American pharmacies can learn a lot from the Germans about safety, cost containment, and pharmacist satisfaction.
Three years ago, my wife, Denise, planned another vacation of a lifetime.1 In 2001 and 2013, we had traveled, with our parish priest and our kids, to Italy on a pilgrimage to various religious sites. We had a marvelous time. This trip, though, would be different: We were going to Germany, where all of my grandparents are from. My dream to see the Passion Play in Oberammergau would become a reality in May 2020.
The Passion Play was performed there first in 1634 and every 10 years thereafter as a thanksgiving offering for the village being spared from the plague. The Passion Play deviated from every 10-year schedule only twice: in 1940, during World War II, and again in 2020 for the COVID-19 plague. The Germans seemed to know that COVID-19 would last longer than 1 year and rescheduled the performance for 2022. We were excited to get tickets to the second performance on May 15.
Whenever I travel to a different locale, I like to stop by the pharmacy for a quick visit. In Germany, it is easy to find a pharmacy. Each store is designated by a big, red A for apotheke.
Pharmacies, by German law, are owned and operated by a pharmacist who has graduated from an accredited school of pharmacy. It is a strange experience when you walk in. The employees, technicians, and pharmacists are sharply dressed in white lab coats with name tags. Throughout the country, pharmacies had the same vibe: calm, quiet, and professional—unlike the chaos in some American pharmacies. Each pharmacist we talked to happened to be a woman and spoke English with proficiency.
Prescription products were available only in unit-of-use blister packs. I asked one pharmacist if they ever split the boxes and received a firm no in response. These boxes were dispensed as a single unit, QR-coded with the lot and expiration date entered on the patient’s profile. There are absolutely no stock bottles and no prescription vials.
German pharmacists do not frequently receive electronic prescriptions. Instead, patients carry a pink and white prescription blank from their physician. There are no directions or drug names on the blank; there is a serial number that, when entered, populates the drug name, quantity, and directions for use. This information is contained in a central database and it is virtually impossible for a pharmacist to enter data incorrectly. There is no chance the pharmacist will enter amitriptyline 100 mg for an order written for amitriptyline 10 mg.
All pharmacies in Germany utilize the same formulary. Patients pays 10% of the cost of the prescription: between €5 and €10, maximum. Can you imagine a prescription in your pharmacy having a maximum co-pay of $10? Best of all, there are no prior authorizations in the pharmacy; everything is approved.
Of all the wonderful experiences Denise and I had interacting with our fellow pharmacists, our encounter in Oberammergau stands out. It was Sunday afternoon and I went to the apotheke to buy a box of ibuprofen 400 mg. When she rang up the sale, she warned me that there would be a €2.5 inconvenience fee because it was a Sunday purchase. I told her I would be honored to pay a surcharge; I’ve always been annoyed with Sunday shoppers. Of the prescriptions we fill on a Sunday, seldom are there more than a few true emergencies.
The German population is covered by a national insurance, which seems satisfactory to most of the citizens there. They have had national health insurance since 1883 thanks to Otto Von Bismarck’s social legislation. Today, the German government spends $685 for health care for the average citizen. Compare that with the United States, which spends over $1000. When it comes to providing drugs to our patients, we could learn a lot from the Germans about safety, cost containment, and satisfaction of its pharmacists.