controls 48% of the pharmaceutical products of the Greek market.

2.5. Italy In Italy as well the co-operative movement has a long tradition in the pharmacy sector. There are at least 30 buying co-operatives representing 4 900 members and serving 8 000 pharmacies. The total turnover is of 2,7 billion €, that is about 33 % of the overall market of pharmaceutical products in Italy.

Italy: wholesaler/ buying co-operatives in the pharmacy sector

Number

Wholesaler/ Buying co-ops 30*

Other buying groups 3**

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http://girp.eu/membersprofiles.php?urlxx=GREECE http://www.osfe.gr 8 http://girp.eu/membersprofiles.php?urlxx=GREECE 9 http://www.osfe.gr 10 http://www.osfe.gr 7

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Total

Members Served Pharmacies Employees Turnover

4 900 8 000

XXXXXXXXXXXX 19 310

XXXXXXXXXXXX 27 310

2 716 760 850,61 €

5 434 000 000 €

8 150 760 850,62 €

* Members of Federfarma Servizi ** Alleanza Salute, Comifar, So.Farma.Morra

Some of the Italian co-operatives working in the pharmacy sector have created a representative organisation: Federfarma Servizi. The presence of co-operative pharmacies has to be signalled as well.

2.6. Netherlands In the Netherlands there used to be a big co-operative pharmacy (O.P.G.), which has a current turnover of 2 400 000 000 €, but it was listed in the stock exchange in 1992. At that time the cooperative owner retained 90% of the control. In 2000 it was converted into a corporate as the cooperative’s ownership percentage had declined to below 20%. The company is now slowly but steadily buying up the pharmacies that once used to be the owners of the company. As for buying groups, there are two co-operatives, which are actually relatively small.

2.7. Poland In Poland there is no co-operative working in the pharmacy sector as wholesaler. There is no cooperative pharmacy as well. However, a relatively relevant sector for the co-operative movement in this country is the pharmaceutical manufacture. As a matter of fact, there are at least 6 co-operatives in this field, some of them extremely modern and with a relevant market position.

Poland: co-operatives, drug producers (both directly and indirectly) Name 1. UNIA Pharmaceutical Plant Co-op in Warsaw 2. FILOFARM Pharmaceutical Workers’ Cooperative in Bydgoszcz 3. ESPEFA Chemistry and Pharmacy Cooperative in

Country of manufacture Poland

Employees 264

15 000 000 € (esteemed)

Poland

124

8 570 000 € (2007)

Poland

105

5 140 000 € (planned for 2008)

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Turnover

Cracow 4. SEPTOMA Chemical and Pharmaceutical Workers’ Cooperative in Zabki 5. GALENA

Poland

36

570 000 € (2007)

Poland

140

8 570 000 € (2007)

Poland

48

2 570 000 € (2007)

717

40 420 000 €*

Pharmaceutical Manufacturing Cooperative in Wroclaw

6. LABOR Pharmaceutical and Chemical Workers’ Cooperative in Wroclaw Total

* This is an indicative amount, as the data refers to different years. However, it is indicative of the business volume.

2.8. Portugal The Portuguese co-operative movement has a longstanding tradition in the pharmaceutical sector. Fecofar, Federação de Cooperativas de Distribuição Farmacêutica, is the national organisation representing pharmaceutical product wholesaler co-operatives. Fecofar has a market share of 33,7%, has 3 735 associated pharmacies and 569 employees. In 2007 it registered an annual turnover of more than 950 million Euro.

2.9. Spain The co-operative movement in Spain has a great tradition in the pharmacy sector, namely in the form of buying groups. Of the 21 00011 pharmacies which work in Spain, nearly 18 000 are members of a co-operative. Nowadays there are at least 32 co-operatives, which distribute 85% of the pharmaceutical products sold on the Spanish market12. Spain: wholesaler/ buying co-operatives in the pharmacy sector

Number Members Served Pharmacies 11 12 13 14

Wholesaler/ Buying co-ops 32 18 000 18 000

Other buying groups 26 XXXXXXXXXXXX 2 741

http://girp.eu/membersprofiles.php?urlxx=SPAIN http://www.acofarma.com/ad_bienvenida.html http://girp.eu/membersprofiles.php?urlxx=SPAIN http://girp.eu/membersprofiles.php?urlxx=SPAIN

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Total 5813 XXXXXXXXXXXXXX 20 74114

Employees Turnover

€

€

€

Considering its dimensions and its history, it is quite obvious that the Spanish co-operatives working in the pharmacy sector have succeeded in gathering in a national structure: Acofarma, a co-operative owned and managed by co-operatives. Among its activities of promotion and support of the member co-operatives, Acofarma launched some years ago an own brand – Acofar – which now counts about 5 000 references.

2.10. Switzerland We dispose of restricted information about the Swiss situation. It has to be signalled the presence of some co-operatives pharmacy such as the Geno Apotheken, which count 4 dispensaries. Another interesting co-operative experience is that of Apodata15, a pharmacists co-operative which collects data about sales from its members and than sell them. Among its clients there are of course pharmaceutical industries.

2.11. Turkey In this country the pharmacy sector represents an important branch for the co-operative movement. Turkish co-operatives have already gathered in a national structure: TEKB (Tüm Eczacı Kooperatifleri Birliği, Association of Pharmacy Cooperatives) was created in 1989 which can now count on 7 members. According to the data provided through the questionnaire, the 7 members of TEKB serve 10.000 pharmacies and employs about 1.500 people for a total turnover of about 1,25 billion Euro.

Turkey: wholesaler/ buying co-operatives in the pharmacy sector Wholesaler/ Buying co-ops Number Members Served Pharmacies Employees Turnover

Other buying groups

7 10 000 10 000

Total

4 XXXXXXXXXXXX

1 500 1 256 000 000 €*

6 594 000 000 €

7 850 000 000 €

* The data were provided in USD and converted in EURO according to the exchange rate on 1st November 2008. Furthermore, the presence FarmaLojistik has to be signalled. It is a private company, completely owned by co-operatives; it provides pharmacy wholesalers and pre-wholesalers logistic services. It currently employs 35 people.

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http://apodata.ch

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2.12. UK In the UK, The co-operative Pharmacy gathers together 793 co-operative pharmacies, representing 3,5 million members.

UK: cooperative pharmacies (consumer co-operatives)

Points of sale Employees Employees (pharmacists) Members Turnover (year?)

Co-operative pharmacies 793 5 626 1 000

Other pharmacies

Total

11 75416

12 547

3 500 000 816 043 696 €*

XXXXXXXXXXXXX

* The data were provided in GBP and converted in EURO according to the exchange rate on 1st January 2008. The Co-operative Group’s pharmaceutical wholesale subsidiary, Sants, signed an agreement with Tasly Group China on the 29th July 2007 which will lead to the construction of a state-of-the-art production facility in the city of Tianjin in a total investment of up to 30 000 000£. The facility will manufacture well established generic pharmaceutical products including OTC for the Co-operative’s own pharmacies. Product will also be manufactured for Tasly’s own pharmacies and extensive distribution in China.

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http://girp.eu/membersprofiles.php?urlxx=UNITED KINGDOM

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3. CO-OPERATIVES WORKING IN THE PHARMACY SECTOR IN EUROPE: KEY FIGURES

?

2 728,6

40,4 950 ? ? 1 256 816 1 416

13 787

? 40,4 17 972

Total per country

? 5 658,3 2 456 750 2 716,8 ?

Corp controlled by coops

600

Drug producers

Wholesaler/ Buying Co-ops

Belgium France Germany Greece Italy Netherlands Poland Portugal Spain Switzerland Turkey UK Total per category Overall total

Coop Pharmacies

Cooperatives in the pharmacy sector: turnover (in million €)

600 5 658,3 5 184,6 750 2 716,8 ? 40,4 ? ? ? 1 256 816

2 728,6

Belgium France Germany Greece Italy Netherlands Poland Portugal Spain Switzerland Turkey UK Total per category Overall total

3 500

?

? 5 480 1 540 800 ? ?

2 554

717

? 1 500

14

9 889

? 717 22 286

3 500 5 480 4 094 800 ? 717 ? ? ? 1 500 5 626

569 ?

5 626 9 126

Total per country

Corp controlled by coops

Drug producers

Buying Coop

Coop Pharmacies

Cooperatives in the pharmacy sector: employees

2554

? 10 000 5 000 5 100 8 000 ?

32

3 735 18 000

7

10 000

115

59 835

Total per country

9 6 2 27 30 2

Corp controlled by coops

Wholesaler/ Buying Co-ops

Belgium France Germany Greece Italy Netherlands Poland Portugal Spain Switzerland Turkey UK Total

Cooperatives

Cooperatives in the pharmacy sector: pharmacies served by wholesaler/ buying cooperatives

10 000 13 000 5 100 8 000 ?

8 000

? 18 000 ? 10 000 8 000

64 100

Belgium France Germany Greece Italy Netherlands Poland Portugal Spain Switzerland Turkey UK Total

Employees (pharmacists)

Employees

Cooperative Pharmacies

Cooperatives in the pharmacy sector: cooperative pharmacies

600

3 500

1 000

?

?

?

5 626 9126

786 1786

4 786 1390

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FIRST OUTCOMES The survey is far from being exhaustive and, considering the first results obtained, it would be worth to devote more energies to this sector. However, a perspective is needed. Spain, Portugal and Greece, though the great potential of their co-operative movement in the pharmacy sector, did not take part in the survey. To get them involved, to let them co-operating to a survey at European level, they need to see an objective, a reason for which it would be worth to spend time and energy. Furthermore, the mapping allowed discovering that in some countries such as Sweden and Cyprus, where co-operatives do not work in the pharmacy field yet, but where this sector is experiencing a moment of changes and is being opened to private actors. Obviously, the national co-operative movements are trying to take advantage of these moments, but they expressed the need of getting in touch with the experiences of other countries. The co-operative actors of the pharmacy field need to be gathered together, to become aware of their potential, to exchange experiences and opinions, to put their strengths together and begin to think of common interests and strategies.

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ANNEX 1: QUESTIONNAIRE MAPPING: CO-OPERATIVES IN THE PHARMACY SECTOR DATA ABOUT YOUR ORGANISATION: PLEASE, SPECIFY AT LEAST NAME, COUNTRY, ADDRESS, CONTACT PERSON. BESIDES, PLEASE BRIEFLY DESCRIBE YOUR ACTIVITY AND YOUR RELATIONSHIP TO COOPERATIVES EUROPE’S MEMBER. Name Country Address Contact

Italy

1. WHICH ARE THE EXISTING CATEGORIES IN YOUR COUNTRY? A. Co-operative pharmacies B. Buying co-operatives in the pharmacy sector C. Medicine manufacturer co-operatives (both direct and indirect producer) D. Other (non co-operative) enterprises in the pharmacy sector, owned by co-operatives (50% minimum) E. No co-operative in the pharmacy sector 2. IF IN THE QUESTION N° 1 YOU TICKED A, B, C, OR D, PLEASE FILL IN THE FOLLOWING CHARTS AND THAN GO TO QUESTION 4. IF IN THE FIRST QUESTION YOU ANSWERED E, GO TO QUESTION 3. A. Co-operative pharmacies (consumer co-operatives) Co-operative pharmacies Points of sale Employees Employees (pharmacists) Members Turnover (year?)

Other pharmacies

Total

XXXXXXXXXXXXX

B. Wholesaler/ Buying co-operatives in the pharmacy sector Wholesaler/ Buying co-ops Number Members Served Pharmacies Employees Turnover (year?)

Other buying groups XXXXXXXXXXXX

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Total

C. Co-operatives, drug producers (both directly and indirectly) Name

Country of manufacture

Employees

Turnover (year?)

1. 2. 3. …

D. Other (non co-operative) enterprises in the pharmacy sector, owned by co-operatives (50% minimum) Name

Share owned by co-operatives (%)

Sector of activity

Employees

Turnover (year?)

1. 2. …

3. WHY ARE THERE NO CO-OPERATIVES WORKING IN THE PHARMACY SECTOR IN YOUR COUNTRY? IS THEIR ABSENCE DUE TO LEGISLATIVE OBSTACLES?

___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

4. OTHER REMARKS:

_______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

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ANNEX 2: COUNTRY SHEETS Below the country sheets fulfilled by the participants in the European Seminar “Co-operatives in the pharmacy sector in Europe” (Rome, 30-31 March 2009).

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CO-OPERATIVES WORKING IN THE PHARMACY SECTOR BELGIUM COUNTRY: Belgium ORGANIZATION: OPHACO (www.ophaco.coop) BRIEF DESCRIPTION OF THE ORGANIZATION: OPHACO is constituted by 15 consumer co-operatives companies, specifically active in the intermediary distribution (8 wholesalers, 600 pharmacies, 50 Health Products shops) of medicines (human and animal) and health products: medical devices, medical nutrition or cosmetics. OPHACO is one of the major founding and contributing member of the European Union of the Social Pharmacies (EUSP) represented also in France, Italy, Poland, Portugal, The Netherlands and Switzerland. COUNTRY LEGISLATIVE FRAMEWORK In Belgium wholesalers, pharmacies and pharmacists are submitted to the European regulations, successively transposed in the Belgian Law on one side, namely, the directive 85/433/EEC (16 09 1985) (mutual recognition of diplomas, certificates and other evidence of formal qualifications in pharmacy, including measures to facilitate the effective exercise of the right of establishment relating to certain activities in the field of pharmacy), the Directive 85/432/EEC (16 09 1985) (coordination of provisions laid down by law, regulations or administrative action in respect of certain activities in the field of pharmacy), the directive 2001/83/EC (6 11 2001) (Community code relating to medicinal products). On the other side, namely, the several Belgian dispositions concerning the health practitioners (Art. 4 of the royal decree n° 78 for the pharmacists), the pharmacies (royal decree of September 25th, 1974), the medicines (Law of May 1st, 2006 and royal decree of December 14th, 2006) and the pharmacist (royal decree January 21st, 2009). Other dispositions are concerning the reimbursement of health care to the patients (including medicines) (law of July 14th, 1994 and their application dispositions). Many other legal dispositions are concerning the transparency and the governance of companies and societies, co-operative or not. DESCRIPTION OF THE SECTOR (FACTS & FIGURES) Medicine distribution and dispensation are the vital link between the producers and the patients/consumers. The actors of the medicines sector in Belgium are the producers (400 medicines or medical devices manufacturers or representing producers companies), wholesalers (16 companies), Pharmacies (5.200). 80% of the consumption depends from abroad. The compulsory social protection covers 50% of the health products market for which the average patient level of co-payment is about 1/5. ROLE OF THE CO-OPERATIVES IN THE SECTOR Each consumer co-operatives member of OPHACO deals with the medicines ditribution and dispensation. The market share covered by the members of OPHACO is about 20% of the sector market. This success is due to the fact that OPHACO members are representing an alternative to the monopoly of the stand alone pharmacists’ pharmacy. Those alternatives are based on the specifi Values and Finalities of the Co-operative entrepreneurship and of the Social Pharmacies. STRENGTHS AND WEAKNESSES OF THE CO-OPERATIVE MOVEMENT IN THE PHARMACY SECTOR The turnover of the medicines distribution and dispensation depends for 50% from the reimbursable medicines. The income of the distribution and the dispensation represents respectively 5% and 15 % of the global turnover VAT excluded. As a consequence, the dispositions aimed to reduce the public expenditure have a direct impact on the economy of the sector. A strong point of the co-operatives is constituted by their coordinated organisation model which permits scale economies and a global coherence of their network. As a result, the average turnover of a co-operative pharmacy is two time higher than the average one of the stand alone pharmacy. This indicates the global satisfaction of their 2.2 million co-operators. The competence of the pharmacies teams through their in company continued training constitutes a major strong point strengthening the co-operative pharmacy. A weakness is actually constituted by the difficulties to recruit pharmacists, a global problem of the sector. THE MAJOR CO-OPERATIVE ENTERPRISES OF THE COUNTRY IN THE PHARMACY SECTOR SCRL MULTIPHARMA CVBA, PHARMACIES POPULAIRES LIEGEOISES SCRL, CV VOORUIT, CV DE VOORZORG HASSELT, CV DE VOORZORG MECHELEN, PHARMACIES POPULAIRES “ LA SAUVEGARD ” SC, LES PHARMACIES DU PEUPLE SCRL, V-PHARMA, EPC, CVBA VIVANTIA, VZW M.S.I. ROESELARE-TIELT , VZW APOTHEKEN DE VOLKSMACHT IEPER, CV APOTHEEK IN HET ZWAARD, DE LINDEBOOM APOTHEEK, CV DE VOLKSMACHT TURNHOUT.

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FUTURE PRIORITIES AND STRATEGIES The priorities of the Belgian co-operative Pharmacies and Wholesalers for the next months are: - The new system of payment of the pharmacist and the wholesaler; - The traceability of the medicines from the producer to the patient; - The new Information and Communication technologies: electronic prescription, memories and data transmission; The strategies remain in the expansion of the networks to reinforce the competitive advantage of the companies.

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CO-OPERATIVES WORKING IN THE PHARMACY SECTOR FRANCE COUNTRY: France ORGANIZATION: Groupe WELCOOP BRIEF DESCRIPTION OF THE ORGANIZATION: Groupe WELCOOP is a cooperative of more than 1700 French pharmacists founded and managed by pharmacists for 70 years. Groupe WELCOOP changed its name in September 2008 (previously Cerp Lorraine Group). Groupe WELCOOP develops 7 business activities in Europe, all dedicated to the pharmacists. Only pharmacists who own a pharmacy in France and in Belgium can be shareholders of Groupe WELCOOP. COUNTRY LEGISLATIVE FRAMEWORK In France, the sector laws are grouped in the French Health Code (mainly Articles L.5124-1 to L.5124-18, R.5124-1 to R.5124-15 and R.5124-58 to 5124-64) and the Good Distribution Practice dated 30 June 2000, which have implemented in France the European directive 2001/83/CE of 06/11/2001 for example. The Ministry of Health together with the French Medicines Agency (Afssaps) and the National Order of Pharmacists (Ordre National des Pharmaciens) regulate the sector and control the medicine wholesale distribution. In addition, the National Competition Enquiries Authorities (DGCCRF) is very active in the sector to control the application of the new French law (loi LME): many manufacturers and pharmacies are being inspected by this State Administrative body. DESCRIPTION OF THE SECTOR (FACTS & FIGURES) The major actors of the pharmaceutical chain in France are: pharmaceutical manufacturers (330 companies), pre-wholesale/depositaries (30 companies), wholesalers (10 companies with 232 warehouses), Pharmacies (22.600), Hospitals (3.000). ROLE OF THE CO-OPERATIVES IN THE SECTOR Groupe WELCOOP proposes to the 22.600 pharmacists of France to become owner of their suppliers. This new economic model is based on 3 major grounds: 1. Computing and Management with Pharmagest Interactive, leader in France with 43% market share equipping 9.800 pharmacies in France with a complete back office solution. 2. Advice and Organization with Profidia (merchandising, pricing structure…) 3. Products Offer with generics, medicinal equipment and parallel imports with Cristers, D. Médica and Pharma Lab. This new economic model adds a two-way value for the pharmacists: - increasing the margins with the right to get co-operative dividends based on a percentage on all purchase done with the Products Offer (20% for Cristers, 4% for D. Médica, 5% for Pharma Lab); - accessing the capital of the Group by opening the capital of the holding Welcoop Pharma. STRENGTHS AND WEAKNESSES OF THE CO-OPERATIVE MOVEMENT IN THE PHARMACY SECTOR With the risk of the opening of the capital of pharmacies leading to chains, the strategies of the sector become clearer and the old models implode: consolidation of wholesale activities at European level (Millenium), wholesale competition at national level in areas where historically co-operatives were lonely (Cerp Rouen, Cerp Rhin Rhône Méditerranée), connections with Group of pharmacies (CERPenthès), disengagement of the historic wholesale business activity (Cerp Lorraine sold to Phoenix Pharma) and introduction of a new economic model (Groupe Welcoop). THE MAJOR CO-OPERATIVE ENTERPRISES OF THE COUNTRY IN THE PHARMACY SECTOR Excepting Groupe WELCOOP, the other of co-operatives working in the pharmacy sector in France deal with the medicine distribution and are members of the Chambre Syndicale de la Répartition Pharmaceutique (CSRP): CERP Rouen (Astera), CERP Bretagne Nord, CERP Rhin Rhône Méditerranée. FUTURE PRIORITIES AND STRATEGIES Find the model of tomorrow to allow the pharmacists to remain competitive, liberal and independent.

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CO-OPERATIVES WORKING IN THE PHARMACY SECTOR GREECE COUNTRY: Greece ORGANIZATION: OSFE BRIEF DESCRIPTION OF THE ORGANIZATION: OSFE Represents 27 co-operatives and 18 soc. Anonyms. Members – shareholders of these 45 companies are 5.600 pharmacists who own a pharmacy. COUNTRY LEGISLATIVE FRAMEWORK: The activity of storage and distribution of pharmaceutical products for human use only is governed by the law which is adjusted to community law on “the distribution of products for human use only”. Most of our companies – members are certified at ISO & CE.

DESCRIPTION OF THE SECTOR (FACTS & FIGURES): The actors of the pharmaceutical chain in Greece are: 283 pharmaceutical manufacturers and agency distributors, 4 logisticious, 148 wholesalers (45 co-operatives and 103 private sector) and 10.300 pharmacies ROLE OF THE CO-OPERATIVES IN THE SECTOR: the market share covered by the members of OSFE is about 51%. The annual turnover of 2008 was 2.3 billion euro. STRENGTHS AND WEAKNESSES OF THE CO-OPERATIVE MOVEMENT IN THE PHARMACY SECTOR: The powerful weapon of co-operatives is the number of 5.600 pharmacies – members as well as the service we provide to them. The problem of our co-operatives is the invested capital and the bureaucratic entanglements causing difficulties to get quick decisions and adapt to new arrangements fast. The problem of funding and fluidity of the insurance system creates pressure for new government decisions, directing in limitation of expenditure. The trend of big manufacturers for direct to the pharmacy is another problem for us. THE MAJOR CO-OPERATIVE ENTERPRISES OF THE COUNTRY IN THE PHARMACY SECTOR: The major services that co-operatives offer to pharmacies are: information services, training, merchandising services and crm and from the 1st June 2009 we will start the advertisement of products using display screens, returning profit to pharmacies and home management by OSFE. Also, within 2009 we will begin indication of 5.600 pharmacies as a virtual chain under the name of “Green Pharmacy”. Finally OSFE has developed a service of providing statistical information of the market which sells to producers and 68 from the make use of this tool, either displacing IMS or in combination with the data of IMS, a service which provides an important income for the co-operatives. FUTURE PRIORITIES AND STRATEGIES: A. Building the virtual chain “Green Pharmacy” B. Our entry in logistics services on behalf of our big suppliers C. The continuous battle in collaboration with the associations of pharmacists and PGEU for maintening of property arrangement of pharmacies in the hands of pharmaciests.

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CO-OPERATIVES WORKING IN THE PHARMACY SECTOR ITALY COUNTRY: Italy ORGANIZATION: Federfarma Servizi, National Association of Service Societies for Pharmacies BRIEF DESCRIPTION OF THE ORGANIZATION: Federfarma Servizi represents 34 Companies, most of which are cooperatives in the intermediary distribution of drugs. Only societies whose members are pharmacy owners can be members of the association. COUNTRY LEGISLATIVE FRAMEWORK In Italy the sector laws are grouped in the legislative decree n. 219/06 (implementation of the EU directives in relation to the European rules concerning medicines for human use). It is a Consolidated Law containing the rules concerning all the phases of the life of a medicine. The Title VII regulates the medicine wholesale distribution.

DESCRIPTION OF THE SECTOR (FACTS & FIGURES) Medicine distribution is the makes the bridge between the medicine production and dispensation to the patient/customer. The actors of the pharmaceutical chain in Italy are: pharmaceutical manufacturers (about 230 companies), dealers/depositaries (about 130 companies), transport and logistic companies (about 5.000 companies), intermediary distributors (wholesalers, 245 companies), Pharmacies (17.000). ROLE OF THE CO-OPERATIVES IN THE SECTOR The great majority of co-operatives working in the pharmacy sector in Italy deals with the medicine distribution and are members of Federfarma Servizi. The market share covered by the members of Federfarma Servizi is of about 30%. STRENGTHS AND WEAKNESSES OF THE CO-OPERATIVE MOVEMENT IN THE PHARMACY SECTOR Regardless of the juridical form of distribution companies, the crucial problems of the sector derive from the rules issued to reduce the public expenditure on medicines. A weakness of co-operatives could be a lower investment capacity, due to the fact that they dispose of fewer capitals than the private enterprises. The major strength of co-operatives in the pharmacy sector is the equal treatment of the members, regardless of their profits; this element, if correctly perceived, generates a strong loyalty among the members, which sensibly strengthen the cooperative. THE MAJOR CO-OPERATIVE ENTERPRISES OF THE COUNTRY IN THE PHARMACY SECTOR These are the major services that co-operatives offer to pharmacies: Merchandising services (equipment layout, product layout, display, suggestions for an optimal use of the shop space), home-care (home delivery services for patients), training (training sessions), information services. One of the most relevant co-operatives working as medicine distributor is CEF (Cooperativa Esercenti Farmacia, co-operative of pharmacy shopkeepers); it works in the provinces around Brescia and it has an extremely high loyalty level among its members. FUTURE PRIORITIES AND STRATEGIES One of the priorities of the Italian co-operatives working in the pharmaceutical sector is to “build a network”, which means to support forms of integration to strengthen services already implemented and to create new ones.

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CO-OPERATIVES WORKING IN THE PHARMACY SECTOR PORTUGAL COUNTRY: Portugal ORGANIZATION: FECOFAR- Federation of Pharmaceutical Distribution Cooperatives BRIEF DESCRIPTION OF THE ORGANIZATION: FECOFAR represents 3 Cooperatives, Cofanor, Cooprofar and Udifar Group, which members are pharmacy owners. COUNTRY LEGISLATIVE FRAMEWORK After the National implementation of the EU directives concerning medicines for human use, new legislation about Pharmacy Ownership was recently introduced, such as: Decreto-Lei 307/2007, 31st August and Portarias 1427, 1428, 1429, 1430/2007, 2nd November a. Liberalise pharmacy ownership (not included Industry, Doctors and Wholesalers) until the limit of 4 pharmacies per person/company b. Pharmacies will be permitted to sell some medicines over the internet allowing the users to buy while staying at home. c. News Services at Pharmacy d. The present network Pharmacies will be enlarged. The minimum distance between Pharmacies will be reduced from the present 500m to just 350m and the minimum population to be served per Pharmacy will decrease from 4000 to 3500. DESCRIPTION OF THE SECTOR (FACTS & FIGURES) The actors of the pharmaceutical chain in Portugal are: pharmaceutical manufacturers (about 280 companies), wholesalers (7 full-line wholesalers companies, representing 89,44% of market share), Pharmacies (about 2800). ROLE OF THE CO-OPERATIVES IN THE SECTOR Most of National Cooperatives working in the pharmacy sector in Portugal are full-liner wholesalers, and are members of FECOFAR. The market share covered by cooperatives is about 42,98%, which 35% are FECOFAR’s members. STRENGTHS AND WEAKNESSES OF THE CO-OPERATIVE MOVEMENT IN THE PHARMACY SECTOR The legal cooperative model in Portugal, imposes strong restrictions on access to capital factor. The Cooperative wholesale distribution’s main propose has been the Independent Pharmacy. Concerning the recent legislation and the future changing perspectives (about pharmacy liberalization), this propose will be threatened. So, the Cooperatives must themselves adapt to this new reality, gathering their strengths on loyalty and sense of belonging. The globalization of markets emphasizes the need for partnerships to allow a global response. THE MAJOR CO-OPERATIVE ENTERPRISES OF THE COUNTRY IN THE PHARMACY SECTOR In Portugal there are concentration’s movements in the Cooperative Sector. Udifar was born from the merging of the two largest cooperatives (Codifar and União), with 18,06% market share. The former cooperatives Farbeira, Cofarbel and Farcentro have also merged and represent today Plural (non- member of FECOFAR) with 7,44%. The remaining cooperatives, Cofanor and Cooprofar have respectively, 8,32% and 9,16% of market share. FUTURE PRIORITIES AND STRATEGIES One of the priorities of the Portuguese cooperatives working in the pharmaceutical sector is to “build a network”, which means to support forms of integration and to gain market share and cover all national territory. Concerning the markets globalization and the importance of global response in this sector, FECOFAR is, among Italy, Turkey, France and soon Spain and Germany, member of SECOF- European Society of Pharmaceutical Cooperatives.

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CO-OPERATIVES WORKING IN THE PHARMACY SECTOR SWEDEN COUNTRY: Sweden ORGANIZATION: Coompanion BRIEF DESCRIPTION OF THE ORGANIZATION: Through Coompanions work and knowledge of cooperative enterprising – the form of enterprise of this century – we have helped many cooperative enterprises to start and to be successful. If you wants to start a cooperative enterprise Coompanion’s advisers can also help you with start-up and development. Our advice is free of charge. COUNTRY LEGISLATIVE FRAMEWORK In Sweden the phenomenon of public pharmacies started already in the beginning of the 16th century (1500). Until 1970, the Swedish pharmacies was managed by single pharmacists, who had special letter of privileges from the state. Since 1970, the state owned company Apoteket AB has been the only legal pharmacy in Sweden and has had monopoly on retailing of medicine since then.

DESCRIPTION OF THE SECTOR (FACTS & FIGURES) Apoteket AB is 100% owned by the state of Sweden and consists of around 900 pharmacies all around Sweden. In December 2006 the government submitted an investigation in order to re-regulate the pharmacy market and open it up for competition. The aim was to cancel the monopoly from January 2009, but the latest information rather states that this will be reality in mid 2009. ROLE OF THE CO-OPERATIVES IN THE SECTOR there are for the present no cooperative pharmacy in Sweden but an ongoing discussion and process for establishing a cooperative pharmacy movement. STRENGTHS AND WEAKNESSES OF THE CO-OPERATIVE MOVEMENT IN THE PHARMACY SECTOR there are for the present no cooperative pharmacy in Sweden THE MAJOR CO-OPERATIVE ENTERPRISES OF THE COUNTRY IN THE PHARMACY SECTOR there are for the present no cooperative pharmacy in Sweden FUTURE PRIORITIES AND STRATEGIES Coompanion (Cooperative Development Agencies in Sweden) together with SERUS has started an initiative of establishment of a cooperative pharmacy movement in order to establish the necessary knowlegde, platform and support for employers to start cooperative pharmacies when the monopoly end. Since we do not have any experience in this, we would very much appreciate any information, fact or results from cooperative pharmacy movement in Europe.

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CONTACT MIRKO NODARI COOPERATIVES EUROPE EUROPEAN HOUSE OF CO-OPERATIVES Ave Milcamps, 105 1030 Brussels Tel: (+32/2) 743 10 33 Fax: (32/2) 743 10 39 [email protected]

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