Why is the Turkish model of "one pharmacy – one pharmacist" dangerous for Ukraine, and what does Russia have to do with it?

Recently, reports have begun to appear in the information space about the need to change the model of the pharmacy business in Ukraine. Some propose the so-called “Turkish model,” which provides for strict restrictions. For example, only a pharmacist can open a pharmacy, and the creation of networks is prohibited. Supporters consider this system a panacea for reducing drug prices and increasing their accessibility for the population. UNN decided to investigate how the Turkish model will fit into Ukrainian realities and what the Russian trace has to do with it.

What is the “Turkish model” of the pharmaceutical market and its impact on drug accessibilityTurkey has more than 4 times the population of Ukraine and different conditions for doing business. Most importantly, there is no war in Turkey, people are not dying, and its adult working-age population is not leaving in search of safety. According to Turkish legislation, one pharmacy must serve 3.5 thousand patients.

At the same time, the owner of a pharmacy can only be a practicing pharmacist, and they can only have one location. As of 2024, the Turkish Pharmaceutical Association included 34,870 pharmacists.

In Ukraine, as of 2024, there was one pharmacy for every 1,700-1,800 people. In total, there were about 18,000 pharmacies in our country. However, hostilities and constant shelling are making adjustments, so this number is approximate.

Thus, it can be concluded that drug accessibility in our country is higher than in Turkey. Establishing the principle of “one pharmacy – one pharmacist” will lead to the mass closure of pharmacies, especially in villages where it is physically difficult to find a certified pharmacist. This will create additional “white spots” on the map of drug accessibility.

Even now, most rural settlements in Ukraine do not have stationary pharmacies. And this is not about the frontline territories, where their absence is caused by the objective factor of war. This is about the relatively safe center and west of our country.

“89% of such villages in Ukraine do not have stationary pharmacies,” said former First Deputy Minister of Health Serhiy Dubrov during his tenure at the Ministry of Health.

“Turkish model” for pharmacies in Ukraine – it’s the destruction of competitionAs already noted, the introduction of the “Turkish model” will destroy pharmacy chains, making each pharmacist a sole owner. For Ukraine, this will mean a rollback to the past, when queues for medicines were kilometers long.

Over the past 15 years, it is competition between networks that has lowered prices for many drugs, made pharmacies more client-oriented, and invested in digitalization and logistics. It is competition that encourages pharmacies to fight for every consumer, and therefore to the appearance of promotions and discounts, better service. Pharmacy chains are also interested in entering new areas and thus increasing the accessibility of medicines.

Without network development, the patient will lose access to online orders, fast delivery, and unified service standards. And most importantly, the nearest pharmacy will now be not in the next entrance, but in the next district, because the calculation will be based on the number of the population, which the war mercilessly reduces. The patient will lose physical access to medicines and the opportunity to buy medicines more profitably.

Risk of monopolization of the pharmaceutical marketThe liquidation of large networks, which can at least somehow restrain pharmaceutical giants from destroying small producers and completely seizing the market, will mean a green light for unfair competition. Producers, who form 72% of the drug’s cost, will have no incentive to lower prices, as they will easily be able to manipulate pharmacies.

At the same time, mandatory membership in a single Association of Pharmacists, which is to become both a regulator and a protection for pharmacists, will give it unlimited power. And this is a direct path to bureaucracy and corruption risks and a clear departure from European values.

Economic impact: investments, taxes, logisticsIt should not be forgotten that the pharmacy business is not only shelves with medicines, but also jobs, taxes, investments in IT systems, infrastructure, and logistics. Often, large networks invest hundreds of millions of hryvnias in the development of warehouses, electronic tracking systems, and digital solutions to improve their service.

In the event of the liquidation of network business, as provided by the “Turkish model,” these investments will stop. For the state, this will mean a loss of income. And foreign investors will not be interested in a regulated market.

For some reason, those who propose changes did not calculate the economic component. For example, how much the state budget will lose in taxes from such an ill-conceived step, and how many people will lose their jobs.

The emergence of gray schemes bypassing regulation should also not be ruled out. After all, every new restriction gives rise to attempts to circumvent it.

Social risks from radical changes in pharmaceutical market regulationThe Turkish model is based on state subsidies and compensations: more than 8,000 drugs are reimbursed by the social insurance fund. In Ukraine, however, there is no such fund, and “Affordable Medicines” cover only about 600 trade names of drugs. A sharp increase in the list during the war will place an unbearable burden on the state budget.

In addition, the introduction of strict price control without a parallel large-scale reimbursement system will lead to the disappearance of expensive imported drugs from the shelves. Single pharmacies will find it difficult to buy expensive imported drugs, for which there are no analogues in Ukraine, and it will become unprofitable for suppliers to bring them in very limited quantities.

A blow to pharmacistsThe rule “one pharmacy – one pharmacist” looks beautiful only on paper. In reality, it will turn certified specialists into hostages of the system: they will be forced to run a business themselves, even if they do not have entrepreneurial skills.

Moreover, not all pharmacists have sufficient start-up capital, not to mention the willingness to risk it.

Thousands of pharmacists in Ukraine choose to work in networks where they receive a stable salary, social package, and career growth opportunities. But forced “entrepreneurship” for everyone will mean instability and additional stress.

“Turkish model” in the realities of war in UkraineUkraine is at war. And it is even difficult to imagine how most pharmacies in the country will close at once, because network points will be banned. This will lead to chaos in the healthcare system, a shortage of critically important medicines, and an even deeper demographic crisis.

In fact, the pharmaceutical retail will need years to fill all the “white spots” in the physical accessibility of pharmacies. As already mentioned, even now, and even in the relatively safe central and western regions of our country, there are settlements where there is no stationary pharmacy. Patients have to travel tens of kilometers to buy medicines. And what will happen after the closure of existing points?

Of course, chaos and the destruction of Ukrainians play into the hands of our enemy – the Russian Federation. Perhaps that is why some of its adherents have already begun to broadcast this idea and actively support it, otherwise how else to explain such activity?

Therefore, the question here is for the Security Service of Ukraine, why anyone can so easily broadcast ideas designed to destroy the Ukrainian people and the state as a whole?