One of the quickest and easiest ways to bring health services closer to consumers is to extend the ability to sell selected over-the-counter (OTC) medications in retail outlets while expanding the competencies of pharmacies.
In terms of the openness of OTC medication sales, there are no uniform rules across Europe. About half of European countries allow OTC medicines to be sold outside pharmacies under various conditions. These conditions often include a restricted list of OTC medications and requirements such as staff training, storage standards, age restrictions, and more. We have analyzed the Slovak pharmaceutical market and proposed several liberalization measures.
| Countries not allowing sales of OTC medicines outside pharmacies: | Countries allowing sales of OTC medicines outside pharmacies: |
| Slovakia Belgium Cyprus Estonia Finland France Latvia Luxembourg Malta Germany Austria Spain |
Czech Republic
Denmark Greece Netherlands Ireland Lithuania Hungary Norway Poland Portugal Slovenia United Kingdom Sweden Italy Bulgaria Croatia Romania Switzerland |
Slovak Market Should Adopt Czech OTC Model
The market in Slovakia has undergone dynamic development, including the creation of both street and virtual pharmacy networks, the emergence of private-label products and loyalty programs, and the growth of online stores. Some Slovak pharmacies have started offering extended services, especially simple diagnostic tests, on a commercial basis.
The number of public pharmacies in Slovakia has increased by approximately 50 % over the last 15 years, reaching over 1,800 pharmacies—about 30 % more per capita than in the Czech Republic and slightly above the European average.
However, Slovakia does not allow the sale of any OTC medications outside pharmacies. While the pharmacy network in the country is relatively dense, access to these services is limited due to their concentration in urban centers and reduced opening hours. As of 2025, there is not a single pharmacy in the country open after 10:00 PM.
There is a growing number of online pharmacies offering delivery services and delivery boxes for OTC sales, although delivery can take at least half a day, usually longer, and therefore is not suitable for acute needs. At INESS, our objective is to liberalize the market, employ market forces to achieve greater efficiency, and bring services closer to consumers. Therefore, we have begun advocating for the liberalization of selected OTC medication sales outside pharmacies.
Arguments in favor of liberalization include greater accessibility, patient empowerment, reduced costs for both the system and the patient, and alleviating pressure on outpatient physicians. Opponents cite potential risks, such as side effects or delayed diagnoses. In the Slovak context, traditional pharmacies also argue that liberalization could harm the financial viability of smaller pharmacies and reduce overall accessibility, especially in remote regions.
We addressed these concerns in an analytical paper and advocate for fully implementing the Czech model of OTC medication sales. In the Czech Republic, partial liberalization of OTC sales began in 1998 and became widely practiced in 2012. Currently, there are about 3,500 points of sale for “reserved medicinal products.” Under strict regulations, these outlets include retail stores, petrol stations, and other entities, such as doctor offices, spas, or municipal facilities.
The list of approved OTC medications in the Czech Republic includes 86 products from 16 substance groups, selected by the national drug regulatory body based on factors such as the risk of side effects, potential misuse, and experience with the active ingredients. The list includes painkillers, anti-inflammatories, antihistamines, disinfectants, anti-nausea drugs, indigestion remedies, and nicotine cessation products. Vendors must adhere to storage and logistics requirements and complete certified training. Many choose turnkey suppliers for these services, including training programs.
Pharmacy Deserts: Addressing Ambiguous Issue
We demonstrated through financial data that Czech pharmacies were minimally impacted by OTC liberalization. Both Czech and Slovak pharmacies are more significantly influenced by other trends, such as market concentration, the growth of online OTC sales (18% of the OTC market in Czechia and 10% in Slovakia), and the introduction of new services in both online and offline pharmacies.
The concept of “Pharmacy Deserts” (poorly served rural areas without nearby pharmacy access) resonates strongly in public debates in Slovakia. Our analysis of regional data in central Slovakia indicates that pharmacies are indeed disappearing from villages, but the decline is moderate. Some experts, and in particular pharmacy lobbyists, argue that retail sales of OTC medicines would exacerbate the situation.
The issue of “Pharmacy Deserts” is not well-defined. Slovakia is one of the least urbanized countries in Europe, and the concentration of services—and population—is a natural and desired development. However, we suggest several measures to improve regional access to pharmaceutical services in Slovakia.
These measures include leveraging new technologies like telepharmacy, deregulating the delivery of prescription medications, and creating new revenue streams for brick-and-mortar pharmacies. Examples include allowing pharmacies to provide vaccinations, basic diagnostics, health screenings, and prescription services. Shifting these services to Slovakia’s extensive pharmacy network, staffed by highly trained professionals, would not only improve access to these services but also reduce pressure on general practitioners.
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