In January 2021 there were 63 wholesalers in Estonia and three of them were specialized only on veterinary medicines. For information about acivity licences, visit: Activity licence search.
In 2021, 30 wholesalers sold human medicines to general or hospital pharmacies or to other institutions. Two major wholesalers covered 75.3% of human medicinal products market: Magnum Medical (45.7%) and Tamro Estonia (29.6%). Followed by Estonian Health Board (11.5%), Baltfarma (5.5%) and Roche Estonia (4.7%). The total market share of the other wholesalers was under 3%.
Medicinal products market of human medicines
The medicinal products market is expressed in wholesale prices, which includes the price of the manufacturer and wholesaler’s mark-up and does not include the VAT.
As we can see from Fig. 1, the medicinal products market has grown rapidly during the last five years. In 2021 the human medicinal products market exceeded 400 million euros for the first time. Compared to 2020, the increase was 14% (in total 50 million euros) and the market share reached 409 million euros.
Figure 1. Estonian medicinal products market in 2017-2021
Sales to general pharmacies covered 64% (261 million euros) and sales to hospital pharmacies 28% (116 million euros) of total medicinal products market. If in previous years the sales to other institutions has covered about 1% (around 4 million euros) of the market, then in 2021 its share was 8% (32 million euros). This remarkable change was due to Covid-19 vaccines, which covered 26 million euros of it.
The proportion of prescription sales was 87.6% which comparing to over-the-counter sales (11.8%) and hospital package sales (0.6%) covered most of the medicinal products market. Analysing the turnover by quarters, then usually medicinal products market can be characterized by seasonality: the turnover of prescription medicines is higher in 2nd and 4th quarter (Fig. 2), whilst the sales of over-the-counter medicines increase in 1st and 4th quarter (Fig 3). Year 2020 was exeptional due to Covid-19 crisis. Due to that, the turnover was unexpectedly high in first quarter just before the lockdown and was unusually low in the second quarter. Nevertheless, the situation stabilised in the second half of 2020. During 2021 the normal seasonal trend continued and for the 4th quarter the medicinal products market reached its highest level.
Figure 2. Prescription medicines turnover in 2017-2021 quarterly
Figure 3. Over-the-counter medicines turnover in 2017-2021 quarterly
Medicinal product market share and drug consumption
Based on ATC classification the greatest market share of medicines belonged to antineoplastic and immunomodulating agents (22%) and antiinfectives for systemic use (19%), of which one third were Covid-19 vaccines. Alimentary tract and metabolism medicines as well as blood and blood forming organs covered 10.5% of total market share. These four ATC groups covered 62% of total market share of medicines (Fig. 4).
Figure 4. Estonian medicinal products market share between ATC groups in 2019-2021
DDD/1000/day describes often population drug consumption better than turnover which can be quite unstable, for example new generic drugs that come to market affect prices greatly or the fact that some medicines are remarkably expensive, i.e. antineoplastic and immunomodulating agents, antiviral medicines.
Defined Daily Dose (DDD) is the assumed average dose per day for the drug used in its main indication in adults. Defined Daily Dose per thousand inhabitants a day (DDD/1000/day) expresses the proportion of the population within a defined area treated daily with certain drugs. However, the DDD system cannot be applied to all medicines, mainly due to very individual dosing. For example, most of the dermatological medicines as well as antineoplastic and immunomodulating agents or preparations in ATC group Various (diagnostic agents, contrast media) have not been assigned DDDs.
Analysing the medicinal product consumption in Estionia by using the unit DDD/1000/day, we can see that the most consumed medicines in 2021 were cardiovascular system drugs (450 DDD/1000/day), forming more than one third of the total consumption of medicines. Alimentary tract and metabolism medicines cover 15% (188 DDD/1000/day) and nervous system medicines 12% (148 DDD/1000/day) of the total consuption (Fig. 5).
Figure 5. Consumption of medicinal products in Estonia in 2021 (defined daily doses per 1000 inhabitants a day)
Based on DDD/1000/day, the most used active substances of prescription medicines were:
- Ramipril (53 DDD/1000/day),
- Rosuvastatin (45 DDD/1000/day) and
- Atorvastatin (34 DDD/1000/day).
And of OTC drugs were the combination of
- Acetylsalicylic acid and Magnesium oxide (40 DDD/1000/day),
- Ibuprofen (25 DDD/1000/day) and
- Xylometazoline (22 DDD/1000/day).
In 2021, 4451 different medicinal preparation packages and 1355 active substances were marketed in Estonia.
More information about medicines consumption in Defined Daily Doses can be found:
Summary of 2021 medicinal product market:
- Medicinal products market: 409 million euros
- Sales to general pharmacies: 261 million euros
- Sales to hospital pharmacies: 116 million euros
- Sales to other institutions: 32 million euros
- Antineoplastic and immunomodulating agents: 92 million euros
- Antiinfectives for systemic use: 76 million euros
- Alimentary tract and metabolism medicines: 43 million euros
- Medicines for blood and blood forming organs: 43 million euros
Last updated: 31.08.2022