Prescription Drugs by Mail? Not Yet.

One of the features of German life that expats notice right away is how expensive and difficult-to-get-at drugs are.  You can get find 100 tablets of aspirin for 99 cents on the shelf of any normal American drugstore. In England, they’re a bit more expensive, but still freely available.

In Germany, though you must go an Apotheke — a licensed pharmacist — to get these over-the-counter medications. There, you will be required to ask for the aspirin, which is kept behind the counter. It’s incredibly expensive. Even the online version in Germany costs more than ten times what it does in the U.S.: 9.38 Euro (G) (about $12.50) for 100 tablets. It apparently has to be imported and re-imported in order to make Internet sale legal.

Yes, we’re talking about good old fashioned aspirin here, not some sort of nitroglycerin-laced Super-Aspirin. This price difference might strike you as trivial, unless you’re one of the millions of people who are told by their doctors to take aspirin every day. And the same is true of cold medicines, laxatives, and other routine medical products that have some medicinal effect, but that you do not need a prescription (Rezept) for.

This seems to be another example of rent-seeking in the German economy. Nobody doubts that pharmacists (or chemists, if you prefer the British term) should be involved in the distribution of dangerous medications. But once upon a time, German pharmacists were able to convince the legislator that they needed to be in control of distribution of innocuous, everyday stuff like aspirin and cold medicine. They likely dragged out the German show-stopper argument: Sicherheit (safety). How can somebody without a college degree be trusted to dose themselves with something as terrifyingly dangerous as aspirin?* Now they can force anyone who wants to buy aspirin to visit their shops and pay their prices. You can bet they’re not going to give that up without a fight.

But alas, as with so much rent-seeking behavior, it’s getting a run for its money now. A chain of drugstores in Germany (that is, places in which you can buy soap, fingernail clippers, dishwasher detergent, herbal remedies, vitamins, and pet food — but not drugs) has decided to wade in to the prescription-drug business. You can go into one of these places, put your prescription in a bag, and it would be filled by a pharmacy in the Netherlands (which operate under fewer restrictions) and shipped back to Germany. You come back a few days later and pick it up while you do your other shopping. Yes, you heard me right — they ship your prescription to Holland to get it filled.

Of course, this triggered a counter-offensive from various interest groups and government agencies. The Landgericht Düsseldorf (G) has just basically punted on the issue, saying it doesn’t have jurisdiction. Nobody knows who will win the legal dispute in the long run. But in the meantime, you’ll still have to visit your friendly neighborhood Apotheke for your aspirin.

* Keep this in mind next time you hear someone sneer: "Americans have no sense of personal responsibility — why, they allow people to sue companies when they injured themselves in the most idiotic ways!"

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10 thoughts on “Prescription Drugs by Mail? Not Yet.

  1. You need to consider, though, that when you say ASPIRIN in Germany, you’re talking about the original medication from Bayer, as they have a trademark for the term.

    If you’re not a pharmaceutical fashion victim, you are free to get some generic stuff with an identical medical formula. I bought my box of 30 pills for I believe € 4.50 at my local Apotheke. Which is still more expensive than in any US Wal-Mart but at least is in the same ballpark.

  2. Aaah, obviously I bought the 30-tablets box for € 1.50.

    But, of course you’ll need three of the boxes to compare them to the 100-tablets units Andrew is referring to in the article.

  3. “But, of course you’ll need three of the boxes to compare them to the 100-tablets units”

    3 1/3 actually. It takes 5 euros to buy the quantity of arpirin which you can buy in the US for a dollar. Given the current exchange rate of 1.3596 dollars to the euro that makes the German price more than 650% of the US price.

    Even here in the UK OTC drug prices tend to be a lot higher than in the US, I can buy 1000 generic ibuprofen for $9.99 in most drugstores. The best deal readily available in the UK is 33p for 16 at Tesco, which works out to about £20 for 1000, four times the US price.

  4. I’m sorry, maybe I’m wrong but we don’t speak about vitamins, do we?
    Drugs are chemicals which interfer with your body, mostly in a bad way (so do too much vitamins by the way).
    Aspirin may be so common today that nobody really cares anymore but that doesn’t make it any less harmfull when taken by the wrong person.
    Do you really know if your body is as healthy as it seems and the drugs you take are good for you? Do you really know what you are doing just because you have a college degree?
    I’m all for liberalizing the drug market but I’m not so fond of making any drugs prescription free.

  5. Apothekenpflicht and Preisbindung are separate issues. (The latter one doesn’t exist anymore for non-prescription drugs since 2004, BTW). They are probably related, but in a subtle and complex way.

    Andrew makes an excellent case against Apothekenpflicht, i.e. the law that says (roughly) that certain non-prescription medicine must only be sold by a licensed pharmacist: Other countries sell the same drugs in supermarkets, and they apparently manage to survive somehow. Another case against it would be the actual day-to-day experiences in German pharmacies, where in many, many cases no consultancy happens at all. But whatever you think about that, the Apothekenpflicht cannot in itself explain the high prices. Because, what would prevent pharmacies from competing among each other by offering discounts on aspirin?

    German pharmacists have for decades cultivated very restrictive industry practices – e.g. the prohibition of mail-order sales, the prohibition against owning more than one pharmacy, etc. You have to look at all these things together, then I believe you may get an accurate idea about why medicine is so expensive.

    It’s generally accepted that cheap medicine is nice to have, but I wonder if that’s always true. If you compare, for example, the per-capita use of aspirin in Germany and the US, and it turns out the average American consumes much more each year – is that necessarily a good thing? Maybe it would be good to have lower prices if you have a prescription, but high over-the-counter prices.

  6. Interesting post because many people ignore this information so important and clear.Thank you for the helpful information. I hope you keep up the good work on making your blog a success

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