Parallel distribution generates gains for importing and exporting countries as well as increasing the choice of medications doctors can prescribe and lowering costs for patients. Thus four groups gain from parallel distribution.

“That PI generates savings in Europe is not disputed any longer. The question is more how much savings it generates, to whom these savings accrue and whether the patient, and the final payer – in most cases the health insurance system – draw a significant benefit from the commercial practice of parallel distribution” (EAEPC, The Parallel Distribution Industry: A closer look at savings (January 2013))

“The distribution of any savings in drug prices will depend on the regulatory environment and health care financing system. Ultimately, however, all patients pay for health services through contributions, taxes and direct fees and therefore gain either directly or indirectly, if savings materialise” (Ulrika Enemark, Kjeld Moller Pedersen, Jan Sorensen, The economic impact of parallel import of pharmaceuticals, Centre for Applied Health Services Research and Technology Assessment, University of Southern Denmark (June 2006))

Importing countries do:

  1. In the UK - the National Health Service recovers funding via the "clawback" mechanism, a sliding scale of rebate based on prescription volume.
  2. In Ireland and Sweden - a parallel distributed product must offer savings to the state before it is reimbursed
  3. In the Netherlands and Norway - the cost difference between the domestic product and its parallel- distributed equivalent is split between the dispensing pharmacist and the payer
  4. In Germany and Denmark - the sick funds and government respectively oblige pharmacists to dispense cheaper synonyms, including parallel-distributed forms, when certain levels of savings are possible

As do exporting countries:

  1. Wholesalers in exporting countries are legally obliged to meet domestic demand first - in fact most countries impose, through national law or a voluntary code of conduct, a so-called "public service obligation"
  2. But the distribution chain - wholesalers and community pharmacies - needs a certain level of income to provide the prompt and highly efficient service European patients have come to expect. Additional income from margins with parallel distribution sales lessens the burden on the social healthcare system of exporting countries

So do patients:

  1. In Belgium, Denmark, Finland, France, Greece, Luxembourg, Norway, Portugal, Spain, Sweden the majority of patients pay a share of the cost of prescribed medicines they consume, so use of cheaper parallel- distributed products will mean lower out-of-pocket expense
  2. WIdO, the statistical arm of the AOK, the Federal Association of Local Sick funds in Germany, is on the record as saying that women in Germany can save 54% on the pharmacy-selling price of Stediril D, an oral contraceptive, by purchasing it in parallel distributed form (Wissenschaftliches Institut Der AOK (WIdO): Importierte Arzneimittel können jährlich 450 Mio. (December 2002)).

Finally, doctors and pharmacies also benefit:

  1. It has been estimated that office-based doctors in Germany can save between €2500 and €5000 on their drug budget each year by prescribing parallel- distributed versions, all of which are priced on average 10% less (some can be even 30% less) than their domestic equivalents.
  2. It is no coincidence that parallel distribution penetration is highest where pharmacies are either financially rewarded for the use of parallel distribution (Netherlands) or penalised for not doing so (UK, Germany).