[The domino effect of drug distribution channels on the management of chronicity.]

Drug distribution channels affect all actors in the drug supply chain: healthcare institutions, healthcare professionals, patients, pharmacies, pharmaceutical companies and distributors. They should be redesigned in line with the new proximity care model planned in the Pnrr and DM 77, while avoiding a negative domino effect on the management of chronic diseases. A guide recently published by the MaCroScopio project is useful to shed light on this issue and to understand the relationship between the distribution channels present in Italy (distribuzione diretta - DD; distribuzione per conto - Dpc; distribuzione convenzionata) and the management of chronic diseases. Analysis of OsMed data showed that the majority of medicines dispensed in DD and Dpc are for chronic patients; therefore, a change in distribution channels inevitably affects chronicity management and could lead to increased expenditure. It is necessary to evaluate the transfer of drugs from one channel to another on a case-by-case basis according to the specifics of each drug. Proximity care reform requires a redesign of drug distribution channels, but this must be done with respect to the clinical, social and economic sustainability of the system.