THE PHAR­MACY BUSI­NESS

The UB Post - - FRONT PAGE - Trans. by B.DULGUUN

You can find a phar­macy on al­most ev­ery street in Ulaan­baatar. While the ac­ces­si­bil­ity to phar­ma­cies in Mon­go­lia is rel­a­tively good, their sales and stor­age of prod­ucts are not su­per­vised as much as they ought to be.

Ac­cord­ing to the Ulaan­baatar Health Of­fice, there are 990 phar­ma­cies op­er­at­ing in the cap­i­tal and only 189 of them are con­sid­ered first-rate, or up to stan­dard, while the rest are sec­ond-rate. Es­pe­cially around ger ar­eas and the out­skirts of the city, peo­ple are able to buy any drug with­out a pre­scrip­tion from a doc­tor. In some phar­ma­cies, the phar­ma­cist be­hind the counter rec­om­mends medicines based on their ex­pe­ri­ence of which medicines peo­ple typ­i­cally buy for a par­tic­u­lar ail­ment. Most phar­ma­cists have no for­mal knowl­edge or cer­ti­fi­ca­tion of phar­ma­col­ogy.

The Na­tional Coun­cil of Stan­dard­iza­tion re­vised the Gen­eral Re­quire­ment for Phar­macy (MNS 5260:2015) on Novem­ber 26, 2015, based on rec­om­men­da­tions by the World Health Or­ga­ni­za­tion and amend­ments to the Na­tional Medicines Pol­icy and Law of Medicines.

The fol­low­ing rec­om­men­da­tions were re­flected in the re­vised Gen­eral Re­quire­ment for Phar­macy:

To use this stan­dard as cri­te­ria for ac­cred­i­ta­tion process

Add a def­i­ni­tion for clin­i­cal phar­macy ser­vices

The di­rec­tor of the cen­tral phar­macy in a prov­ince must live in the re­spec­tive vicin­ity

A hospi­tal phar­macy must be man­aged by a phar­ma­col­o­gist spe­cial­ized in phar­macy man­age­ment and clin­i­cal phar­macy

A phar­macy must have sep­a­rate sec­tions for pre­scrip­tion drugs and over-the-counter drugs

Cor­ri­dors and stairs con­nected to a phar­macy must be wider than one me­ter and shelves and other fur­ni­ture must not be placed in this area

Phar­ma­cies must sub­mit op­er­a­tions re­port

Un­for­tu­nately, most of these cri­te­ria are dis­re­garded and not im­ple­mented. Large phar­ma­cies such as Monos, Asia Farm, Tavin Us, Mon­gol Em Im­pex Con­cern, and Khur­men are the only ones close to the stan­dard. How­ever, they’re lack­ing in some ar­eas as well. For ex­am­ple, the ma­jor­ity of their branches lo­cated near ger ar­eas do not meet re­quire­ments set for phar­macy build­ings.

Ac­cord­ing to ex­perts, some of their phar­ma­cists ne­go­ti­ate with cus­tomers and sell medicine that has the same ef­fect as a pre­scribed drug. Many phar­ma­cies are lo­cated on the first floor of an apart­ment build­ing within a small area. There have been re­ported in­stances where a phar­ma­cist couldn’t read a doc­tor’s pre­scrip­tion and gave a wrong drug.

Ex­perts noted that op­er­at­ing with a vague “phar­macy” la­bel in­stead of a spe­cific la­bel vi­o­lates the law. It wouldn’t be an ex­ag­ger­a­tion to say that nowa­days, phar­ma­cies op­er­ate purely for profit, not for the pub­lic health or well-be­ing.

MONGOLIAN PHAR­MA­CIES FAIL TO MEET

STAN­DARDS

Spe­cial­ist from the Ulaan­baatar Health Of­fice D.Bold­baatar, who man­ages is­sues re­lated to the qual­ity, sup­ply and su­per­vi­sion of medicine, medic­i­nal equip­ment and phar­ma­cies, gave a brief in­ter­view about phar­ma­cies in Mon­go­lia.

The Ulaan­baatar Health Of­fice is­sues per­mits re­quired for op­er­at­ing a phar­macy. How many per­mits has the of­fice granted since Jan­uary?

At present, 990 phar­ma­cies are op­er­at­ing in Ulaan­baatar with per­mits pro­vided by our of­fice. Out of these phar­ma­cies, 189 are first-rate and 801 are sec­ond-rate. Since Jan­uary, we have given per­mits to 97 more phar­ma­cies. Per­mits are granted af­ter re­view­ing the lo­ca­tion, its de­mand, and whether it meets stan­dards on phar­ma­cies.

There’s a stan­dard which spec­i­fies that there needs to be a phar­macy for ev­ery 5,000 peo­ple and that phar­ma­cies have to be at least 500 me­ters apart from one another. Is this stan­dard be­ing en­forced?

The Stan­dard on Phar­macy was re­newed in 2015. The stan­dard about hav­ing a phar­macy for ev­ery 5,000 peo­ple and their dis­tance be­ing at least 500 me­ters isn’t be­ing fol­lowed right now be­cause the Au­thor­ity for Fair Com­pe­ti­tion and Con­sumer Pro­tec­tion com­plained to have the article re­moved as it vi­o­lates two to three ar­ti­cles in the Law on Con­flicts and gives an ad­van­tage to an or­ga­ni­za­tion. In other words, peo­ple can run a phar­macy as long as they have a stan­dard build­ing, is equipped with nec­es­sary equip­ment and de­vices, and man­aged by a pro­fes­sional. How­ever, we’re more sup­port­ive of those try­ing to open a phar­macy in ger ar­eas lo­cated in the out­skirts of the city.

Phar­ma­cies pro­vide ser­vices like ordinary stores. An­tibi­otics are sold as if they’re candy. Are you do­ing any­thing to su­per­vise the sales of phar­ma­cies?

There’s no prob­lem if phar­ma­cies are fol­low­ing the Gen­eral Re­quire­ment for Phar­macy (MNS 5260:2015). It sets spe­cific stan­dards for the qual­ity of med­i­cal equip­ment and ser­vices of phar­ma­cies. For ex­am­ple, a sec­ond-rate phar­macy must be at least 24 square me­ters in size and have one or two phar­ma­cists and a phar­ma­col­o­gist, ac­cord­ing to the Gen­eral Re­quire­ment for Phar­macy.

PRIC­ING AND STOR­AGE IS­SUES

Have you ever won­dered why two to three phar­ma­cies on the same street sell the same prod­uct for dif­fer­ent prices? Let’s take Monos Phar­macy for ex­am­ple. The price of Vita­grip tea against cold dif­fers de­pend­ing on the lo­ca­tion of each branch of Monos Phar­macy. They’re sold for a slightly higher price near apart­ment com­plexes and for lower prices near ger ar­eas. Even vi­ta­min C sup­ple­ments are sold for dif­fer­ent prices at two phar­ma­cies lo­cated right across the street from one another. The first phar­macy charged 750 MNT per pack of vi­ta­min C, while the sec­ond charged 1,000 MNT. When en­quired about the dif­fer­ence in price, the phar­ma­cists at the counter ex­plained that it was re­lated to their man­u­fac­ture date.

More­over, the same sup­ple­ments are sold for al­most dou­ble the price at phar­ma­cies in­side hos­pi­tals. This is the re­al­ity for ordinary vi­ta­min C sup­ple­ments, which we can buy any day. Based on this, the gov­ern­ment clearly needs to have a pol­icy for en­sur­ing fair prices of med­i­ca­tions in the fu­ture.

Some phar­ma­cies are said to be cheaper than oth­ers mainly be­cause the med­i­ca­tion has been kept for a longer time, or are near­ing the ex­pi­ra­tion date. When phar­ma­cies aren’t able to meet the ba­sic build­ing re­quire­ments, it’s dif­fi­cult to con­vince our­selves that they prop­erly fol­low stan­dards on the stor­age of med­i­ca­tions and other prod­ucts.

Most peo­ple know that drugs can lose some of their po­tency over time, but what is less un­der­stood is that the sub­stances that re­main as drugs break down can ac­tu­ally be harm­ful. Hence, al­ways re­mem­ber to check the la­bels, es­pe­cially ex­pi­ra­tion dates, on med­i­ca­tions.

Doc­tors ad­vised that when drugs aren’t achiev­ing the ex­pected re­sults, pa­tients should talk to their health­care providers about the pos­si­bil­ity of hav­ing a prob­lem with the drug it­self, not their re­sponse to it. Peo­ple should be es­pe­cially care­ful with com­pounded prod­ucts, like when a par­ent crushes a tablet and adds wa­ter to make it easy for chil­dren to swal­low, as they could have be­come less ef­fec­tive than in their orig­i­nal form.

Med­i­ca­tions are spe­cial prod­ucts that re­quire spe­cial stor­age, but phar­ma­cies don’t seem to re­al­ize it or are sim­ply un­able to en­sure proper stor­age of med­i­ca­tions. These prob­lems need to be ad­dressed and re­solved be­fore a ma­jor in­ci­dent oc­curs. Phar­ma­cies might be pri­vate companies but their op­er­a­tions need to be reg­u­lated and su­per­vised so that med­i­ca­tions are safer and peo­ple don’t have to worry about the qual­ity of med­i­ca­tions when buy­ing them from a nearby phar­macy. These is­sues with phar­ma­cies shouldn’t be taken lightly as they could have tremen­dous health reper­cus­sion.

A phar­macy in Ulaan­baatar

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