Enrique Ayuso, president of Hefame, warned that foreign pharmacy groups and new rules are putting Spain’s pharmacist-owned community pharmacy model under pressure. He said the model’s future could be at risk if foreign chains expand, with consequences for healthcare access and rural communities.
Spain’s system differs from that of much of Europe. Pharmacies are more than shops: in many rural towns, they are the only place people can get medicine or health advice. Pharmacists own their businesses and decide what to stock and which technology to use. Ayuso says this structure keeps medicines safe and traceable. Sector reports cited by Europa Press support his view that the cooperative model has remained strong, even in difficult times. Hefame recorded more than €1.9 billion in revenue in 2025, and its market share rose 22% in nine years.
The Federation of Pharmaceutical Employers (FEFE) advocates for a network of professionally managed pharmacies owned by pharmacists, with broad territorial coverage. It also calls for community pharmacies to be included in Spain’s future national health strategy.
At the VII Simposio del Observatorio de la Sanidad de EL ESPAÑOL-Invertia, Ayuso criticized foreign chains, saying they judge pharmacies by turnover and put profit ahead of public service. These groups currently hold only a small share of the market. Ayuso warned that if they grow, Spain could end up with a split system: some pharmacies focused on profit, while others maintain the existing model. He said the solidarity holding the system together could break. Official sector analyses, but, say there is no evidence yet that foreign groups control a large part of the market. The takeover warning concerns a possible future risk.
Ayuso also fears that new pharmacists might lose sight of the cooperative spirit behind Spain’s distribution network. “They need to understand that the Spanish distribution network belongs to them,” he said, calling for unity even among rivals. The sector also faces tight profit margins and medicine shortages. Geopolitical shocks, including fuel price spikes after the Ormuz closure, add to the pressure. Europa Press reports that Spanish distributors are merging to survive. Hefame’s merger with Cofarcu is one example. The goal is to remain strong and invest in new technology.
Technology presents another challenge. Artificial intelligence is already in use, mostly for prevention work, but Ayuso sees a risk that only the biggest players will have the resources to use these tools fully, leaving smaller pharmacies behind.
Ayuso remains committed to the cooperative model. Most distributors are owned by pharmacists, which he says gives them staying power. “Being larger companies helps us make better investments and have more partners,” he said. He wants the government to recognize that these cooperatives are not global giants and should not face the same rules. FEFE has made the issue a political priority for the next legislative period, saying in official statements that it concerns national health as well as business.
Spanish law still protects pharmacists’ roles as owners and decision-makers. Ayuso says the sector cannot become complacent: “The debate we need is about what model we want in Spain: an assistive, social, and solidarity-based system that guarantees access to medicines? Then we must defend it.”
The debate reflects wider pressures on local institutions in Spain, where established models face global money and new technology. Recent coverage of local institutions adapting to international influences has described the same pattern.
Spain’s pharmacy model supports public health and rural life. If foreign chains and new rules weaken pharmacists’ independence, the country could lose a system long associated with universal access and social stability. The government and the sector face a choice: protect the model or let it fade. The outcome will shape healthcare for years to come.
