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during this 6-year period (INEM, 2015). Transportation of patients, along
with emergency unit activity (vehicles and helicopters) have also increased in
a similar percentage range.
5.6 Pharmaceutical care
Pharmaceuticals that require prescription can only be sold in a pharmacy. Until
2007, pharmacies had to be owned by a qualified pharmacist. However, the
Ministry of Health passed a law (Decree-Law No. 307/2007, of 31 August
2007) allowing ownership of a pharmacy to have no constraints other than
a maximum number of four pharmacies per owner. It is still mandatory
to have a technical director with a degree in pharmaceutical sciences in
each pharmacy.
The location of pharmacies is highly regulated. There are a maximum
number of pharmacies permitted in each community. The Ministry of Health
decides whether there is a need for a new pharmacy in an expanding residential
area. In the first instance, there must be proof of at least 3500 new clients,
and there must be no other pharmacy within 350 metres of the proposed site.
Hence, established pharmacists have a considerable degree of monopoly over
the prescription drug market. Despite the changes that have occurred, there is
as yet no change in the enforcing of demographic and geographic constraints
for the opening of new pharmacies.
In primary care centres, only those vaccines that are part of the National
Immunization Programme, and therefore provided free of coinsurance, are
dispensed directly by the institution. Otherwise, patients have to take their
prescriptions to a private pharmacist, whether they receive the prescription
from an NHS doctor in a primary care unit or from an outpatient department
of a hospital.
In 2005, a major change occurred in the over-the-counter market, as
it underwent a double liberalization: over-the-counter products have to
be registered with the regulatory institute for the pharmaceutical sector,
INFARMED, and can now be sold in specialized stores, which no longer need
to be pharmacies, and prices are no longer fixed.