Bonus and benefits system, or why a large number of pharmacies are not feared in developed countries

The most accessible link in the healthcare system for patients is the pharmacy. This is what they believe in the European Union. The Pharmaceutical Group of the EU – an association uniting pharmacists from over 30 countries – in its plans for the development of the pharmacy market in the coming years, focuses on increasing this accessibility and expanding services. The Ukrainian pharmacy market is also following this path, but, as expected, the war has made its adjustments, and the rapidly developing segment found itself literally in a zone of turbulence, also contributed by regulatory changes introduced by the authorities, writes UNN.  

Many pharmacies and even more gapsFrom the house where I live to the nearest pharmacy was almost three kilometers. And no, I’m not talking about a remote village or a mountainous area, but about one of the large settlements of the capital’s agglomeration. When the pharmacy finally opened in the neighboring building, everyone rejoiced without exaggeration, especially the elderly and those who do not have their own car, because public transport is also not easy to use. Therefore, when I hear that we have pharmacies at every turn, it makes me smile skeptically.

No, not at every turn. Not even every settlement has a pharmacy. According to the Ministry of Health of Ukraine, 89% of Ukrainian villages do not have stationary pharmacies at all. A report published in 2024 by the World Health Organization states that only 22% of electronic prescriptions issued in villages were filled in the same settlement where they were issued. This means that in 78% of cases, people had to travel to another settlement to get their medications. 

As of 2025, there are over 18,000 pharmacies operating in the country — an impressive figure. But this is 88% of the pre-war level, and moreover, it is less than, for example, in Spain, where over 22,000 pharmacies operate, or in Italy – over 20,000. Of course, the population in these countries is also larger than in Ukraine, but if we look at the indicator of the number of pharmacies per hundred thousand population – our country is also not a leader.  At its peak of development – before the start of the full-scale war – the average number of pharmacy points per 100 thousand population was 23. While the average indicator in OECD countries (Organization for Economic Cooperation and Development, which unites 38 economically developed countries) is 28 pharmacies (and these are only those located outside medical institutions). The number of pharmacists in most of these countries also exceeds Ukrainian indicators.

So, is the pharmacy the most accessible link in the healthcare system in Ukraine?

There is work to be doneWhile in large cities, given the greater number and density of population and higher purchasing power, there are indeed relatively many pharmacies, in small settlements, as we have already found out, there are often none at all. And this is what needs to be worked on, because access to medicines is a vital factor. But let’s not forget that a pharmacy is also a business, and no one will work at a loss, if only because they won’t be able to maintain it. And a pharmacy in a village or in frontline territories, where there is also a constant risk of shelling, will not bring profit. Large pharmacy chains could bear this burden, but the rules for regulating the pharmaceutical market introduced this year actually nullified this possibility. Pharmacies were deprived of the right to conclude agreements with manufacturers for the provision of marketing services, which turned even profitable pharmacy points into much less profitable ones. And individual entrepreneur pharmacies generally found themselves on the verge of extinction, as they did not have the same margin of safety as chains.

Under such conditions, the most accessible link in the healthcare system has become almost unattainable for many.

The return of marketing agreements and, in general, the liberalization of the pharmacy market could rectify the situation. Many developed countries, by the way, are also leaning towards this. Recently, there has been much talk about strengthening control over this segment, citing EU countries as an example. However, despite the existence of some rules and restrictions there, the market is generally more self-regulating. And a large number of pharmacies does not scare anyone, as it has a number of advantages.

System of advantagesAn obvious advantage of a significant number of pharmacies is increased physical accessibility to medicines. Of course, the factor of a more even geographical distribution of pharmacy points throughout the country should also work here.  And this issue was gradually being resolved, as pharmacy chains increasingly opened points in remote regions, and some, in addition, launched mobile pharmacy points that proved effective in frontline territories. But, as mentioned above, the cancellation of marketing agreements negatively affected this trend. And new pharmacies in small and remote settlements stopped opening, and mobile pharmacies even had to be partially curtailed. By the way, speaking of areas without pharmacies, it is worth mentioning another Ukrainian feature of today – the destruction of pharmacies by the enemy. And reconstruction takes time and money. Not every business can afford to restore what was destroyed, especially in an area where the confidence that tomorrow there will be a pharmacy here, and not a burnt-out shell after an arrival, is rather illusory.

High competition contributes to a number of other advantages for the consumer – a wider assortment, better service, discounts, loyalty programs. All these advantages are in demand among consumers – some need rare drugs, some need the opportunity to save money, others need online booking, and still others have long befriended the pharmacist in the nearest pharmacy, because they know him “as always.”

Many convenient and functional services, high service standards, promotions, and the ability to get medicines near home that are in stock at the other end of the country are products of competition, especially among pharmacy chains that have established contacts with manufacturers and distributors, well-thought-out logistics, develop and implement innovative electronic services and staff training.  But even small chains or even individual pharmacies have their advantages for customers – they can better take into account local peculiarities and demand.

All this, with the ability to provide consumers with access to programs like the domestic “Affordable Medicines,” contributes not just to the possibility of quickly obtaining medicines, but also increases the overall level of public health.  

Economic aspectAny business is not just about profits, but also about taxes. And this is already an advantage for the state, and a considerable one – thus, legal entities and individual entrepreneurs engaged in retail trade of medicines in pharmacies paid about 5.4 billion hryvnias in taxes to the budget in 2024.  Of course, the lion’s share belongs to chains, but individual entrepreneurs are the development of small businesses, increasing self-employment of the population, economic activity, and as a result, improving well-being.

A significant number of pharmacies means a large number of jobs, as well as a multiplier effect that extends to other sectors of the economy: from the production and transportation of medicines to IT and education, from real estate rental to the impact on the development of the public health sector. This is the development of a new segment of the pharmaceutical market – the introduction of private labels by pharmacy chains, the lower price of which can be maintained through a large-volume distributor or through contract manufacturing.

And it’s also about social responsibility – participation not only in state programs to ensure access to medicines, but also a constant search for new tools to increase the price accessibility of medicines, and in Ukrainian realities, this means launching mobile pharmacies, supporting doctors, helping IDPs and the military. All this also has a multiplier effect, which in its highest manifestation is the preservation of life. And in economic terms, it stimulates demand and supports the socio-economic activity of the population even in the face of difficult challenges.

So, there is no need to be afraid of a large number of pharmacies – we need to let the market develop, only stimulating the ability to satisfy consumer demand and needs. At least one pharmacy must be near your home, and it would be even better if there was one near your work as well.