Community pharmacies in Italy: An inevitably growing role?

Since 1978, Italy has adopted a public health system, the Italian National Health Service (INHS), which has involved from the real beginning private organizations in delivering services. Historically, community pharmacies (CPs) are mainly private shops everywhere in Europe, Italy included, and have always been regulated in every country.

Many regulatory provisions regarding CPs have been passed during the new millennium in Italy, which can be summarized in four points.

Since 2006, the historical 'one pharmacist-one pharmacy' rule for ownership has been cancelled. Italy has also become the only European country where not all community pharmacists are allowed to dispense ethical drugs. Since 2012, regional authorities have been allowed to authorize the opening of further CPs in highly frequented areas and the potential ownership of CPs has been extended to non-pharmacists. Starting from 2009, CPs have been legally allowed to shift from merely drugs dispensing centres to providers of services in community care. The number of services is expected to be significantly expanded under the current government. In 2024, a new complex distribution margin has been adopted to remunerate the traditional public service of dispensing drugs provided by CPs, which led to extra expenses for the INHS at the end of the year.

A likely scenario is that CPs will play a pivotal role in primary care within the INHS. Because private providers (obviously) concentrate on profitable services and this can induce opportunistic behaviours, the INHS will have to bear high transaction costs in order to constrain them.