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This presentation by Adrian Majumdar was made at the 2014 Global Forum on Competition (27-28 February) at the session on competition issues in the distribution of pharmaceuticals. Find out more at http://www.oecd.org/competition/globalforum
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OECD Roundtable on Competition Issues in the Distribution of Pharmaceuticals: A UK Retail Perspective
Adrian Majumdar
Paris, 28 February, 2014
2
Overview
• Product market
• Geographic market
• Simple screens for competitive effects analysis
• Complications with simple screens
• Brief introduction to input foreclosure
• Concluding remarks
3
Retail Pharmacies – Relevant Product Market
OFT has identified three types of products requiring separate analysis:*
Prescription only medication (POM): heavily regulated by National Health
Service (NHS) can be purchased only with a prescription from a doctor
Pharmacy only medicines (P-only): must be sold in the presence of a
pharmacist but do not require prescription
General sales list (GSL) medicines: sold in pharmacies as well as
supermarkets, convenience stores and gas stations, and are milder versions of
pharmacy-only medicines
Mergers unlikely to reduce competition for GSL sold in pharmacies due to
sufficient competition from GSL items sold in other channels
* UniChem PLC/ GEHE AG/ Lloyds Chemists PLC
4
Horizontal Concerns: Prescription-only Medicines
OFT historically has identified limited pre-merger competition and hence no material scope for harmful effects caused by a merger in relation to POMs (see Boots/ Alliance UniChem):
• No price competition:
• prices charged for POMs are strictly regulated by NHS
• P-only and GSL are not substitutes for prescription medicines
• Limited non-price competition: location, range, opening hours, quality of service.
• Non-price factors strictly regulated by NHS, and subject to highly incentivised financial reward schemes (e.g. for number of prescriptions served)
• NHS minimum standards for service and required opening times
5
Horizontal Concerns: Pharmacy-only Medicines
OFT found possibility for mergers to harm competition in relation to P-only medicines (see Boots/ Alliance UniChem).
• Price competition: • Some scope for price competition exists
• Non-price competition:• Non-price aspects are strictly regulated• Limited scope for competition effects of a merger on non-price factors
• Interaction with GSL: • Some competitive pressure from GSL, as many P-only medicines are stronger
variants of general medicines.
• Regulation and GSL constraint implies limited scope for lost competition and hence relatively “generous” screens regarding fascia counts
6
Geographic Markets / Screening rule
National level
• Relevant markets are local in nature
• However, OFT considered possible adverse competitive effects nationally might occur if the merger reduced the number of national pharmacy chains from three to two
Local Competition
• OFT adopted a one mile radius
• OFT found that over 75% of consumers travel less than one mile to go to a pharmacy; over 90% travel less than three miles
Screening rule
• Reduction of fascia from “3 to 2” found by OFT to be problematic
• Comments:
• Reduction of fascia from “4 to 3” could be problematic if looks similar to a “3 to 2” (i.e. one rival is weak)
• In practice, “4 to 3” areas may be assessed – though not presumed problematic – given potential for screens to fail to capture important local level complexities...
7
Identifying Areas of Reduced Competition: Fascia Screening
“4 to 3”: pre-merger, there are 4 fascia, post-merger there are 3 fascia.
The OFT would have viewed this structure to be okay.
Merging party’s pharmacy
1 mile / 1.6 km
Other merging party’s pharmacy
Competing pharmacies
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Complications with the Screening Approach (I)
Geographic closeness of competition: In terms of structure, it is a 4 to 3 but in practice the merging parties’ pharmacies may compete together closely due to their geographic location.
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Complications with the Screening Approach (II)
Demand centring: On a supply-centred approach (centred on the red triangle), this is a problematic “3 to 2”. But the source of demand is the doctor’s surgery. From the “demand-centred” perspective, there is no overlap. Example: The brands may be positioned to target different types of area (e.g. “community pharmacy” located in residential area versus “high street pharmacy” located in high footfall areas).
Doctor’s Surgery
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Complications with the Screening Approach (III)
High fascia but high concentration: This is a 4 to 3 and so would “pass” the fascia test. However, the merger would create a high market share in the local area (the merged firm would control 4 of the 6 pharmacies after the merger).
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Input Foreclosure
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2. Upco’s rivals gain market power
UpcoUpco’srivals
Downco’srivals
Downco
1. Upcocompetes less aggressively
4. Upco supplies Downco at cost. Downco gains share from its rivals.
3. Downco’s rivals may face higher input costs
5. Final price determined by relative strengths of efficiency and cost raising effects
Input Foreclosure – Brief Introduction to the Theory
Integrated Wholesaler
Wholesale rivals
Rival Pharmacies
IntegratedPharmacy
1. Integrated wholesaler may compete less aggressively. (But this will not impact on rivals if the integrated wholesaler has no market power.)
2. Wholesale rivals may gain market power.
3. Rival pharmacies may face higher input costs and therefore pass on higher prices, diverting sales to the integrated pharmacy. (But the integrated firm has no incentive to raise rivals’ costs if pass-through is low or diversion to integrated pharmacy is low.)
4. Integrated wholesaler supplies integrated pharmacy at cost or gains logistical efficiencies which put downward pressure on price. 5. Price effect for end consumers
determined by relative strength of efficiency gains for integrated pharmacy versus incentive and ability of integrated wholesaler to raise costs of rival pharmacies.
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Concluding Remarks – Retail Pharmacy Mergers
• In standard retail scenarios the UK authorities usually are concerned with “4 to 3” or worse fascia reductions.
• With pharmacies, due to regulation and GSL constraints, the UK authorities have been concerned (historically) only with “3 to 2” or “2 to 1” cases.
• Where pharmacies are vertically integrated with wholesalers, pharmacy chain mergers may give rise to an input foreclosure concern: this is assessed by considering the ability and incentive to engage in foreclosure and the ultimate effect on end customers.
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Locations and contact
London
The Connection198 High HolbornLondon WC1V 7BDUnited KingdomT +44 20 7421 2410E [email protected]
Brussels
Bastion TowerPlace du Champ de Mars 51050 BrusselsBelgiumT +32 2 792 0000E [email protected]
The Hague
Lange Houtstraat 37-392511 CV The HagueThe Netherlands
T +31 70 302 3060E [email protected]
Madrid
Pinar 528006 MadridSpainT +34 91 745 59 34E [email protected]
Stockholm
Östermalmstorg 1114 42 StockholmSwedenT +46 8 5025 6680E [email protected]
Johannesburg
Augusta House, Inanda Greens54 Wierda Road WestSandton, Johannesburg, 2196South AfricaT +27 11 783 1949E [email protected]
Melbourne
Rialto South Tower, Level 27525 Collins StreetMelbourne VIC 3000AustraliaT +61 3 9935 2800E [email protected]