With his posters “pharmacy in danger”, Marc Alandry, pharmacist in the village of Couiza in the Aude, goes to the fire to save the strategic pharmacies. – Idriss Bigou-Gilles for LesEchos Read also
- Pharmacists have experienced a contrasting increase in their compensation
In 2018, the bill of the drug will have to fall by 1.4 billion euros – not in net, but compared to the “spontaneous” progression of expenses. A new record. Since Nicolas Sarkozy in 2007, savings plans follow one another, first with derecognitions and tariff cuts of the order of 500 million euros per year. In 2012, the left came to power and decided to close the abysmal deficit of health insurance. We go to billions of savings a year, playing on prices and volumes.
Since 2015, the objective has been to simply reduce the turnover of the drug in the city; a policy without a fight to make room for innovative therapies in hospitals. The regulated price of pills and syrups distributed in pharmacy is decreasing, so that the Social Security can pay expensive treatments against hepatitis C or cancer.
At the end of the chain, the pharmacies suffer. Every other day, one of them lowers the curtain. Until now, the flanking pharmacies were small, downtown-based institutions that were not strong enough to compete. A form of restructuring of the sector assumed by the public authorities.
According to a report of the Court of Accounts published in September, the French dispensary network is oversized compared to neighboring countries, with 10,400 pharmacies “in excess” out of 22,000. Public deficit monitoring criticizes income support policies, which are too generous, such as aid to put forward generic medicines.
National Order of Pharmacists
However, the court recognizes that 400 to 500 pharmacies “play a strategic role of access to medicines in some rural and peri-urban areas” . They should receive specific help, she adds. Because, in the long run, the dry regime also weakens the signs that serve an isolated population, despite their monopolistic position on the ground.
When asked about the subject, the Regional Health Agency did not wish to follow up. As for the College of Pharmacists, it does not have statistics on this category of pharmacies in particular and does not wish to speak on the subject.
The two wounds of the pharmacist
These pharmacies may be strategic for residents living nearby, often elderly and dependent, their fragility is obviously not at the heart of thinking about the future of the profession. Philippe Besset, vice-president of the Federation of Community Pharmacists, one of the unions representative of the profession, regrets afterwards not to have defended their specificity during the last conventional negotiation, in July.
“If I had known that we would only get 215 million euros over five years for the whole profession, I would have insisted that they be sent to rural areas! ” Recognizes this pharmacist installed in the small town of Limoux, 16 kilometers from Couiza. “One-third of pharmacies are in rural areas ,” said Albin Dumas, president of the Association of Rural Pharmacies. The network has melted, however they are not the most threatened, except in case of medical desertification, as in Couiza, ” he added.
All is not lost: an order made by the former Minister of Health Marisol Touraine, but presented to the Council of Ministers on January 3, 2018, paves the way for a zoning of “fragile territories” . This mapping work will help create targeted support for primary drug stores.
With the lower prices, the disappearance of doctors is the plague of the pharmacist. While going up to the city for the consultation, one buys its pellets and mouthwashes. Gradually, rural pharmacists see their sales of reimbursable drugs, which account for most of their sales, plummet. It’s the decline. “Unfortunately, pharmacists are hiding to die,” said Albin Dumas, adding that ” not all pharmacies will die” .
Indeed, there is a part of bad luck, even sacrificed generation, in the misadventures of Marc Alandry. Entering the quarry at the wrong time, just before the change in the economic model of the sector, he contracted a big loan in 2005, when the margins were at the highest, to help his brother to acquire a pharmacy. He also bought his father’s business for the equivalent of one year of turnover.
It was done at the time. We bought his patient. From now on, the patients abound, it is the caregivers who are becoming rarer. So, the pas-de-porte is no longer worth a nail. “When my father sees my situation, he regrets the sale,” says the pharmacist, covered with debts.
It does not pity yet, with its 3,500 euros monthly, this idealist who, in his spare time, records rock’n’roll clips on YouTube with his family. But it undergoes a form of social downgrading. His great-grandfather belonged to the local upper middle class – “In Saint-Hilaire, there was the priest, the doctor and him. “His father lived bourgeois” We could afford everything we wanted, a guitar for me, an Audi trendy for my brother studying in Paris … “
As for him, he is just a problem client for his banker. Fortunately, the job is rewarding: “The barrier of the notable has fallen, he says , but there is still a lot of affection: people tell me their life, write me letters. “
“The barrier of the notable has fallen, says Marc Alandry, but there is still a lot of affection: people tell me their life, write me letters.” – Idriss Bigou-Gilles for Les Echos
If he works a lot, it is therefore graceful. Six times a week, at 6.30 am, he went down to the shop lit by a green Occitan cross on the ground floor of his house to prepare orders. His small business creates business, with his three employees managing the counter and administrative tasks. In the back, he has installed a table of auscultation, to dress the elderly, measure their constants, or bring first aid to the sick.
“The last time was a child with a fish hook in his eyelid. People do not even try to go to the doctor anymore , “he says. It also happens that a villager rings at his house in the middle of the night for an emergency. Finally, on weekends, when he is not on call, Marc Alandry can be called as a volunteer firefighter, since he is a commander in the Couiza Brigade.
Twenty years ago, it took five minutes to deliver; now it’s thirty minutes.
With his posters, Marc Alandry goes up in the fire to save strategic pharmacies. Ideas, he has some. For him, we must stop paying pharmacists as traders but rather as caregivers. Pay them a fee, rather than margins on each box of pills. So far, nothing very original: this switch has been triggered since 2015 at the national level, with the creation of new lines of fees, for example to execute a “complex prescription”, including more than five drugs.
“Twenty years ago, it took five minutes to deliver; now it’s thirty minutes, because everything is prescribed, and because doctors no longer have the time to explain the nature of these prescriptions, ” confirms Marc Alandry. This year, the conventional partners decided to create other fees for pharmacists. “This will help desensitize some price reductions by 2020, but it will be too late for some,” regrets Philippe Besset.
Marc Alandry does not content himself with it. He claims specific fees for pharmacies like his, which could be labeled “strategic”. In Couiza, little luxury beauty creams are sold. The average basket is 8 euros, against 40 euros in Carcassonne. On the other hand, we take care of the patients.
I relieve emergencies and release medical time, I am a real bush hospital!
Nosebleeds, compressive bandages, strapping, the holder lavishes a lot of primary care. “I relieve emergencies and release medical time, I am a real bush hospital! happily boasts the pharmacist. If everything I do for free was paid, I would be a billionaire, “he jokes again.
In addition, Marc Alandry enthusiastically embraced the Medicare initiative, which now reimburses the pharmacist’s “pharmaceutical interviews” with asthmatic patients or with anticoagulants. Objective: to prevent crises and emergency hospitalizations. The consultation lasts one hour, the pharmacist is paid 60 euros.
The rocker Couiza has created a room with a medical bed in the village health house, deserted by doctors. He spotted a lady who was urinating blood because of her meadow-herb tea; he saved her. He feels useful. “But why do we have to wait a year before getting paid? And why could not we touch 2 euros for a simple focus in ten minutes above the counter? He asks, ready to jump into his boots and girdle his sparkling helmet to save the country pharmacies.