The deregulation of the pharmacy retail market often brings significant changes in the market structure [1]. Such an example is the Slovak pharmacy retail market, where the liberalization started in 2001 when the Antimonopoly Office investigated the entry conditions for new pharmacies. The following year, the competition authority lifted entry barriers due to their anti-competitive nature [2].

However, it was the legislative change in 2004 and 2011 that shaped the current structure of the industry [3]. These reforms relaxed constraints on pharmacy ownership, allowing both private individuals and legal entities to own one a pharmacy.

At the same time, GPs underwent similar reforms in 2004. The critical change for the profession was privatizing insurance companies, which became responsible for contracting physicians based on minimum primary care availability in the eight Slovak NUTS 3-level regions; one example of such is the Bratislava self-governing region [4], [5].

These changes almost doubled the number of pharmacies between 2005 and 2019, while at the same time, the number of GPs experienced a slight decline. This substantial shift in the ratio of pharmacies to doctors could disrupt the interdependence between these providers.

Therefore, the paper aims to determine the extent to which pharmacies’ dependency on the presence of GPs has changed over time.

To address this, the study employs a measure known as the entry threshold, which represents the market size required for an additional pharmacy to cover its entry costs [6]. In theory, the presence of a GP should decrease the entry threshold for pharmacies due to increased revenues from prescriptions. However, suppose the business model of pharmacies has evolved, or the availability of doctors per pharmacy is limited. In that case, the entry thresholds are expected to increase.

The findings in this paper indicate that in small municipalities with at least one GP in the market, the entry thresholds increased by roughly one-third between 2005 and 2019. In 2005, the first pharmacy could enter a market served by GPs with an average population of just 690. However, by 2019, this threshold had risen to 920 inhabitants.

Conversely, an opposite trend was observed in markets without GPs. In 2005, the first pharmacy entering such a market required an average population of 4,200. By 2019, this entry requirement had decreased to approximately 2,700 inhabitants.

This implies that while in the year following the liberalization, the presence of a GP reduced the required market size for pharmacies to enter by around 83% on average, by 2019, this effect had diminished to only 65%.

From a policy perspective, access to pharmacy services may worsen in very small markets with GP’s presence. Pharmacies may now seek locations in different areas, for example, with high retail demand, and the presence of a GP may no longer be sufficient to cover their entry costs alone.

Moreover, the reduced reliance on GPs corresponds with a rise in over-the-counter sales, though this study doesn’t investigate the exact causes. This aligns with similar studies on pharmacy market organization post-deregulation, where pharmacies increasingly offer additional services [7].

This paper contributes to the existing literature on the effects of deregulation in the pharmacy retail market [1], [8], [9], [10], research on interdependencies between healthcare professions [11], and the effects of entry in healthcare sectors [6], [12], [13]. The novelty of this research lies in quantifying the diminishing effect of a doctor’s presence using estimated entry thresholds in deregulated healthcare industries.