Dispensing and Variabilities in Pricing of Headache OTC Medicines by Community Pharmacies in a German Big City: A Simulated Patient Approach

Abstract

Background In Germany, over-the-counter (OTC) medicines for self-medication may only be dispensed by community pharmacies (CPs). From the customer’s point of view, “adequate” counseling includes not only the recommendation of medicines that meet guidelines, but ao the dispensing of low-priced medicines. This is all the more important in Germany against the background of free pricing and a lack of obligation to display prices. The aim was to analyze the dispensing and possible price variability of OTC medicines for headache. Methods The cross-sectional design of the study based on the simulated patient methodology (SPM) included all 42 CPs of the German big city Potsdam and used eight trained simulated patients (SPs). Between October and December 2020, four different SPs visited each CP four times with two almost identical scenarios with the demand for a medicine for headache. Results All 168 planned visits were successfully completed and ibuprofen (60.1%) was dispensed most frequently. Across all dispensed medicines, prices varied from €0.93 to €9.97 (∆ 972%; median €3.46 [interquartile range (IQR) €2.25]). For repeated dispensing of the same CPs, the price variability was a maximum of €8.77. In addition, packs with ≤10 tablets were dispensed in 47.6%, with 11 to 20 tablets in 50.6%, and with >20 tablets in 1.8% of visits. Conclusion Increasing price transparency and strengthening price competition could make it easier for customers to access OTC medicines according to their personal needs.

The Quality of Counseling for Headache OTC Medications in German Community Pharmacies Using a Simulated Patient Approach: Are There Differences between Self-Purchase and Purchase for a Third Party?

“…Medication was dispensed at all visits, with exactly one medication dispensed per visit (168 medications in total). The dispensing behavior (active ingredient, package size, original vs. generic drug, single drug substance vs. fixed-dose combination, recommended vs. not recommended drug, price) and its economic impact were published elsewhere [ 27 ].…”

“…The BAK tool for self-medication for headache [ 18 ] formed the basis for the two scenarios (see Tables 1 and 2 ) [ 27 ] and for the assessment form (see Table 3 ). The two scenarios are designed as “normal” scenarios so that the limits of self-medication, that is, towards a possible recommendation of a physician visit, should not be exceeded by the pharmacy staff.…”

“…Regarding possible differences in the quality of counseling, numerous possible influencing factors have already been investigated worldwide for various indications, such as person of the customer [ 25 ], gender of the customer [ 26 ], age of the customer [ 27 ], type of request (symptom-based vs. medication-based) [ 28 ], time of request [ 29 ], queue at the pharmacy visit [ 30 , 31 ], professional group of the pharmacy staff [ 32 ], age of the pharmacy staff [ 32 ], gender of the pharmacy staff [ 33 ], number of questions asked of the pharmacy staff [ 34 ], pharmacy location [ 25 , 35 ], socioeconomic status of the pharmacy location [ 36 , 37 ], pharmacy type [ 35 , 37 ], pharmacy size [ 36 ], CP quality certificate [ 37 ], private counseling area [ 26 ], types of medication [ 29 ], and price of dispensed medicines [ 38 ].…”

Oral emergency contraception practices of community pharmacies: a mystery caller study in the capital of Germany, Berlin

“…Thus, in a medium-sized city with 84 on-site visits in 21 CPs each, these two determined prices, which also included both originals and generics, from €2.36 to €8.49 (Δ €6.13, 260%) [ 68 ] and from €2.28 to €10.98 (Δ €8.70, 382%), respectively [ 69 ]. A recent German SPM study on not chronic tension-type headache in a large city with 168 on-site visits to 42 CPs even found prices also including originals and generics ranging from €0.93 to €9.97 (Δ €9.04, 972%) [ 70 ]. In contrast, the most recent international SPM studies found lower, but also in some cases even noticeably higher price ranges for oral EC, although restrictively the study sites of the following studies in Brazil and the Democratic Republic of Congo show a different price level in comparison.…”

“…For pricing, in fact, no single German study is known. However, at least three German SPM studies for other OTC medicines have already shown that price ranges also exist within geographically narrowly defined areas (e.g., for cities) [ 68 – 70 ].…”