Facts and Figures 2016 pharmasuisse

Facts and Figures 2016 pharmasuisse

The role of pharmacists illustrated by a sample of 1,000 people 250 people are healthy Initial contact (selfcare) Prevention (e.g. vaccination, colorectal cancer screening) 750 people have a health problem within three months Initial contact Consultation and treatment (minor ailments and health problems) Triage (possible referral to physician or emergency ward) 250 people see a physician directly Patient compliance Patient safety 50 people could also receive treatment in a pharmacy Source: White KL, Williams TF, Greenberg BG. The ecology of medical care. N Engl J Med. 1961;265:885-92.

The pharmacies service range Initial consultation Prevention checks Provision of medicines Vaccination Consultation medicines Patient compliance Aids Medicine chest Pharmaceutical care in nursing homes Production of medicines Checking Smoking cessation The pharmacy: Easily accessible services Customer-friendly opening hours No appointment necessary Friendly and personal service Central locations

Healthcare turnover by service providers 5.7 % Pharmacies incl. cost of goods of 64.3 % ( 4.0 bn) 8.5 % Others ( 6.0 bn) 17.3 % Social-medical institutions ( 12.3 bn) 36.4 % Hospitals ( 25.9 bn) Total 71.2 bn 32.1 % Outpatient provider ( 22.9 bn) Source: Swiss Federal Statistical Office, healthcare costs according to service providers 2014

Compulsory health insurance (CHI): gross benefits according to cost categories 25 % 20 % 15 % 10 % 5 % 0 % 23.3 % 7.0 bn 23.2 % 6.6 bn Physician outpatient 22.8 % 6.9 bn Hospital inpatient 23.3 % 6.7 bn 16.7 % 5.0 bn 17.5 % 5.0 bn Hospital outpatient 11.5 % 3.5 bn 11.4 % 3.3 bn Medicines pharmacy 6.2 % 1.9 bn 6.2 % 1.8 bn Medicines physician 19.5 % 5.9 bn Others 18.5 % 5.3 bn 2015 2014 2015 2014 thereof LOA * 256 m thereof LOA * 257 m Distribution share ** 908 m Distribution share ** 889 m 2015: Total 30.1 bn 2014: Total 28.6 bn * LOA: service-based remuneration, tariff agreement between health insurers and pharmacies. ** Source: IMS Health Switzerland, estimation by pharmasuisse Source: Federal Office of Public Health; Compulsory health insurance (CHI) 2015 (STAT KV 15) and 2014 (STAT KV 14)

Pharmacies and physicians, dispensation of medicines and CHI benefits according to canton 517 247 VD 353.84 JU 39 19 339.24 134 57 NE 337.94 140 69 FR 298.57 BS 223 75 393.63 SO197 27 323.67 BL 231 48 354.76 822 169 BE 327.50 353 120 AG 281.48 259 37 LU 276.59 24 3 OW 271.13 SH 63 13 276.57 ZH 312.52 22 3 NW 85 15 ZG 265.12 263.10 1,113 236 16 2 UR 246.98 90 17 SZ 280.76 166 24TG 275.56 331 54 SG 278.75 GL 31 2 283.37 37 6 AR 276.86 11 1 AI 235.30 167 44 GR 263.16 Dispensation at pharmacies (Rx) Mixed form (MF) Self-dispensation (SD) 407 174 GE 384.06 213 120 VS 306.44 262 192 TI 357.53 Source: Swiss Federal Statistical Office, monitoring of cost development in health insurance, Federal Office of Public Health, pharmasuisse 2015 2014 General practitioners (general practitioners as well as 5,953 5,945 physicians in the outpatient sector) Pharmacies 1,774 1,764 Gross benefits of compulsory health insurance (CHI) per insured person 2015 (in )

Price index medicines and healthcare services 120 110 100 90 80 70 5 4 3 2 Hospital services Outpatient services Physician services Healthcare 60 50 2000 2002 2004 2006 2008 2010 2012 2014 1 Medicines Basis 2000 = 100 Source: Swiss Federal Statistical Office, Swiss consumer price index, conversion basis 2000 pharmasuisse

Cost development of Medicines subject to LOA 135 130 125 120 115 110 105 100 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 4 3 2 1 Sales volume in packages Invoiced amount Earnings from dispensation of medicines A, B of specialities list (SL) Earnings Federal Office of Public Health price system net Indicators for dispensation of prescription medicines at the expense of compulsory health insurance (CHI) by pharmacies, basis 2005 = 100 * LOA = service-based remuneration, tariff agreement between health insurers and pharmacies. Source: Medicpool, calculations pharmasuisse

Operating revenue allocation according to financial key figures 8.2 % Other operating costs 7.0 % EBITDA 20.4 % Personnel costs Operating revenue allocation minus cost of goods 7.0 % Others 5.5 % Office and administrative expenses 10.6 % Rental expense 57.3 % Personnel costs 19.6 % EBITDA 64.3 % Cost of goods Source: Survey of rolling costs in pharmacies (RoKa) 2015 (fiscal year 2014)

Range of cost reductions by pharmacists Increasing patient compliance Officially mandated price reductions Relieving general practitioners Pharmaceutical care in nursing homes LOA tariff agreement Relieving hospital emergency wards Substitution with generics Quality circles

20,145 employees in pharmacies (medical- and health professions) 1.9 % Pharmacy business assistants (388) 5.2 % Other sales personnel (1,041) 8.9 % Other employees including chemists (1,799) 14.4 % Trainees (2,893) 41.9 % Pharmacy assistants (8,450) Health professions Medical professions (academic) 16.8 % Employed pharmacists (3,387) 9.5 % Managing pharmacists (1,905) 1.4 % Pharmacists in their studies (282) Source: Survey of rolling costs in pharmacies (RoKa) 2015 (fiscal year 2014)

Greatest challenge of the chronically-ill: patient compliance 4 costs Patients recognise necessity of treatment Take medicines when symptoms are acute Take medicines Patients have reservations about medicines Conviction Patients are convinced of the effects of medicines 4 costs 4 costs Do not take medicines Patients trivialise necessity of treatment Take medicines when they feel like it

Patient compliance reduces costs 6.5 million 20 % costs 1.2 million compliant chronically-ill patients 1 costs 2.2 million chronically-ill patients 80 % costs 1 million non-compliant chronically ill patients 4 costs Population in Switzerland Compulsory health insurance (CHI) Patient compliance Cost comparison Source: Swiss Health Observatory Obsan, Federal Office of Public Health

Medication costs with and without quality circles 190 180 170 160 150 140 130 120 110 100 174 177 181 179 180 174 176 174 175 170 167 162 143 139 131 141 139 137 137 138 138 136 122 130 133 132 132 129 133 133 127 115 1999 2001 2003 2005 2007 2009 2011 2013 2015 Control group without quality circle Quality circle pharmacists-physicians (example Fribourg-Pionniers) Basis 1999 = 100 Source: Prescription data OFAC 2016

Trends of medication costs in nursing homes with and without pharmaceutical care 1.2 1.1 1.0 0.9 Nursing homes without pharmaceutical care Nursing homes with pharmaceutical care 2009 2010 2011 2012 2013 2014 Solid line: average value from analyses compared to nursing homes without pharmaceutical care, reference year 2009 Dashed line: trends Source: Helsana, report Pharmaceutical Care in Nursing Homes of 16/06/2016

Price composition of medicines subject to prescription and covered by health insurance Competence Turnover Beneficiaries Health insurers and pharmacies Federal Office of Public Health Federal Office of Public Health and pharmaceutical industry 8.5 % LOA 18.2 % fixed margin 7.3 % %-margin 66.0 % ex-factory price of manufacturer Pharmacy Tariff agreement on service-based remuneration Wholesalers and pharmacies Personnel, infrastructure Capital costs, warehousing and outstanding receivables Transport, wholesale Pharmaceutical industry Research and development Marketing and approval Profit margin Distribution share Retail price of medicines Total costs Source: pharmasuisse

Cost allocation for medicines of varying prices 1.21 4.00 0.15 3.38 4.00 0.41 8.17 8.00 0.98 14.99 12.00 1.80 136.53 16.00 16.38 1,224.73 60.00 85.73 Novalgin (Price category 1) Amoxicillin Spirig HC (Price category 1) Candesartan Sandoz (Price category 2) Keppra (Price category 3) Abilify (Price category 4) Rebif (Price category 5) Revlimid 7,619.66 240.00 (Price category 6) 0 % 10 % 20 % 30 % 40 % 50 % 60 % 70 % 80 % 90 % 100 % Ex-factory price () Surcharge per package () Price-related surcharge () Source: pharmasuisse

Development of sales volume per price category 900 800 6 Price category 6 700 600 500 400 300 200 100 5 1 3 2 4 Price category 5 Price category 1 Price category 3 Price category 2 Price category 4 0 2007 2008 2009 2010 2011 2012 2013 2014 2015 Basis 2007 = 100 Source: IMS Health, calculations pharmasuisse

Pharmacy density compared with other European countries per 100,000 inhabitants 28 Portugal 39 Ireland 47 Spain 22 The UK 33 France 44 Belgium Denmark 12 6 The Netherlands 22 Switzerland 25 Germany 16 Austria* 30 Italy 14 Sweden 30 Poland 36 Slovakia 38 Estonia 40 Romania 51 Bulgaria 31 = European average * state allocation Source: ABDA Deutschland, 2016 51 Malta 87 Greece 55 Cyprus