A crowded pharmacy is not much use if the patient cannot make a purchase

I have been following the debate for several days about those private pharmacies that are emerging in Cuba, featuring medications that are almost NEVER found in state pharmacies. And while some are shocked that they are private and others respond that "at least they are available there," I believe we are neglecting a much more important discussion.

If the Cuban state is not able to guarantee all the medications that the population needs and has decided to allow the existence of private pharmacies, that’s fine. Then let’s do it right. Because perhaps the issue is not their existence, but how they are integrated into the healthcare system and what real benefits they ultimately provide to the patient.

I live in Spain. Here, pharmacies are private establishments, but that does not prevent the existence of a public system that finances a significant portion of prescribed medications. Depending on the medication and the patient's circumstances, they may pay a part, a reduced amount, or may not pay anything directly.

And I say this from a very personal experience: my son is undergoing a biological treatment that costs thousands of euros each year, and we do not pay a single cent for that treatment.

That’s why I’m not convinced by the argument that “medications are expensive everywhere.” Of course they are. Some cost a lot of money. But we are confusing two completely different things: one is the actual cost of a medication, and the other is how much the patient ultimately pays out of pocket.

So I wonder: if Cuba is already allowing these private pharmacies, why not take advantage of them as part of the solution?

The State could determine which essential medications are funded, cover part of their cost, and create greater protection mechanisms for retirees, chronic patients, vulnerable individuals, or particularly expensive treatments. This is not about forcing private owners to sell below their costs. That would condemn the business to failure. It's about the State helping to cover the difference so that the medication can reach the patient.

But there is something more that, as a doctor, I find essential to point out: A pharmacy is not a supermarket.

It cannot become a place where one enters and asks for amoxicillin, cephalexin, or any other medication as if buying rice, oil, or detergent. There are over-the-counter medications, of course, but many others require a prescription, supervision, and responsible dispensing. This is especially important with antibiotics, as their indiscriminate use not only affects the patient who consumes them but also contributes to a global problem as serious as antimicrobial resistance.

That is why these pharmacies, whether state-run or private, must be subject to true health regulation: qualified professionals, proper storage conditions, expiration date control, provenance and traceability of medications, compliance with prescriptions when applicable, and accountability in dispensing.

Private should not mean uncontrolled. And public should not imply being deprived.

Perhaps therein lies one of the possibilities that Cuba should explore: private initiative to help ensure availability, a state that regulates to ensure security, and public funding to assist in guaranteeing access.

It is not necessary to replicate exactly what is done in Spain or any other country. Each system has its own particularities. However, after so many decades of discussing a medicine "by and for the people," it should not be revolutionary to understand something so fundamental: the patient does not care much about who owns the pharmacy. What matters to them is finding their medication, that it is safe, and that they can afford it.

Because a state pharmacy with empty shelves solves nothing, and a private pharmacy filled with medications that a retiree or a Cuban worker can only look at behind the counter or must choose between eating or getting medication, also does not solve the problem...

Between those two extremes, there is a vast space to improve things.

In the end, the true success of a healthcare system is not measured by a well-stocked pharmacy. It lies in ensuring that the right medication, under proper health regulations and at an affordable price, reaches the hands of the patient who needs it.

That would indeed be putting the health of the people above the rhetoric.