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Executive Summary

Mail Order and Internet Pharmacy in Europe the 2015 edition - Entering the Digital Battle Ground

There has been a huge change in the European mail order and Internet pharmacy landscape since the last edition of this study in 2012. Much of this is due to the rapid pace of developments in the e-commerce sector as a whole. Yet since 2012 France, Italy and Austria have at last cleared the legal hurdles allowing their domestic businesses to enter the online pharmacy sector.

356 million Internet users live in the 17 countries covered in this edition of Mail Order and Internet Pharmacy in Europe. There are around 7,000 authorised pharmacy e-commerce websites some of which operate as small scale independent businesses, others are larger cross border ‘pure play’ mail order pharmacies and many are integrated into the multi-channel strategies of leading pharmacy chains. Yet among the major innovations challenging ‘pure play’ mail order and Internet pharmacies sweeping in from North America is the development of a multi-channel seamless shopping experience. This they call omni-channel retailing and it is the new digital battle ground.

The integration of PCs, notebooks and mobile app technologies into traditional pharmacy retailing to capture the multi-channel shopping audience is an emerging trend in the USA. According to Walgreens, America’s largest drugstore chain, multi-channel shoppers are estimated to be three times more valuable than a single-channel shopper and so the company is evolving technology based strategies to capture this valuable audience.

Across Europe a number of major retail groups are combining traditional pharmacy with Internet pharmacy and online medical consultation services to capture specific target audiences seeking confidentiality, convenience and low prices. In Austria and Germany druggist chains are partnering with online pharmacies in order to capture a share of the healthcare sector which until now has been the exclusive province of pharmacies.

Today, the Internet and mail order pharmacy channel is breaking through as a rapidly growing, new and challenging retail channel. It is expanding its scope to include a wide range of front end pharmacy categories such as cosmetics, hygiene, dietary supplements and medical devices. In some European States repeat prescriptions, contraception and orthopaedic care are included in an ever widening repertoire of lines.

Table Of Contents

Mail Order and Internet Pharmacy in Europe the 2015 edition - Entering the Digital Battle Ground
Contents
Chapter 1 16
Mail order and Internet Pharmacies in Europe Entering the Digital Battleground. 16
Table 1: Share of Internet Users Compared with total B2C e-Commerce in Europe's Main Markets.. 16
From ‘Pure play' Pharmacies to Omni-channel Drugstore Chains 17
Table 2: Non-prescription and Prescription only Medicines Status for Mail Order and Internet Pharmacy in European Countries under Study.. 18
The Legal Status of Mail Order and Internet Pharmacies for Medicines in Europe.. 19
History of the Legal Status of Mail Order and Internet Pharmacies for Medicines in Europe 20
European Measures against Dubious Mail Order Pharmacies.. 21
Different Models . 22
Figure 1: Key Characteristics of the different Types of Mail Order and Internet Pharmacy in Europe 24
Traditional Independent Pharmacies in Europe with Online Services 25
‘Pure play' Online Mail Order Pharmacies in Europe 25
Top ‘Pure play' Pharmacy E-commerce Websites in Europe . 26
Graph1: Leading ‘Pure play' Mail Order and Internet Pharmacies in Europe - based on estimated euro Turnover for 2014 . 27
Online Consultation Pharmacies in Europe .. 29
Table 3: Legally Operating Online Doctor Consultation Services in Europe 2014 30
Pharmacy Chains Multi-channel and Omni-channel retailing in Europe .. 31
Pharmacy chains with Multi-channel Strategies in Europe 32
Online Pharmacy Portals Linking Independent Pharmacies in Europe.. 34
Online ordering for Non-pharmacy Pick-up Points in Austria and Germany .. 34
Table 3: Mass Market Retail Chain Partnerships with Mail order and Internet Pharmacy Partners 36
Conclusions - The Future Evolution of Mail order and Internet Pharmacy Business Models in Europe 36
Chapter 2 38
The Development of Mail Order and Internet Pharmacy in the USA 38
Mail Order and Internet Pharmacy - in the USA 38
VIPPS Accreditation Program . 38
Americans Seeking Health Information Online 39
Graph 1: US Consumers Seeking Information about Health Online 39
Table 1: US Consumers Purchasing Healthcare . 40
Share of the US Pharmacy Market by Channel 40
Graph 2: How the US Market for Prescription Medicines and OTC Health and Personal Care is divided between Retail and Mail Order Channels 41
Prescription Pharmaceutical Market in the USA. 41
Graph 3: % Share of the US Prescription Pharmaceutical Market by Channel - estimated for 2014. 42
Table 2: % Value Turnover Share of the US Prescription Pharmaceutical Market by Channel 2008
to 2013 42
USA - Mail Order Service - Pharmacy Benefits Managers (PBMs) 43
Graph 4: USA - % Growth of Mail Order Pharmacy Turnover 2009 to 2013 (est . 43
The Role of Pharmacy Benefit Managers and their Influence on the Development of Mail Order and Internet Pharmacy in the US. 44
Figure 1: The Role of Pharmacy Benefits Managers (PBMs) in Processing and Reimbursing Prescription Medicine Claims in the US. 45
Graph 5: USA Market Share Top 10 Leading Pharmacy Benefit Managers (PBMs) in the US 46
Graph 6: Top 10 Leading Pharmacy Benefit Managers (PBMs) in the US - Number of Prescriptions 47
Express Scripts.. 47
Graph 7: Express Scripts Mail Order and Speciality Pharmacy Business compared to Net Revenues 2011 - 2013 48
CVS/ Caremark Rx, Inc. . 48
Graph 8: CVS Health Pharmacy Services Segment - Mail Order and Speciality Pharmacy Business compared to Net Revenues 2011 - 2013 .. 49
USA - Consumer OTC Health and Personal Care Market . 50
Graph 9: US OTC Health and Personal Care Market % Share by Category .. 50
Graph 10: US OTC Health and Personal Care Market % Share by Retail Channel 51
Table 3: Beauty and Personal Care Top Destinations for Online Shoppers. 51
Chain Drugstores in the USA .. 51
Table 4: US Leading Drugstore Chains - Estimated Sources of Net Revenues .. 52
Table 5: US Leading Drugstore Chains - % Share of USA Prescription Medicine Dollars 2013/14 52
US Drugstores' Omni Channel Retail Strategies.. 52
Graph 11: USA Location-based Signal Technology - In store Use of Smart phones by Category . 54
USA Drugstores - Walgreens - Evolving Omni-channel Retail Model. 54
Graph 12: % Share of Walgreens Sales by Category 2013/14 55
Walgreens Omni-channel Pharmacy Experience 55
Walgreen's -Drugstore.com Acquisition 56
Graph 13: % Share of Drugstore.com Sales by Category .. 57
Sam's Club Example of Using Mobile Apps and Tablets for Scanning QR Codes and
Receiving E-values Discounts . 57
Online Consultation Pharmacies .. 58
Conclusions - Mail Order and Internet Pharmacy in the USA .. 59
Chapter 3 61
Mail Order and Internet Pharmacy Development. 61
The German Experience 61
Mail order and Internet Pharmacy in Germany.. 61
Graph 1: Top e-commerce Countries in the World . 61
History of Mail order and Internet Pharmacy in Germany . 61
Mail order and Internet Pharmacy Landscape in Germany 62
Turnover of the German Mail Order Pharmacy Sector by Product Group 62
Internet Access in Germany 63
Graph 2: Germans Who Buy Goods and Services on the Internet .. 64
Germans Seeking Health Information on the Internet. 64
Germans Searching for Information about Non-prescription OTC Medicines on the Internet 65
Graph 9: German Adults Source of Information about Non-prescription Medicines. 65
Germans Purchasing Healthcare on the Internet 65
Graph 3: Number of Times Germans who claimed to have purchased from Mail Order Pharmacies in Last 3 Years 66
Graph 4: Age of Germans who claimed to have Purchased from Mail Order Pharmacies in Last 3 Years 66
Germans Purchasing Non-prescription Medicines by Mail Order and Internet Pharmacies 67
German Consumers Frequency of Shopping in Pharmacies .. 67
Table 1: Frequency of Consumer Visits to Pharmacies in Germany 2014 67
German Consumers Multi-channel Shopping for Healthcare 68
Table 2: Reasons Consumers in Germany Give for Choosing a Pharmacy .. 68
Health and Personal Care Sales through Mail Order and Internet Pharmacies in Germany 68
Graph 5: Internet and Mail Order Pharmacy Share of Sales by Category 2013 69
Non-prescription OTC Medicine Sales through Mail Order and Internet Pharmacies in Germany . 69
Graph 6: Sales of Non-prescription Healthcare through Mail Order Pharmacies in Germany.. 70
Graph 7: % Split of Sales of Non-prescription and OTC Medicines through Mail Order Pharmacies
in Germany by Category 71
Healthcare Therapeutic Categories most frequently bought through Mail Order and Internet Pharmacies in Germany.. 71
Graph 8: Germany - % Share of Pharmacy only Non-prescription Medicines Bought through Mail
Order Channels by Therapeutic Categories . 72
Prescription only Medicines Purchased through Mail Order and Internet Pharmacies in Germany . 73
Cosmetics and other Personal care Products purchased through Mail Order and Internet
Pharmacies in Germany 73
Mail Order and Internet Pharmacies Challenging Traditional Pharmacies in Germany . 73
Graph 9: The Number of Pharmacies in Germany 1995 to 2013.. 74
Mail Order and Internet Pharmacies - Medium sized Businesses in Germany? 75
Table 3: Number of Pharmacies in Germany with a Mail Order License.. 75
Top Mail Order and Internet Pharmacy Brands in Germany . 76
Graph 10: % Share of Internet and Market Mail Order Pharmacies in Germany 2013 . 76
Brand Awareness of Mail Order Pharmacy Brands in Germany .. 76
Table 4: Consumer Awareness of Mail Order Pharmacy Brands - Customers compared to Nonusers 77
Share of Consumer Shopping for Mail Order Pharmacy Brands in Germany.. 77
Table 5: % Consumers claiming to have Purchased from Mail Order Pharmacies .. 78
Consolidation of the Internet and Mail Order Pharmacy Channel in Germany . 78
Zur Rose - the Largest Mail Order Pharmacy Group in Germany as a Result of
Acquisitions and Multi-channel Strategies 79
Europa Apotheek Venlo (EAV) - Shop-apotheke Mail order and Internet Pharmacy in Germany . 81
German Druggist and Grocery Chains Multi-channel Healthcare Strategies through ‘Pickup Point' Collaboration with ‘Mail Order Pharmacies . 81
Pioneers of Multi-channel Drug-market Pharmacy Strategies in Germany Europe Apotheek Venlo and DM.. 82
Other Mail order and Internet Pharmacies with Tie-ups to Non-pharmacy German Retail Chains 83
Development of On-line Services by Pharmacy Cooperation Groupings in Germany . 83
Table 6: Leading Pharmacy Cooperation Groups Online Customer Services in Germany 84
The Future for Mail Order and Internet Pharmacies in Germany 85
Chapter 4 88
Mail order and Internet Pharmacy Development in Switzerland 88
The Rise of Mail Order and Internet Pharmacy in Switzerland. 88
Graph 1: % Share of Swiss Pharmaceutical Market by Channel 2013 89
Table 1: Switzerland - Mail order Pharmaceutical Sales Compared to other Channels 2004 to 2013 est. CHF millions at Manufacturers' Prices 89
Graph 2: Swiss Pharmaceutical Market % Value Growth by Channel 2005-2009 compared to 2009 - 2013. 90
Mail order and Internet Pharmacy Channels in Switzerland . 91
Graph 3: Switzerland - Market Shares of Leading Mail Order and Internet Pharmacies. 91
Switzerland - ‘Direct Dispatch' Home Delivery Pharmacies 92
MediService - Swiss Distance Speciality Pharmacy Concept.. 92
Zur Rose - Online Pharmacy Switzerland, Germany and Czech Republic.. 94
Zur Rose in the Development of Apps and Mobile Technology 95
Statutory Health Insurers in Switzerland Collaboration with Mail Order Pharmacies 96
Major Pharmacy Chains in Switzerland - Internet Offer . 97
Table 2: Switzerland - Online Services by Leading Pharmacy Chains. 97
Conclusions for Mail order and Internet Pharmacies in Switzerland . 97
Chapter 5 99
Arrival of Mail Order and Internet Pharmacies in Austria. 99
Mail Order and Internet Pharmacies in Austria.. 99
Austrians' Access to Online Healthcare.. 99
Austrian Consumers Seeking Health Information and Using Internet Pharmacies .100
Graph 1: Austria - % Respondents using Internet Pharmacies by the Number of Times they Shopped the Channel in last 24 Months. 100
Graph2: Austria - % Respondents by Average Value of Cart when Shopping at Internet Pharmacy in last 24 Months . 101
Reasons Why Austrian Consumers Purchase from Online Mail order Pharmacies .101
Graph 3: Austria - % Respondents - Reasons for Shopping Online Pharmacies . 102
Consumer Awareness and Usage of Online Mail Order Pharmacies Brands in Austria .102
Graph 4: Austria % Of Respondents Claiming to be Familiar with Internet Mail Order Pharmacy Brands.. 103
Graph 5: Austria % Respondents Claiming to Shop Internet Pharmacies by Pharmacy Trade Name 104
The Main Players Internet and Mail Order Pharmacies in Austria.104
The future for Mail order and Internet Pharmacy in Austria107
Chapter 6 ..108
Multi-channel Pharmacies in the UK.108
Mail Order and Internet Pharmacies in the UK..108
Graph 1: UK % All Adults in the Who Purchased Online 2013. 109
Online Healthcare - Consumers' Usages and Attitudes in the UK .109
Graph 2: UK - % All Adults Using the Internet Seeking Health Related Information 2013 110
British Pharmacy Shoppers by Type of Pharmacy they Choose ..110
Graph 3: UK - % Types of Pharmacies from which Respondents bought Products in last 12
Months 2014 (Allows for Multiple Answers) 111
What do British Pharmacy Shoppers buy On-line? ..111
Graph 4: UK - % Respondents Types of Products bought from an Online Pharmacy in last 12 Months 2014. 112
Why Do British Pharmacy Shoppers buy Online112
Table 1: UK - Reasons why British Pharmacy Shoppers buy On-line .. 112
Table 2: UK - Most Used Pharmacy Websites - High Street Retailers Compared to ‘Pure play' Online Pharmacies. 113
Mail Order and Internet Pharmacies in the United Kingdom ..113
History of Mail Order and Internet Pharmacies in the UK.114
Table 3: Leading Pharmacy Chains and Number of Outlets in the United Kingdom 2013 115
‘High Street Pharmacy Chains' Role in Pharmacy e-commerce in the United Kingdom 115
Table 4: Top 20 Pharmacy Chains in the UK with Online Pharmacy Status.. 116
Multi-channel Shopping Driving online Pharmacy116
British Consumers Source of Internet Pharmacy Purchases .117
Graph 5: Respondents Source of Online Pharmacy Purchase 2014(Multi responses) .. 117
Development of Multi-channel Pharmacy Strategies in the United Kingdom ..117
Boots the Chemist Omni-channel Retail Drugstore in the United Kingdom ..118
Top ‘Pure Play' Internet Pharmacies in the UK..120
Online Doctor Consultation Clinics in the UK registered as Independent Medical
Online Animal Health Pharmacies in the UK ..124
Conclusions Mail Order and Internet Pharmacies in the United Kingdom .124
Chapter 7 ..126
Mail Order and Internet Pharmacies in the Netherlands .126
Mail Order and Internet Pharmacies in the Netherlands ..126
Graph1: Netherlands - % of Internet users Making Purchases through the Internet in the previous 12 months 126
Dutch Pharmacy Chains Internet based Multi-channel Strategies.128
Table 1: Main Pharmacy Chains in the Netherlands 2014. 129
Online Health and Beauty and Non-prescription OTC Medicine Sales through Druggist
Chains in the Netherlands..131
Independent Pharmacy Web sites in the Netherlands131
Online Medical Consultation websites in the Netherlands ..132
Internet Pharmacies in the Netherlands - Conclusions..132
Chapter 8 ..133
Mail Order and Internet Pharmacies in Belgium..133
Mail Order and Internet Pharmacies in Belgium ..133
Graph1: Belgium - % of Internet users making Purchases through the Internet in the previous 12 months. 133
Conclusions Belgium.136
Chapter 9 ..138
Mail Order and Internet Pharmacies in Denmark, Finland, Norway and Sweden .138
Development of Mail order and Internet Pharmacies in Denmark138
Table 1: Denmark - Population Access and Usage Frequency of the Internet 2013 138
Graph1: Denmark - % of Internet users making Purchases through the Internet in the previous 12 months.. 139
Graph 2: Denmark - Share of Medicinal and Cosmetics Market by Retail Channel. 139
Virtual Pharmacy Chains in Denmark providing Internet Access 141
Development of Mail order and Internet Pharmacies in Finland142
Table 2: Finland - Population Access and Usage Frequency of the Internet 2013 142
Graph 3: Finland - % of Internet users Making Purchases through the Internet in the previous 12 months. 143
Development of Mail Order and Internet Pharmacies in Norway .145
Table 3: Norway - Population Access and Usage Frequency of the Internet 2013.. 145
Graph 4: Norway - % of Internet users making Purchases through the Internet in the previous 12 months. 146
Table 4: Market Shares Leading Retail Pharmacy Chains in Norway 2013 147
Development of Mail order and Internet Pharmacies in Sweden..148
Table 5: Sweden - Population Access and Usage Frequency of the Internet 2013.. 148
Graph 5: Sweden - % of Internet users making Purchases through the Internet in the previous 12 months. 148
Re-regulation of Sweden's Pharmacy Structure 149
Graph 6: The number Pharmacies owned by leading Chains in Sweden 2013 150
Sweden's Leading Pharmacy Chains adoption of Multichannel Strategies in 2014.150
Table 6: Sweden Pharmacy Chains URLs 151
Chapter 10 153
Mail Order and Internet Pharmacies in Poland 153
The Internet Population in Poland..153
Table 1: Poland - Population Access and Usage Frequency of the Internet 2013 153
Graph 1: Poland - % of Internet users making Purchases through the Internet in the previous 12 months. 154
Polish Consumers Using the Internet for Health Related Information.154
Table 2: Poland - % Polish Population Seeking Health Related Information from the Internet in Last 12 Months 154
Table 3: Sources of Information about Health, Proper Nutrition, Prevention and Treatment of Diseases .. 155
Table 4: Influence of Internet Information on Purchasing Healthcare Product Decisions 155
Development of Mail Order and Internet Pharmacies in Poland156
Estimating the Internet Opportunity for Pharmacy in Poland.157
Growth of ‘Pure play' Online Pharmacies in Poland 158
Table 5: Leading Internet Pharmacies in Poland 158
Dom Zdrowia, Poland's first Online Pharmacy ..159
Table 6: Dom Zdrowia Selected Financial data 159
Apteki dbam Zdrowie (I care for my Health) Health Portal and Multi-channel Pharmacy 159
Independent Retail Pharmacy Chains in Poland 160
Table 7: The largest Independent Retail Pharmacy Chains in Poland . 160
“Online Pharmacy and Traditional Pharmacy Networks in Poland161
Online Shopping Portals..162
Conclusions Mail Order and Internet Pharmacies in Poland 162
Chapter 11 164
Internet Pharmacies and Distance Selling of Pharmaceuticals in the Czech Republic 164
Table 1: Czech Republic - Population Access and Usage Frequency of the Internet 2013 .. 164
Graph 1: Czech Republic - % of Internet users making Purchases through the Internet in the previous 12 months 165
Czech Consumers Seeking Health Information on the Internet ..165
Table 2: Czech Republic- % of Population Seeking Health Related Information on the Internet165
The Development of Internet Pharmacies in Czech Republic ..166
Collaboration and Multi-channel Models.166
Dr Max Multi-channel Development .167
Chapter 12 168
Internet Pharmacies Slovakia ..168
Table 1: Slovakia - Population Access and Usage Frequency of the Internet 2013 . 168
Graph 1: Slovakia - % of Internet users making Purchases through the Internet in the previous
12 months.. 169
Slovakian Consumers Seeking Health Information on the Internet ..169
Table 2: Slovak Republic- % of Internet Users (last 3 months) Seeking Health Related Information on the Internet 169
The Development of Internet Pharmacies in Slovakia 170
Slovakia - Pharmacy Cooperative Groupings involved in e-commerce 171
Table 3: Slovak Republic - Main Cooperative Pharmacy Groupings - Involvement in e-commerce. 172
Wholly Owned Pharmacy Chains - Participating in e-commerce 172
Table 4: Slovak Republic - Leading Retail Pharmacy Chains - Online services and e-commerce. 173
Chapter 13 174
Mail Order and Internet Pharmacies Hungary..174
Table 1: Hungary - Population Access and Usage Frequency of the Internet 2013. 174
Graph 1: Hungary - % of Internet users making Purchases through the Internet in the previous 12 months.. 175
The Development of Internet Pharmacies in Hungary 175
Online Services from Hungary's Main Pharmacy Chains 176
Chapter 14 177
Mail Order and Internet Pharmacies in France.177
Mail Order and Internet Pharmacies the Laggard Markets in Europe..177
Mail Order and Internet Pharmacies in France..177
Table 1: France - Population Access and Usage Frequency of the Internet 2013 178
France - Online Pharmacy Market Values 178
Graph 1: France - % of Online Shoppers Most Favoured Online Shopping Destinations for Beauty
and Personal Care.. 179
Internet Pharmacies in France..179
Table 2: France - Number of Authorised Pharmacy Web Sites by Region. 180
Internet based Services of Leading French Pharmacy Groups and Virtual Chains of
Pharmacies180
Table 3: Online Offerings Leading Voluntary Groupings and Virtual Chains of Pharmacies in France .. 181
The Future for Internet Pharmacies in France 182
Chapter 15 183
Mail Order and Internet Pharmacies in Italy .183
Table 1: Italy- Population Access and Usage Frequency of the Internet 2013 .. 183
Graph 1: Italy - % of Internet users making Purchases through the Internet in the previous 12 months. 184
Online Service Leading Italian Pharmacy Groups and Virtual Chains of Pharmacies..185
Conclusions - Internet Pharmacies in Italy ..186
Chapter 16 187
Mail Order and Internet Pharmacies in Spain187
Table 1: Spain- Population Access and Usage Frequency of the Internet 2013. 187
Graph 1: Spain - % of Internet users making Purchases through the Internet in the previous 12 months. 188
Spain - Profile of Internet Pharmacy Shoppers and the Types of Products they Choose..188
Table 2: Spain- Consumers who Shop Online Pharmacies - What they Buy .. 189
The Development of Internet Pharmacies in Spain .189
Conclusions Mail Order and Internet Pharmacy in Spain ..190
Chapter 17 191
Conclusions of the Report - The Future for Mail Order and Internet Pharmacy in
Europe 191
Figure 1: Matrix showing the Evolutionary Splits in the Mail Order and Internet Pharmacy
Landscape .. 192
Factors influencing the Future Shape and Development of the Mail Order and Internet
Pharmacy Landscape in Europe195
The Growth of e-commerce in general as access to the Internet increases and
Consumers become increasingly Confident in making Transactions Online..195
Regulatory trends across the European region have had their Impact on both the Shape
of the Market and the Speed of Development ..196
European Measures to improve Consumer Safety, Security and trust in Mail Order and
Internet Pharmacies .196
Consolidation of ‘Pure play' Pharmacy Ownership and Growth of Cross Border Clusters..197
Developments in e-commerce in Newly Regulated European States since 2012.198
Multi channel Retail Pharmacy Chains are Emerging in Sweden 200
The Response of Retail Pharmacy Chains and other organised Retail Groupings to the
Challenges posed by ‘Pure play' Mail order and Internet Pharmacies .201
Mail Order and Internet Pharmacy Developments in Switzerland - a Special Case202
Multi-channel and Omni-channel Retail Drugstore and Pharmacy Chains.203
Portals - Collectives of Independent Pharmacies and Variants204

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