of Neuchâtel, 14.08.2020
Questions asked during the interview:
• Pouvez-vous rapidement vous présenter et parler de votre parcours professionnel ?
• Quand est-ce que le projet pilote a-t-il commencé ?
• Avez-vous déjà reçu un retour des pharmacies participantes au projet pilote ? • Quels ont été les critères de sélections pour participer au projet pilote ?
• Est-ce que vous pensez qu’un nouveau système de distribution pourrait être implémenté en Suisse ?
• Comment est-ce que le projet pilote est-il conduit ?
• Le prix des antibiotiques facturé est-il adapté si certains comprimés sont enlevés ?
• Voyez-vous des inconvenants dans ce genre de système de distribution à l’unité ?
• Est-ce que vous pensez que ce genre de système de distribution pourrait être intéressant pour un autre type de traitement ?
• Avez-vous observé une certaine tendance entre les produits de marque et les génériques ces 20 dernières années ?
• Que pouvez-vous dire du marché des génériques ?
• J’ai récemment lu un article parlant d’une rupture de stock de certains médicaments et antibiotiques à l’échelle international, et que la majorité des antibiotiques étaient produits au même endroit, qu’en pensez-vous ?
• Il y a une croyance populaire que les médicaments retournés sont envoyés dans divers pays du tiers monde, est-ce correct ?
Translated summary of the interview conducted in French
SJ: Sophie Janett VdB: Virginie de Biase
SJ: Could you quickly introduce yourself?
VdB: I started working as a pharmacist 20 years ago and is now the cantonal pharmacist for the canton of Neuchâtel.
SJ: When did the pilot project start?
VdB: The project started mid- March but got interrupted from mid- April to mid-June due to COVID-19.
SJ: Have you already gotten a feedback about how the pilot project went? VdB: A check-in with the participating pharmacies will be done end of August. SJ: What made the canton of Neuchâtel to be selected for the pilot project?
VdB: After the parliamentary motion passed, Zug and Neuchatel were candidates for the pilot project, Zug got rejected as they dispense antibiotics through doctors and the unpacking and preparing of an antibiotic prescription was considered to be done at manufacturing level which doctors are not.
SJ: do you think a new distribution system for antibiotics could be implemented in Switzerland?
VdB: A change in the distribution system would result in massive changes for the cantons, especially for the 15 cantons dispensing through doctors.
SJ: How is the pilot project carried out?
VdB: To comply with the leaflet obligation, the pharmacies hand out the antibiotics in their original packaging. They (the pharmacists) remove the excess antibiotics only if the blister has perforations, if not the excess antibiotics are not removed. Mainly to avoid confusing the patient during his treatment.
SJ: is there any price adaptation made if pills are removed?
VdB: The price stays the same even If less pills are handed out as the current pilot project is only to test feasibility. The goal of this motion is mainly to combat AMR not to reduce waste from an economic point of view. A study in France showed that dispensing antibiotics differently than in blisters was feasible but not interesting from a cost and time point of view for pharmacists.
SJ: do you see any weak points for this pilot project, or for this type of distribution system?
VdB: Individually preparing each prescription is very time consuming for the pharmacies and the waiting time for the patient is high
SJ: would you see this distribution system currently tested to be economically interesting for another kind of drugs?
VdB: This distribution system could be financially interesting for expensive treatments like oncology. Antibiotics do not represent a high cost for insurance companies compared to oncological treatment.
SJ: have you seen any tendency change between branded and generic drugs during the past 20 years working as a pharmacist?
VdB: A reversed tendency was observed regarding the branded and generic preferences of the Swiss population. When I started as a pharmacist, most patients refused generics and only used branded medication, now it is the opposite where mostly generics are handed out to the patients. Branded medication is handed out only very rarely and most often it is when the inactive substance is different between the generic and the branded version.
SJ: what can you say about the generic drug market?
VdB: A lot of pharmaceutical companies are the one producing a generic medication once the patent is expired by just changing the name of the medication. if the generic is a new generic, the price difference can be as much as 50 percent but sometimes the price is the same.
SJ: I have recently read about a worldwide drug shortage and that most antibiotics are produced in the same place, what can you say about that?
VdB: There is a major problem with drug shortage in Switzerland for the past few years. The problem is the globalization and outsourcing, resulting in many medications to be produced in very few production sites in India and China. If a problem occurs at their production site, many countries suffer from drug shortage as they highly depend on very few suppliers. Switzerland is a small country and their medication orders are relatively small too compared to other countries, which results in Switzerland’s medication orders not to be treated in priority compared to other countries which a much higher medication order.
SJ: there is a popular belief that unused returned drugs are sent to third world countries, is that true?
VdB: Unused pills used to be sent to third world countries in the past but not anymore. The pills that are brought back to the pharmacies, that have not been used by the patients are all destructed and none of it is sent to third world countries. This is to avoid putting these third world countries population in danger as pharmacists do not know how the pills were stored at the patient’s home. NGO’s and other associations buy the medication at a much lower price directly from the pharmaceutical companies to send them to third world countries.