Pharmacies for Patients and Chains: When Municipalities Speak with Big Business

• A chain of pharmacies owned by an American investment fund has signed letters of intent with small municipalities, declaring actions to improve access to medicines
• The mayors of some of the letter signatories have begun actively calling for changes to the provisions of the Pharmaceutical Law, those that most burden pharmacy chains.
• Critics of the regulations cite data on thousands of closed facilities, but the Ministry of Health and the pharmaceutical inspection consider these figures to be a biased narrative.

"We are calling for an urgent overhaul of the law on pharmacies, which undermines the health and rights of patients. A short and simple deregulation bill will be enough to remove the most harmful and unconstitutional provisions pushed through as 'Pharmacies for pharmacists'. Let's give pharmacies back to patients, not pharmacists!" - this is an excerpt from the appeal that Barbara Mazurczyk , mayor of the Miłki commune (Warmian-Masurian Voivodeship), sent to Prime Minister Donald Tusk .

"As many as three thousand pharmacies have been closed in Poland over the past few years due to market overregulation," Jakub Wierzbicki , mayor of the Perlejewo commune (Podlaskie Voivodeship), pointed out in an interview with TVN. At the same time, he participated in a debate organized by the Employers of Poland (whose members include the pharmacy chains Gemini , DOZ , Ziko , and Dr. Max ).

What connects these two municipalities, nearly 200 kilometers apart? In April of this year, the mayors of both signed letters of intent with the Gemini pharmacy chain, owned by the American fund Warburg Pincus . The same fund that threatened Poland with a lawsuit to the International Court of Arbitration for adopting regulations restricting the expansion of large pharmacy chains in Poland ( the so-called Pharmacy for Pharmacists, hereinafter referred to as the AdA ).

In short: the AdA has introduced a requirement that only pharmacists, with a maximum of four per person, receive new pharmacy operating permits. There are also restrictions on the location of pharmacies (the location depends on the population in a given town and the distance from another pharmacy). The development of pharmacy chains is still possible, but only under a franchise model, with an independent pharmacist at the helm. This is a disadvantage for large companies that would like to conquer the market without any restrictions.

In a press release from Gemini, we read that representatives of the company's management board "expressed their willingness to develop pharmacies in municipalities that have been deprived of access to pharmaceutical care and presented challenges and legal barriers blocking the possibility of opening new pharmacies."

All those present then signed letters of intent "regarding cooperation to improve access to medicines and pharmaceutical services in the municipalities." Gemini also declared that it would "verify potential pharmacy locations in each municipality."

The letter of intent was also signed by representatives of the following municipalities: Milejewo (Warmian-Masurian Voivodeship), Sorkwity (Warmian-Masurian Voivodeship), and Wądroże Wielkie (Lower Silesian Voivodeship). Unlike in Miłków and Perlejewo, we found no instances of calls for changes to the regulations from representatives of these particular municipalities.

Mariola Plichta , mayor of the Sorkwity commune, tells us directly that she is unaware of any regulations that would prevent the opening of any pharmacy in her commune. She emphasizes that she is not "partnering" with any chain, but only signed a letter of intent because the residents of her commune are very keen on opening a pharmacy (and there isn't even a pharmacy there - editor's note).

Barbara Mazurczyk and Jakub Wierzbicki actively and openly emphasize that the lack of a pharmacy in their commune is due to the AdA regulations. The mayor of the Perlejewo commune ignores the fact that a pharmacy operated in the village, but it was closed for renovations at the local health center and then never reopened.

Meanwhile, in an interview with Artur Osiecki for Rzeczpospolita, Mayor Mazurczyk claimed that there was a pharmacy in Miłki, but that regulations had changed in the meantime and it had been closed. This claim raises doubts. Information from the Pharmacy Register indicates that only a pharmacy operated in Miłki until March 2021 (four years after the introduction of the first version of the Pharmaceutical Law). Therefore, the amendment to the Pharmaceutical Law should not have had any impact on this event.

Mazurczyk also pointed out that the closest pharmacy to Miłki is located in Giżycko, 14 kilometers away, which suggests that there are no legal contraindications in terms of location that would prevent opening a pharmacy in Miłki (so-called geographical restrictions from the AdA).

Magdalena Jurgielewicz, Deputy Mayor of the Miłki Commune, explains that the regulations governing the maximum number of pharmacies a pharmacist can own (four) are problematic. In her opinion, only a pharmacist with an established and developed network is willing to take the risk of opening a pharmacy in a more remote location.

Jurgielewicz stops responding when we ask why Miłki are still calling for a change in the regulations, since the Gemini chain has declared that it will analyze the possibility of opening a pharmacy in this commune.

"We are in advanced work and discussions on the possible launch of new pharmacies, and the details are covered by trade secrets," says Aleksandra Murawska , head of Gemini's management, communications and PR office, in response to our question about when pharmacies will open in the municipalities that signed letters of intent in April of this year.

Murawska emphasizes that letters of intent do not create any obligations or mutual claims on the part of municipalities.

Fewer pharmacies do not have to mean their bankruptcy

In an interview with Rzeczpospolita on July 1st, Mayor Barbara Mazurczyk stated: "As is widely known, there are now nearly 400 municipalities in Poland without pharmacies. That's a significant number. This limits the ability to fill prescriptions for approximately 2 million people. What's more, pharmacies are closing in many more municipalities. Something needs to be done about this problem."

In a petition addressed to the Prime Minister (published over a month earlier), the mayor of Miłków went further, writing that 3 million residents from over 500 municipalities lack access to a pharmacy within their municipality. And that each week, more residents lose the ability to purchase medications.

"During the eight years of the regulations restricting the right to run a pharmacy only to pharmacists, 2,320 pharmacies disappeared from the Polish market," she added.

Similar data to those presented by the mayor of the Miłki commune was provided by Mariusz Kisiel from the Association of Franchised Pharmacies and Employers of the Republic of Poland, supported by a report from IQVIA.

"(...) the trend of decreasing pharmacies is gaining momentum, especially after 2017 , when anti-concentration regulations known as 'Pharmacies for Pharmacists' came into effect in Poland. After 2023 , when the aforementioned regulations were tightened, the trend deepened even further. It is therefore clear that the decline in the number of pharmacies is undeniably due to flawed regulations," Mariusz Kisiel explained in an article by Justyna Chwaścińska for Puls Medycyny.

During the Petitions Committee meeting on January 8th, Chief Pharmaceutical Inspector Łukasz Pietrzak stated that the information about several hundred municipalities without access to medicines is "propaganda." He pointed out that in mid-2015, the number of municipalities without a pharmacy or pharmacy service was 323 , while in 2024 it was 329 , an increase of six municipalities .

Deputy Health Minister Marek Kos echoed this sentiment in a recent response to an interpellation by MP Marcin Józefaciuk . He emphasized that when looking at the number of pharmacies, one must take into account the historical perspective.

Since 2015, there has been an increased phenomenon of the so-called reverse drug distribution chain and their export outside the country, which manifested itself in the practice of closing pharmacies covered by pharmaceutical inspection proceedings and then applying for a new permit.

- This justifies the overstated number of permits issued, which is visible in the data and is not justified by the actual needs of patients - explained Marek Kos.

The deputy minister added that the AdA regulations do not prohibit the opening of pharmacies in municipalities where such facilities do not exist. Demographic and geographic constraints are not an obstacle in small towns. Even if such a situation were to arise, the Ministry of Health still has the ability to allow a derogation from the rules if it is justified by the vital interests of patients ( we wrote about such cases in Rynek Zdrowia ). It's also worth noting that pharmacies can open in rural areas (though they may have a limited range of medications, they also have less stringent operating restrictions).

Marek Kos also cited a report by the Agency for Health Technology Assessment and Tariff System , which showed that in most European countries, running a pharmacy is reserved for pharmacists. Some countries limit the number of pharmacies, usually from one to four. The rationale behind these restrictions is that only such conditions allow for effective supervision and patient safety.

The municipal offices of Milejewo, Wądroże Wielkie and Perlejewo did not respond to our questions.

Write to the author: [email protected]

Copyrighted material - reprint rules are specified in the regulations .