Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 1 | 13 REVIEW ARTICLE Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership Dajana Roshi1,2*, Eni Tresa1,3*, Alessandra Lafranconi1, Genc Burazeri1,3, Katarzyna Czabanowska1,4, Helmut Brand1 1 Department of International Health, School CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht, The Netherlands; 2 National Agency for Drugs and Medical Devices, Tirana, Albania; 3 Department of Public Health, Faculty of Medicine, University of Medicine, Tirana, Albania; 4 Institute of Public Health, Faculty of Health Sciences, Jagiellonian University, Krakow, Poland. * These authors contributed equally. Corresponding author: Dajana Roshi, MSc; Address: National Agency for Drugs and Medical Devices, Dibra Street No. 359/1, Tirana, Alba- nia; Telephone: 0035569565614; E-mail: dajana.roshi@maastrichtuniversity.nl Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 2 | 13 Abstract Aim: Shifting from a communist regime to a democratic system has affected health system fun- damentally in most of the Western Balkan countries including Albania. Albania became a Euro- pean Union (EU) candidate country in 2014. Since then, one of the main concerns has been to approximate the legislation with the EU framework. The aim of this paper is to review the evolve- ment of pharmaceutical legislation in Albania and challenges toward achieving full approximation to the EU’s respective legislation. Methods: We used qualitative techniques, especially means of conventional content analysis and two sources to collection data. First, we consulted the Albania’s National Publications Office webpage and analysed all available legislation regarding “pharmacy”, “medicine” and “pharma- ceutical products” from 1994 to 2021. Then, we analysed the National Integration Plans that have been published by the Government of Albania from 2014 to 2021. Results: The decrease of the price margin system goes in parallel with the increase of the pharma- ceutical expenditure, including out-of-pocket expenditure on medicines and lack of adequate and sensitive reimbursement policies. The main pillars of the pharmaceutical sector in Albania are well-covered legally but not fully in concordance with the EU framework. Conclusion: There is a need to foster laws implementation that regulate the opening of pharma- cies; a detailed regulation on pharmacovigilance; and a regulation on medicinal products for pae- diatric use. Also, the existing legal framework should be aligned with the European one. Medicine pricing methods should go in the same line with the decrease of out-of-pocket expenditure. Keywords: Albania, European Union membership, legislation, pharmaceutical policies. Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 3 | 13 Introduction The Western Balkan countries (WB) – Alba- nia, Bosnia and Herzegovina, Republic of North Macedonia, Kosovo, Montenegro and Serbia – are facing a formidable array of chal- lenges such as demographic, socio-economic and legislative (1). Beside the complex past, WB aspirate to join the European Union (EU) (2). Albania is a EU candidate country since June 2014 and, from March 2020, the EU opened the accession negotiations with Alba- nia (3). The process of European Integration is followed by “construction, diffusion and implementation of formal and informal rules, procedures, policy paradigms, styles, ’ways of doing things,’ and shared beliefs and norms which are first defined and consoli- dated in the EU policy process and then in- corporated in the logic of domestic discourse, identities, political structures and public pol- icy”, known as Europeanization process (4). The Albanian health system is mainly public, and the state provides the majority of services regarding promotion, prevention, diagnosis, and treatment of diseases (1). The private sec- tor covers mostly the pharmaceutical and dental services, and some specialized diag- nostic services (5). Never the less, the Euro- peanization process in expected to influence health sector and contribute to protection of health, safety and economic interests of con- sumers (6). In this regard, the government has started to align the pharmaceutical legislation and practices with the EU respective direc- tives including measures to simplify the med- icine registration, licensing of professionals and pharmacies, price controls and reim- bursement of drugs and implication of ethical standards (7). The process of Europeaniza- tion of medicines regulations “involves har- monization and mutual recognition of regu- latory decision making as well as the transfer of some authority from Member States to su- pranational EU regulatory agencies” (8). However, there are differences in the way the countries approach new pharmaceutical leg- islation including how various stakeholders are involved in policy making and how easy it is for the country to implement the new leg- islative changes (9). The national European integration plans (NIP) have been regularly published and up- dated since 2014 aiming at description of achievements and setting new objectives (10). In this regard, the Pharmaceutical Poli- cies have been changing, as it is shown in the NIP and the Official Publications Centre (from 1994 to 2014) (10,11). These changes are reflected in the Law on Medicines and Pharmaceutical Services, Clinical Trials, Medicine Pricing, Reimbursement Policies, the list of Over the Counter Medicines/ Med- icines given without prescription (OTC), and the Pharmaceutical Education, laws that reg- ulate the most important parts of the pharma- ceutical field in Albania (11). In the same time, the number of the pharmacies in Alba- nia has been increasing from year 1993 to year 2014 (from 1,097 pharmacies in 1994 to 1,600 pharmacies in 2014) (7,12). However, there is not a clear picture of the pharmaceu- tical legislative development in Albania fos- tered by the Europeanization process. The aim of this review is to explore how the phar- maceutical legislation of Albania has evolved from 1994 to 2021 and where does it stand toward achieving the full approximation to the EU respective legislation. Methods This study is based on qualitative research techniques, especially means of content anal- ysis. We used two sources to collect data. First, we consulted the Albania’s National Publications Office webpage and analysed all Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 4 | 13 available legislation regarding “pharmacy”, “medicine” and “pharmaceutical products” from 1994 to 2021 (11). The second source of data were National Integration Plans (NIP) that have been published by the Government of Albania from 2014 to 2021 (10). In both cases we included in the analysis the laws and chapters that contained the words “Phar- macy”, “Pharmaceuticals”, “Price”, “Medi- cine”, “Out of Pocket”. All consulted docu- ments are available at Appendix 1. Then, we used Conventional Content analysis to group the data and identify the “coding categories directly from the text data” (13). Each NIP has 33 chapters that cover different areas. The chapter which covers pharmaceutical issues and medicines is chapter 28 on “Consumer and Health Protection”. All data are pre- sented in the results section based on four cat- egories we identified through content analy- sis: Sale at distance and pharmaceutical indi- cators; Pricing policy and Pharmaceutical Expenditure; Clinical trials; Marketing Au- thorization, Distribution and Storage Prac- tices. Results and Discussion The law on medicines and pharmaceutical service has changed many times from 1994 to 2014. The latest published version (the 2014 one) is the most compatible to the respective EU directive (Directive 2001/83) (8,9). How- ever, when comparing the EU pharmaceuti- cal legal framework to the Albanian one, it results that the Albanian legal framework lacks many regulations such as the one on pharmacovigilance and the regulation on me- dicinal products for paediatric use. Sale at distance and pharmaceutical indica- tors After the fall of the communist regime (in 1991), various reforms took place in Albania such as the permission of private service pro- viders to operate, decentralization of primary care management, the privatization of the pharmaceutical and dentistry sectors, and the founding of the Health Insurance Institute (16). Data shows that the number of pharma- cies has been increasing from 1994 to 2014 (Table 1) (7,12). This might be related to the opening of pharmaceutical private universi- ties since 2003 which resulted to a higher number of pharmacists graduated annually in Albania (17–19). Even though, the govern- ment started to apply the professional state exam (to control the number and professional quality of pharmacist who graduated), the number pharmacists licenced annually con- tinued to increase (11). The increased number of pharmacies is not proportional with the to- tal population (Table 1). Table 1. Pharmaceutical indicators (7,12,20–22) INDICATOR 1990 2003 2005 Last year available Number of pharmacies (total) - 1097 1000 1600 (2014) Pharmacists per 100000 inhabitants 36.37 35.28 38.3 108.4 (2018) Pharmacists graduated per 100000 inhabitants 0.7 1.2 2.8 3.5 (2013) Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 5 | 13 Only the pharmacies that plan to have a con- tract with the Compulsory Health Care Insur- ance Fund (CHIF) must fulfil some condi- tions before opening the pharmacy (23). As per the Albanian legislation, a pharmacy that signs a contract with the with the CHIF for the first time should, be at least 50 meter square, at least 150 meter linear away from an existing pharmacy and in a distance at least 30 meter from the health care centre (23). The Law on Medicines and Pharmaceutical Service of 2004 specified that: The pharma- cies could be opened in urban areas in a dis- tance lower than 150 meters from each other, depending from population density (one pharmacy for 3000 inhabitants), but the leg- islations on distance is not in force anymore (compared to the actual law of 2014) (11). Pharmacies are periodically controlled/in- spected by the National Agency for Drugs and Medical Devices and CHIF (The Re- gional Branch and National Office in case the pharmacy has a contract with this institution), by the Order of Pharmacist and the Tax Ad- ministration Office (TAO). All these institu- tions inspect the pharmacies regarding the conditions on storing the medicines; the or- der/timeline in which they keep the prescrip- tions; if they give any non-Over The Counter (OTC) without prescription; if they sell med- icines that do not have a marketing authori- zation (contraband medicine); if they store the expired medicines in a non-separate area inside the pharmacy; if the number of the re- imbursed medicines is the same with the one shown in the electronic prescription system (only for the pharmacies with a contract with CHIF); if they give a coupon after each sale; or/and if the employed pharmacists are li- censed (11,14). A yearly report from the State Central In- spectorate mentions that in 2017 were in- spected and controlled 424 subjects out of which 352 were pharmacies and pharmaceu- tical agencies and 48 were pharmaceutical distributors or importing warehouses. In this regard, 25 administrative measures were taken (24). In 2018, the same report showed that out of 603 controlled subjects, 592 were pharmacies and pharmaceutical agencies, 11 were phar- maceutical distributors or importing ware- houses, 14 inspections for expired medicines upon request of the subjects themselves and one inspection in collaboration with the State Policy (Sector against economic and finan- cial crime). Overall, 182 administrative measures were taken (25). The European Directive (2001/83) specifies the sale at distance to the public (15). In this regard, taking in consideration the existing Albanian Law on Medicines and Pharmaceu- tical Service 105/2014, the selling of medi- cines at distance to the public is difficult to be monitored (14). Pricing policy and pharmaceutical expendi- ture Medicine pricing in Albania is done by an of- ficial committee assigned by the Minister of Health (19). This committee aims at achiev- ing a lower price of the medicines regardless the quality. The Committee uses a specific formula and the reference price to calculated the medicine price (20). The pricing policy since 2014 is as follows: i) The medicine reference price for Al- bania should be the lowest among: - The wholesale prices in the ref- erence countries. - The retail price the medicine has in its origin place. Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 6 | 13 - The price that the medicine has had in the last 12 months of im- port (11). ii) The generic medicine price should be 80% of the patent medicine price registered in the National Agency for Drugs and Medical Devices. In case the patent medicine does not have a marketing authorization in Albania, then its price in the origin place should be taken into consideration (19). iii) The retail selling price of the medi- cine should be the same with the price of the medicine in the origin place (19). In the meantime, the price margin has changed – Table 2 shows the price margins during the period 2005-2006. Table 2. Regressive margin system for medicines in Albania [Source: Imasheva & Seiter, 2008 (7)] TYPE OF MEDICINES Importer and wholesale margin Retail margin Most Expensive 8% 15% Moderately expensive 10% 20% Non-expensive 15% 30% Least Expensive 18% 33% The purpose of such regressive price margin is to reduce the incentive for pharmacists to recommend expensive, branded medicines over cheaper generics (7). Until 2015, the price margin system has changed by decreas- ing the wholesale and retail margin (11). The decision No.143 date 18.02.2015 stated that the margin of the wholesale margin should be 11% (divided 8% for the importer and 3% for the distributor) and 25% for the retail seller (25% of the price that the medicine has once distributed to the pharmacy) (11). Since 2015, in WB a lot of attention has been de- voted to pharmaceuticals, which have be- come one of the largest and fastest growing components of health expenditure (26). The National Health Strategy NHS aims at in- creasing of the medicine quality, safety and affordability in accordance with the Euro- pean Standards (27). This is planned to be achieved by: Reducing the prices and improving access through a progressive expansion of the reim- bursable medicine list. - Registration of medical devices. - Establishing a tracking system to maintain, strengthen and ensure qual- ity during all phases: production, im- port, distribution and sale at the final point. - Achieving quality on pharmaceutical service available throughout the country. - Strengthening the National Agency for Drugs and Medical Devices (27). Table 3 indicates that the pharmaceutical ex- penditure as part of the total health expendi- ture has been increasing. It indicates a con- siderable out of pocket expense on medicines and also lack of reimbursement policies. Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 7 | 13 Table 3. Pharmaceutical expenditure in Albania (28) Pharmaceutical expenditure as a proportion of total health expendi- ture 1993 (earliest year available) 2007 (last year available) 23% 28% In Albania, annual expenditures on reim- bursed medicines increased from ALL 3.5 billion in 2007 to ALL 8.4 billion in 2013, due to a variety of reasons such as: expansion of the health insurance scheme, reimburse- ment of innovative medicines, the tendency of the physicians to prescribe expensive ther- apies, lack of rules and regulations control- ling this sector, and lack of significant policy for using generic medicines as substitutes for expensive products with the same active sub- stances (26). A study conducted on the af- fordability of healthcare payments in Albania showed that the average nominal annual amount spent out of pocket per person in- creased with 37%, from 2009 to 2015 with an annual average growth rate over 5% (29). Some of the main issues that come out of the NIP, are: - The health sector remains a major challenge; new initiatives aim signif- icant changes in health care financing systems and achieving universal cov- erage of ongoing initiatives. New pro- grams for periodic population exami- nations will improve disease preven- tion. Introduction of universal cover- age system is expected to improve the health care system and the provision of health services. (Appendix1) - The National Medicine Control Strat- egy 2018–2022 is envisaged for ap- proval in the last quarter of 2018. (The NIPs of 2018-2020). - The National Health Strategy 2016- 2020 was approved in May 2017 and aims to achieve universal healthcare coverage. (The NIPs of 2019-2021). - In terms of public health, significant progress needs to be made to imple- ment the policy framework and en- sure health care coverage for all in Al- bania. Regarding medical devices, Law 89/2014 "On medical devices" has been revised pursuant to the Eu- ropean regulation on medical devices. The revision of the law was made fol- lowing the process of approximation of Albanian legislation with the Euro- pean one and aims to increase safety during the use of medical devices af- ter their placement on the market and increase access for patients. (The NIPs of 2021-2023) (11). The National Health Strategy (NHS) cites that the medicine market in Albania is well- regulated, while medicines and pharmaceuti- cal services are offered by the private sector (27). The legislation, is progressively im- proved in line with the EU directives (27). The National Agency for Drugs and Medical Devices has been established in 2014, before it was known as the National Centre of Drug Control (27). In order to increase the access to safe medicines and reduce their financial burden, in 2015 a series of medicines were traded at prices around 30% cheaper com- pared to 2013. Also, the list of essential med- icines has been updated with 200 new medi- cines compared to 2013, while the list of re- imbursable medicines was updated with about 80 new medicines (27). In the last two years, cytostatic medicines are doubled, while medical materials for cardiology have increased by 50% (27). Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 8 | 13 Clinical trials Clinical Trials have been a specific chapter of the Albanian Law on medicines since 1994 and later 2004 (11). In March 2018 for the first time the order on approving the guide- lines for clinical trials was published (30). This regulation is nearly harmonized with the EU Directive 2001/20 on the approximation of the laws, regulations and administrative provisions of the Member States in relation to the implementation of good clinical practice during the conduct of clinical trials on medic- inal products for human use (30). The Euro- pean Commission Directive 2005/28/EC of 8 April 2005 on laying down principles and de- tailed guidelines for good clinical practice (including investigational medicinal products for human use, the requirements for authori- zation of the manufacturing or importation of such products) is far more detailed than the before mentioned Albanian ordinance on guidelines on conducting clinical trials (31). Therefore, this part of the pharmaceutical legislation lacks detailed regulation on con- ducting clinical trials. Marketing authorization, distribution and storage practices Regarding the granting of marketing authori- zation for medicines for human use, the pro- cedure is nearly the same as in the EU (11). There is also a specific regulation on granting the marketing authorization for medicines for human use in Albania, Decision No.299 dated 08.04.2015 on the Approval of the Reg- ulation on Granting the Medicines Marketing Authorization (11). Until 2018, no specific regulation existed in Albania on distribution and storage practice, although this chapter was part of the law on medicines on pharma- ceutical service 105/2014 (14,32). This law states that a regulation regarding the good distribution and storage practices should be approved by the minister of health and should be obligatory for the importers, exporters, pharmaceutical distributors, pharmacies and pharmaceutical agencies (14). In the law 105/2014, existed an administrative offense for each pharmacy that did not comply with the foreseen practices, even though such reg- ulation was not in place yet (14). Such issues were solved out in 2018, when the regulation on distribution and storage practice was im- plemented for the first time (32). This ordi- nance was based on the European Medicines Agency’s scientific guidelines on the quality of human medicines; Regulation (EC) No 726/2004 of the European Parliament; World Health Organization Technical Report Series, No. 908, 2003, Guide to good storage prac- tices for pharmaceuticals; US Pharmacopoeia 1079, Good Storage and Distribution Prac- tices; Guidelines of 5 Nov EC ember 2013 on Good Distribution Practice of medicinal products for human use (2013/C 343/01); Guidelines for the Storage of Essential Med- icines and Other Health Commodities 2003; and Pharmaceutical Inspection Co-operation Scheme (PIC/S) Guide to Good Distribution Practice for Medicinal Products (32). Conclusion In conclusion, the main pillars of the pharma- ceutical sector in Albania are well-covered legally but not fully in concordance with the EU framework. There is a need to reinforce the laws that regulate the opening of pharma- cies; a detailed regulation on supervising and controlling the online sale of medicines and taking administrative measures where appro- priate; a regulation on implementing the track and trace system of medicines. There is no regulation regarding pharmacovigilance in Albania. Also, unlike the EU, in Albania, there is no regulation on medicinal products for paediatric use. Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 9 | 13 Conflicts of interest: None. References 1. Sanfey P, Milatovic J, Kresic A. How the Western Balkans Can Catch Up. European Bank for Reconstruction and Development, 2016: https://pa- pers.ssrn.com/sol3/papers.cfm?ab- stract_id=3119685 (accessed: 17.05.2021). 2. 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Urdhri i Farmacistëve të Shqipërisë - Prakikat e Ruajtjes dhe Shpërndarjes së Mirë të Barnave: https://www.ufsh.org.al/content/up- loads/2018/nov/9/rregullore-mbi- praktikat-e-ruajtjes-dhe-shprndarjes- s-mir-t-barnave.pdf (accessed: 30.03.2021) (Albanian). ______________________________________________________________________________ © 2021 Roshi et al; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. DOI: 10.11576/seejph-4604 P a g e 12 | 13 Appendix 1. List of consulted legislation, directives and orders No. The consulted legislation Link Last Ac- cessed 1 Law Nr.10 171, date 22.10.2009 on regulated professions in Republic of Albania https://www.arsimi.gov.al/wp-con- tent/up- loads/2017/10/LIGJ_NR_10_171_P RR.pdf 16.05.2021 2 Law of medicine and pharmaceutical services 2004 https://qbz.gov.al/eli/ligj/2004/11/2 5/9323/25d3c84f-e0ad-4a23-980c- d948f6c7a430;q=299 17.05.2021 3 Decision no. 781, date 14.11.2007 on “Tech- nical functional characteristics of fiscal equip- ment; integrated computerized system for pe- riodic and automatic transferring of financial declarations; communication system on pro- cedure and documentation for its approval; and the criteria for the equipment authorized from the authorized companies for offering fiscal equipment. https://qbz.gov.al/pre- view/302da00f-7476-47a5-a2d7- c583698f8c4e/cons/20181031 15.05.2021 4 Law no. 10 383, date 24.2.2011 on Compul- sory Health Insurance in Republic of Albania https://qbz.gov.al/pre- view/1af1180f-c82e-4ec7-b37b- 9904e9aab976/cons/20170211 17.05.2021 5 Order no.645 date 01.10.2014 on establish- ment and operation of the Commission on Medicine Pricing https://qbz.gov.al/eli/vendim/2014/ 10/01/645/c05dd224-5c03-40ba- 99d9-0dc03882fa1c 17.05.2021 6 Order no.143 date 18.02.2015 on designation of trade and fabrication margins of medicines https://qbz.gov.al/eli/vendim/2015/ 02/18/143/6d99b717-9493-41ae- b77a-8ff1edc5ff63 17.05.2021 7 Law on Medicine and pharmaceutical services 1994 https://qbz.gov.al/eli/ligj/1994/04/2 0/7815/6103b566-80d1-4ccc-a6a9- 9a67dcbc8559;q=299 15.05.2021 8 Order no 299 on “On approving the regula- tion on granting the medicines marketing au- thorization and their classification on the Re- public of Albania” https://qbz.gov.al/eli/vendim/2015/ 04/08/299/60e02154-8b2b-49ea- aa45-6e3e1e849892;q=299 16.05.2021 9 National Health Strategy 2016-2020 https://extranet.who.int/country- planningcycles/sites/de- fault/files/planning_cycle_reposi- tory/albania/draft_strategt_alba- nia_2016-2020.pdf 16.05.2021 https://www.arsimi.gov.al/wp-content/uploads/2017/10/LIGJ_NR_10_171_PRR.pdf https://www.arsimi.gov.al/wp-content/uploads/2017/10/LIGJ_NR_10_171_PRR.pdf https://www.arsimi.gov.al/wp-content/uploads/2017/10/LIGJ_NR_10_171_PRR.pdf https://www.arsimi.gov.al/wp-content/uploads/2017/10/LIGJ_NR_10_171_PRR.pdf https://qbz.gov.al/eli/ligj/2004/11/25/9323/25d3c84f-e0ad-4a23-980c-d948f6c7a430;q=299 https://qbz.gov.al/eli/ligj/2004/11/25/9323/25d3c84f-e0ad-4a23-980c-d948f6c7a430;q=299 https://qbz.gov.al/eli/ligj/2004/11/25/9323/25d3c84f-e0ad-4a23-980c-d948f6c7a430;q=299 https://qbz.gov.al/preview/302da00f-7476-47a5-a2d7-c583698f8c4e/cons/20181031 https://qbz.gov.al/preview/302da00f-7476-47a5-a2d7-c583698f8c4e/cons/20181031 https://qbz.gov.al/preview/302da00f-7476-47a5-a2d7-c583698f8c4e/cons/20181031 https://qbz.gov.al/preview/1af1180f-c82e-4ec7-b37b-9904e9aab976/cons/20170211 https://qbz.gov.al/preview/1af1180f-c82e-4ec7-b37b-9904e9aab976/cons/20170211 https://qbz.gov.al/preview/1af1180f-c82e-4ec7-b37b-9904e9aab976/cons/20170211 https://qbz.gov.al/eli/vendim/2014/10/01/645/c05dd224-5c03-40ba-99d9-0dc03882fa1c https://qbz.gov.al/eli/vendim/2014/10/01/645/c05dd224-5c03-40ba-99d9-0dc03882fa1c https://qbz.gov.al/eli/vendim/2014/10/01/645/c05dd224-5c03-40ba-99d9-0dc03882fa1c https://qbz.gov.al/eli/vendim/2015/02/18/143/6d99b717-9493-41ae-b77a-8ff1edc5ff63 https://qbz.gov.al/eli/vendim/2015/02/18/143/6d99b717-9493-41ae-b77a-8ff1edc5ff63 https://qbz.gov.al/eli/vendim/2015/02/18/143/6d99b717-9493-41ae-b77a-8ff1edc5ff63 https://qbz.gov.al/eli/ligj/1994/04/20/7815/6103b566-80d1-4ccc-a6a9-9a67dcbc8559;q=299 https://qbz.gov.al/eli/ligj/1994/04/20/7815/6103b566-80d1-4ccc-a6a9-9a67dcbc8559;q=299 https://qbz.gov.al/eli/ligj/1994/04/20/7815/6103b566-80d1-4ccc-a6a9-9a67dcbc8559;q=299 https://qbz.gov.al/eli/vendim/2015/04/08/299/60e02154-8b2b-49ea-aa45-6e3e1e849892;q=299 https://qbz.gov.al/eli/vendim/2015/04/08/299/60e02154-8b2b-49ea-aa45-6e3e1e849892;q=299 https://qbz.gov.al/eli/vendim/2015/04/08/299/60e02154-8b2b-49ea-aa45-6e3e1e849892;q=299 https://extranet.who.int/countryplanningcycles/sites/default/files/planning_cycle_repository/albania/draft_strategt_albania_2016-2020.pdf https://extranet.who.int/countryplanningcycles/sites/default/files/planning_cycle_repository/albania/draft_strategt_albania_2016-2020.pdf https://extranet.who.int/countryplanningcycles/sites/default/files/planning_cycle_repository/albania/draft_strategt_albania_2016-2020.pdf https://extranet.who.int/countryplanningcycles/sites/default/files/planning_cycle_repository/albania/draft_strategt_albania_2016-2020.pdf https://extranet.who.int/countryplanningcycles/sites/default/files/planning_cycle_repository/albania/draft_strategt_albania_2016-2020.pdf Roshi D, Tresa E, Lafranconi A, Burazeri G, Czabanowska K, Brand H. Pharmaceutical policies in post-communist Albania: Progress and challenges toward European Union membership (Review article). SEEJPH 2021, posted: 19 July 2021. 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