I have seen numerous instances where Greek and Italian prices are actually on the medicine.
So, is that someone actually avoiding the local wholesaler? You were very limited on the actual details.
What's happening there, Gearoid, is a case of what's called Parallel Importing. Let's say Manufacturer A makes a product B, and had licenses to sell it from the relevant authorities in the various EU countries (In Ireland, it's the IMB, and the license is called a Product Authorisation or PA. There should be a PA no printed on the packaging, if you get your prescription meds in their original box).
The manufacturer sells the product to the various wholesalers in each of the countries. Now this is the vital bit: the price is different in each country. In Ireland, that ex-factory price is set by an agreement between the manufacturers and the Government, and the wholesalers sell it to pharmacies at the ex-factory price plus a 17.66% mark-up (which is equiv to a 15% margin). This is the cost price to the pharmacy, which will have VAT added to it if appropriate. Up to now, this figure (we'll refer to it as the invoice price) is the basis upon which the Govt calculates how much it has to pay the pharmacy. Typically the pharmacy will also use this price as its base for calculating the selling price on a private prescription. My point here is that the pharmacy has NO SAY OR INPUT into what the invoice price is, only in what they do afterwards.
Now, remember I said the ex-factory price is different in each country. In Spain and Greece especially it is only a small fraction of the price here. I'm not sure why, but I believe it has something to do with different intellectual property rights laws there. So why don't we just buy from the spanish factory? It's a free European market, isn't it? Well, yes and no. Pharmacies in Ireland are required by law to purchasse their supplies from wholesalers that are licensed in Ireland. And in general, the product they supply is the product that comes direct from the manufacturer.
That is where Parallel Importing comes in. There are a small number of companies who engage in this practice. A couple of examples are PCO and Imbat. What they do is track fluctuations in prices of various meds in various countries. When they ID a product and a pair of countries where the difference in price is big enough to make it worth their while, they will:
a) Apply for a Parallel Product Authorisation (PPA) number from the IMB (or corresponding body in destination country)
b) Buy up all of the product they can get their hands on
c) Do whatever labelling/repackaging they have to do to satisfy legal conditions in destination country. This will include the PPA no printed on the packaging, similar to the PA number mentioned above
d) sell the repackaged product for the best price they can get (which, if they want it to be reimbursible on Govt-paid schemes, has to be agreed with the Govt in the same way as the 'regular' products are)
Once again, the pharmacist has no say in the price he pays.
By the way, this is all perfectly legal.
If you get a product from a pharmacy that has, for example, the days of the week printed in French, this is probably a Parallel Import. In some cases, and one that I know about is Spain, there will be a price printed on the box, beside the barcode or the expiry date. As far as I know, but I am open to correction on this, this price is what the pharmacy in Spain would buy the product from a Spanish wholesaler for, NOT the price that the consumer pays in the Spanish pharmacy.
So why don't all pharmacies just use the Parallel products? A couple of reasons. Firstly, some patients don't like them or trust them. Secondly, not very many products are available in this way as it only happens if the price differentials are right. Thirdly, only a comparitively small amount of each product is available, as the Parallel Importers have to pick up what they can in the source country, without leaving a shortage of supply there. Fourthly, the price difference by the time the Parallel Importer has done his bit is really not usually very much, and it may not be worth a pharmacy's while various reasons such as he may fall beneath a target set by his main wholesaler.
Unfortunately, there do exist SOME pharmacies who exploit this for their own benefit. If your pharmacy is supplying you with a PI product, you should make sure that they're CHARGING you for the PI product, so that YOU'RE the one to benefit from this reduced cost. MOST pharmacies who supply PIs will do this as a matter of course. However, as in every barrel, there may be a couple of rotten apples.
Hope this helps. Your questions/doubts about Spanish prices etc should be answered now. Answers to other questions are for another post; this one's long anough already!
One more thing, though, and if you have read all the previous posts you'll know that yes I'm a pharmacist and no I don't own a shop. My interest has been declared. Please believe me when I tell you that there is no cosy cartel of pharmacists keeping prescription prices artificially high compared to Spain etc. The difference in prices are ALMOST ALL caused by the fact that we have to buy them at a much higher price than in other countries, and then we have to try to make a profit when we sell. And as everyone knows, that's getting harder and harder these days (and will become virtually impossible if/when the minister's cuts go ahead).