HAMBURG, Germany — If you’re looking for bobby pins, cheap lipstick or a protein bar, well, sorry, Americans, the German pharmacy can’t help you˳
It’s not the CVS, Rite Aid or Walgreens of home˳ Die Apotheke, as a pharmacy is known here, sells medications˳ German drugstores might have some high-end makeup (hypoallergenic, and for sensitive skin!), lotions or baby bottles˳ You’ll also definitely find magnesium supplements and vitamins˳
But they aren’t convenience stores stocking hair dryers, cellphone chargers, toys or groceries˳ This is the place you go for health, and for medicine˳
Germany’s health care system, with its negotiated low drug prices and robust universal insurance program, is hailed as a forward-looking model for the United States, which is hamstrung by ever-growing health care costs and leaves millions of people uninsured˳ Could we learn something from the pharmacies here, too?
Carrying that question in mind, I wandered into three north Hamburg pharmacies, all within a five- to 15-minute walk of one another˳
It turns out this is where the health landscape gets a little fuzzy˳ The pharmacies here offer a glimpse into how Germany’s drug pricing system, for the most part, keeps drugs relatively affordable for consumers˳ But while Apothekes present themselves as health-oriented hubs, they, like so much else in health care, are first and foremost businesses˳
Unlike in the United States, or even other European countries, German pharmacies must be owned by pharmacists˳ Most medications are prescription-based˳ And every purchase of medication — even something Americans consider “over-the-counter” like ibuprofen or cold medicine — requires a conversation with the pharmacist first, to make sure patients understand its effects˳
Economists here aren’t sure the German way is better˳
For starters, there’s no evidence that this specific requirement of a “talk” is somehow more efficient or leads to better health outcomes˳ While expert opinion is in some cases helpful, it can be superfluous, too˳ For instance, does someone with menstrual cramps or a muscle sprain need the pharmacist’s advice before getting ibuprofen?
“The benefits are meant to be safety,” said Tom Stargardt, a professor at the University of Hamburg who studies pharmaceutical economics˳ “The question is, ‘How much do you trust the consumer to be informed, to be able to judge the benefits of the drug?’”
Often, those conversations are quick and cursory˳ At La Vie Apotheke, on a crisp Friday morning, a pharmacy consultation for aspirin took about half a minute˳
German pharmacists have a strict monopoly on dispensing medicine, and that undermines the potential for price competition, economists said˳
Also, drugs here have a set price˳ A government-backed panel defines what public insurance plans will pay˳ Then, wholesalers can add a markup, defined by statute˳ Pharmacists can add one more, also legally prescribed˳ That’s it˳
It’s a window into the ethos of the national health care system˳ “Every prescription drug costs the same in every pharmacy,” Stargardt said˳ “The reason is that every person should have the same access˳ Whether they live in a rural area [or a city], they shouldn’t be punished in terms of prices˳”
Drugs here already cost less than in the United States˳ For instance, Humalog, a brand of insulin, lists a $55 price per vial, compared with an average of hundreds of dollars back home˳
And German patients typically don’t even see that expense˳ If a doctor prescribed the drug, insurance typically must cover it, meaning patients pay virtually nothing˳ (When a cheaper generic is available here, pharmacists are legally required to provide that version, unless the physician explicitly says otherwise˳) For insured Germans with chronic illnesses, the state caps health cost sharing at 2% of their household income˳
There are exceptions˳ One that’s in striking contrast to American health policy: Insurers aren’t required to cover birth control pills for women older than 22˳ Pharmacists said that expense can run up to 60 euros per month — about $67 U˳S˳ dollars — depending on the brand a woman gets˳ Under the Affordable Care Act, American insurance plans must cover contraception as a form of preventive medicine, with no cost sharing˳
And, pharmacists and economists alike will acknowledge, even with the health halo effect German pharmacies enjoy, die Apotheke and the Walgreens have a common motivation˳
At Lillen Apotheke, in Hamburg’s upscale Eppendorf neighborhood, a pharmacist acknowledged that stores like hers sell skin lotion, high-end nail polish (allegedly better for your fingers) or pharmacy-exclusive mascara (also hypoallergenic) not primarily for health reasons — but rather, to drive profits˳
Take the lozenges for sale˳ They’re sandwiched between licorice candies (of which sugar is the first ingredient) and fruit gummies made specially for pharmacies, which claim to have natural vitamins, too˳ And, of course, these are positioned next to the chocolate˳
What’s the health value there?
“Oh˳ That’s just for fun,” the pharmacist said˳
Shefali Luthra is currently reporting from Germany as a 2019 Arthur F˳ Burns Fellow˳ The fellowship is an exchange program for German, American and Canadian journalists operated by the International Center for Journalists and the Internationale Journalisten-Programme˳
Shefali Luthra: @Shefalil
