There are currently only three 24-hour pharmacies operating in all of Estonia. This means that people with minor health concerns, for example, may turn to hospital emergency departments because they have nowhere to buy medication in the evening.

"In such cases, people either have to make a long trip to Tallinn or Tartu or they can go to the emergency department of a hospital near where they live. This undoubtedly puts additional strain on our emergency departments, which is something none of us wants," said Mari Amos, a healthcare organization adviser at the Ministry of Social Affairs.

Last week, the government approved a bill amending the Medicinal Products Act that would, among other things, allow pharmacies to install special vending machines to dispense medications.

Pharmacy vending machines would allow people to obtain both over-the-counter and prescription medications around the clock. A pharmacist would provide advice via video call when customers purchase medication.

"Consultation before purchasing medication from a pharmacy vending machine is mandatory. This service would be available 24/7, meaning there would be an employee remotely managing one or more pharmacy vending machines around the clock," Amos said.

However, pharmacies are cautious about the proposed change. Ly Rootslane, head of the Estonian Association of Pharmacist-Owned Pharmacies, emphasized that patients need broader healthcare support in addition to medication, something vending machines cannot provide.

"We offer various services, such as distributing at-home cervical cancer screening tests, measuring various health indicators and administering vaccinations. Pharmacists are medication specialists who support people in managing their own health and look at the person as a whole," Rootslane said.

To prevent vending machines from driving brick-and-mortar pharmacies out of business, the bill would impose restrictions on their installation. For example, a pharmacy operator would be allowed to install up to 10 machines. In settlements with fewer than 4,000 residents, a machine would have to be located at least one kilometer from a pharmacy operated by another company. However, Rootslane said these safeguards may not be sufficient.

"A number of pharmacies in smaller communities across Estonia have closed recently and giving pharmacy vending machines a competitive advantage could lead to even more closures. Furthermore, if a small pharmacy does close because of a vending machine and the vending machine operator eventually concludes that the business is not profitable, that community could end up without any access to a pharmacy at all," Rootslane said.

The Ministry of Social Affairs recognizes the vulnerability of rural pharmacies but does not see vending machines as a major threat. According to Amos, the viability of pharmacies in rural areas depends primarily on the number of regular customers. Installing a vending machine also requires a substantial financial investment.

"Unfortunately, we are already seeing pharmacies close in smaller communities even without vending machines. This is primarily because there are relatively few customers in these areas to keep a pharmacy financially viable. The same risk applies to pharmacy vending machines. The investment required is substantial and operators installing these machines also have to make sure that their investment will pay off," Amos said.

Despite these concerns, the association does not view the proposed solution entirely negatively. Rootslane said vending machines could work well in larger cities where they could effectively extend pharmacy opening hours into the evening.

The Riigikogu will continue deliberations on the pharmacy vending machine bill. If adopted, the changes concerning pharmacy vending machines will take effect on March 1, 2027.

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