GUIDE TO THE ROLE OF THE PHARMACY
For medicines and pills, lotions and potions, not to mention expert medical advice, look no further than the pharmacies of France, as Kate McNally explains
Cover story This month, Kate McNally explains why pharmacies are an important part of the health care system in France
ittle havens of beatitude lie in wait behind the flashing green neon cross on the streets of France. Shelves are lined with more potions and lotions than you ever knew existed, in delicate, mostly white packaging, making you feel healthier just by looking at them. Kindly pharmacists and their assistants (also in white) wait to listen and advise in a balmy calm that immediately soothes all your senses.
Welcome to the world of the French pharmacy – a boutiquestyle chemist as far removed from the likes of Boots and Superdrug as foie gras is from Spam. But these oases in the desert of ill-health are under threat. The French government has outlined proposals allowing the sale of non-prescription medicines, such as paracetamol and cough mixture, in supermarkets. While this is accepted practice in the UK, French pharmacies play a key role at the tail-end of the sophisticated French health care system which, claim the pharmacists, would be undermined by opening up the sector.
To understand this better, let’s take a closer look at their role.
There are more than 23,000 pharmacies across France, even most rural villages have one. The network is made up of small independent pharmacies owned by qualified pharmacists who will have studied six to seven years to obtain their degree. They take the same foundation training as trainee doctors and other health care clinicians, and in the final year must write a thesis on a specialist subject.
French pharmacists believe their role is as much to advise and educate their customers as it is to supply medicines. They generally have regular contact with their customers, especially in smaller towns and villages, and in many cases are the first port of call for advice on ailments, before doctors, such is the level of trust and respect they command. An important part of their training is centred on what is called ‘ l’éducation thérapeutique du patient’ (patient therapeutic education), which is all about educating people in terms of raising awareness of health issues and diseases, ensuring appropriate use of medicines, and recognising symptoms and side effects.
CESPHARM (the Comité d’Éducation Sanitaire et Sociale de la Pharmacie Française) supports them in this mission, disseminating information and organising campaigns (for example, this summer, how to stay well during a heat wave).
INSIDE THE PHARMACY BEHIND THE COUNTER…
French pharmacies, like a French person’s medical cabinet, are well stocked. Whatever the ache, pain or rash – ears, throat, feet, eyes, stomach – you name it, the pharmacist will whisk a strangenamed remedy out of the seemingly endless behind-thecounter drawers. And there’s the rub. You will have to ask for the medicine, as French pharmacists, being the professionals they are, like to interact with the customer and quite possibly ask a few questions to make sure they are giving you the very precise treatment needed for your specific problem. Which means you will need to know a minimum of French or learn some of the basic brand names – for example Doliprane is paracetamol, Advil is ibuprofen, Biseptine is antiseptic cream – and you will have to ask out loud for certain products that in the UK you prefer to grab swiftly and discreetly from the shelf for yourself!
This approach also means that on occasion you need to be a patient with patience. It is not uncommon for a fairly lengthy consultation to take place, though there is often an assistant to take care of the more straightforward purchases who will come to the rescue.
IN FRONT OF THE COUNTER…
While medicines account for around 80% to 90% of sales, French pharmacies also sell a wide range of natural health and beauty products, usually enticingly displayed in the open free-serve space. These products will always have a beneficial health element, such as organic, natural or therapeutic ingredients, or protective properties. So while you will find lip balm and lavender oils, you won’t find mainstream cosmetics or false nails. Equally, the pharmacist will know the products on sale and have verified their natural composition or therapeutic benefit.
Most pharmacies also stock a range of animal health care products, including flea collars, vitamins and tic treatments, which are usually slightly cheaper than they would be at a veterinary surgery.
WHAT YOU PAY FOR
Although the pharmacist is usually capable of advising which medicine you need, he or she may well suggest you go to the doctor in order to obtain a prescription. Most medicines are entirely or partially free with a prescription.
This payment method works through what is called the carte vitale system – essentially a national health card carrying your personal details, which is the gateway to the French health care system. It is arguably the first administrative piece of paper (or plastic) you should apply for on moving to France (apply at the local CPAM – Caisse Primaire d’Assurance Maladie – where you can find out what to do).
In the pharmacy, simply hand over the prescription and your carte vitale, and quite likely you won’t have to pay a penny. You may also be asked on the first visit to a pharmacy for details of your mutuelle – this is the top-up private insurance that most French people, and those living in France, take out to cover some, or all, of the remaining percentage to be paid for medicines and health care, or to pay for treatments that aren’t included in subsidised French health care. Details of your mutuelle
French pharmacists believe their role is as much to advise and educate their customers as it is to supply medicines
are entered into the system and you won’t normally be asked for them again on subsequent visits. You will pay up front any costs not covered by the state, and are reimbursed a few days later directly into your bank account by your mutuelle.
PRICING AND MARGINS
Medicines are strongly subsidised by the French welfare state, which some believe leads to an over-readiness on both the part of patients to ask for them, and doctors to prescribe them. Pharmacists see their role at the end of the line as one of controlling supply and keeping a check on patients’ use of medicines – as mentioned above, their relationship role often means they are better placed to spot developing patterns or problematic side effects.
The French state sets the price of prescription medicines, and at the start of 2015 raised the payment made to pharmacists per box of medicine from €0.53 to €0.80, rising to €1 from 2016. In return, pharmacies have agreed to aim to increase the sale of generic products, as opposed to branded products, to 85%, and to lower the margins they take on specific medicines sold (these follow a sliding scale downwards according to the price of the
Before leaving the UK, apply for the S1 form which covers your health costs in France on a temporary basis
product). They have also undertaken to add instructions relevant to individual patients on how to administer the medicines or drugs, should patients have concerns.
With the French government aiming to reduce the health care budget, which will inevitably have a knock-on squeeze on medical supplies, the FSPF (Fédération des Syndicats Pharmaceutiques de France) were happy to reduce margins – which are greater for more expensive medicines likely to be more widely hit by cuts – for the guarantee of a higher set payment on all medical products.
When it comes to pricing non-medical products, pharmacies are free to set their own margins and therefore have more control over potential revenues from this sales platform. A careful selection of the right cosmetic and health products to suit a pharmacy’s primary customer profile can significantly boost profits. It no doubt helps to explain why these products are displayed in a manner that makes the sight and smell of them so difficult to resist!