A Look at Community Pharmacy Practice in Argentina
Key takeaways:
Argentina’s healthcare is mostly decentralized, with each administrative region being responsible for the provision of healthcare services.
Like in the U.S., there is no regulation on drug pricing in Argentina, although recent government actions might change that.
Pharmacists are able to give vaccines and provide other clinical services, but reimbursement remains a challenge.
Community pharmacies are those that dispense medications to patients who aren’t hospitalized or in nursing facilities. This series explores how community pharmacy practice differs around the world. In doing so, it allows us to view our own system in a new light and find possible opportunities for improvement.
So far, we’ve explored the practice of pharmacy in Japan, Finland, Australia, Switzerland, England, the United Arab Emirates, Iran, and Malawi. In this post, we’ll look at our first country in South America: Argentina.
To help us understand community pharmacy practice in Argentina, we interviewed Sonia Uema, a faculty member at the Universidad Nacional de Córdoba. Along with her colleagues, she published a piece describing Argentina’s pharmacy system that you can read here.
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How Argentina’s pharmacy system works
Argentina is the largest Spanish-speaking country in the world and is well-known for the tango music and dance tradition, Patagonia, and a rich history and food culture. It is divided into 24 administrative regions, which includes 23 provinces and the autonomous city of Buenos Aires.
Argentina’s regulatory system is controlled both centrally, through the Ministry of Health, and locally, through regulatory bodies in each administrative region. However, each administrative region has more regulatory authority, overall, to make decisions than the central government.
The basics
In 2019 — the most recent year data is available — Argentina’s annual healthcare spending was about $946 per person, or 9.5% of GDP. By comparison, the U.S.’s healthcare spending was $12,530 per person in 2020, according to the Centers for Medicare and Medicaid Services.
Argentina’s under-5 mortality rate, a key indicator of health-system performance, was 8.6 per 1,000 live births in 2020. That is somewhat higher than the U.S., at 6.3 per 1,000 live births the same year. This rate continues to decline in both the U.S. and Argentina.
In 2020, Argentina’s life expectancy at birth, also sometimes used to investigate health-system performance, was 77 years. This is identical to the U.S.
Healthcare in Argentina is divided into three primary sectors:
Social security: This sector covers employees, retirees, and their families. Employees with a formal contract are required to have social security. Private insurers provide social security benefits, and the majority are National Social Health Organizations or Provincial Social Insurance Organizations.
Private: Those with voluntary health insurance can be covered through the private sector.
Public: Covers everyone in the country, but is mostly used by people who do not have social security or private insurance.
According to the latest census data, in 2010, social security and private insurance combined covered about 64% of the population. The remaining people relied on public services for healthcare.
Each administrative region is responsible for administering health services, but the Ministry of Health’s Federal Health Council assists with coordination and other areas related to national public health.
Pharmacy regulation
All medications, medical devices, cosmetics, and food products must be approved by the Medicines, Food, and Medical Technology Administration (ANMAT). ANMAT also oversees the conduct of clinical trials performed in Argentina and is a division of the Ministry of Health.
Certain medications can be distributed in the country prior to ANMAT approval through the Exception Regime for Access to Non-registered Drugs (RAEM).
Like the U.S., there is no regulation on drug pricing in Argentina. However, the medication nusinersen (Spinraza) made headlines when the government negotiated pricing with the manufacturer, leading some to speculate that there could be more pricing regulation implemented in the future.
Argentina also requires tracking and tracing, similar to the Tracing, Tracking and Authentication Control System (TTAC) in Iran, the Drug Supply Chain Security Act (DSCSA) in the U.S, and the Falsified Medicines Directive (FMD) in the European Union.
Medication is divided into multiple categories, similar to the U.S. Drug Enforcement Administration (DEA) schedules. These categories are:
Prescription drugs, no refills
Prescription drugs, refills allowed
Over the counter
Daily pharmacy practice in Argentina
In 2019, there were a total of 13,581 pharmacies in the country. In 2014, chain pharmacies represented about 10% of pharmacies. There are no drive-through windows, but Dr. Uema notes that home delivery is available at some pharmacies.
Many pharmacies, especially chain pharmacies, have front-end merchandise, similar to U.S. drug stores. There are pharmacies located within shopping malls and grocery stores, in addition to freestanding pharmacies.
Although it depends on the province, in most provinces pharmacists can administer vaccines. According to 2017 data, approximately 65% of pharmacies in Argentina offer immunizations. As a whole, though, reimbursement remains an issue. There is no national mandate to reimburse pharmacist-led clinical services, and insurance companies don’t pay for them. Therefore, patients who want these services must pay out of pocket.
In addition to vaccinations, the Official College of Pharmacists and Biochemists in Buenos Aires has set fees for some pharmacist-led clinical services. These include blood pressure control, pharmacotherapeutic follow-up, helping patients organize their medication, and giving nebulized medications.
There are very few medications that are considered interchangeable, or therapeutically equivalent. However, all prescriptions must list the generic name, so that the generic can be dispensed; a provider can add the brand name, but the patient still has the right to request the generic. If they do so, the pharmacist must dispense it as generic.
Although Law 27,553 was passed in 2020 allowing electronic prescribing, Dr. Uema says that most prescriptions in the country are still provided via paper.
Each insurance company has a coverage list that pharmacists must check prior to dispensing to be sure they will be reimbursed for the medication. However, all medications on the Compulsory Medical Program (PMO) must be covered by both social security and private insurers.
According to Dr. Uema, claims for prescriptions are sent at the end of the month to each insurance company for reimbursement.
Becoming a licensed pharmacist
All pharmacy schools must be accredited by the National Commission for University Education and Accreditation (CONEAU). At the National University of Córdoba, where Dr. Uema teaches, the pharmacy program lasts 5 years. It includes a professional practicum, similar to experiential rotations in the U.S.
The curriculum consists of courses in the basic sciences, like anatomy, physiology, chemistry, and physics, as well as pharmacy courses, like pharmacology, medicinal chemistry, and pharmacotherapy. Continuing education is not required to maintain licensure in Argentina.
The bottom line
Argentina has a largely decentralized healthcare system with most decisions being made by each of its 24 administrative regions. Healthcare is provided through multiple channels: social security, which is intended for workers with formal contracts, retirees, and their families; private insurance, which is voluntary; and the public system, which primarily takes care of anyone without social security or private insurance.
Pharmacists are allowed to provide a wide range of clinical services, but reimbursement is an ongoing challenge that must be overcome in order for those services to be widely adopted.
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