price, availability and affordability of medicines international comparison of 29 surveys
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Price, availability and affordability of medicines international comparison of 29 surveys. Presented by: Richard Laing World Health Organization, Geneva - PowerPoint PPT PresentationTRANSCRIPT
Price, availability and affordability of medicines
international comparison of 29 surveys
Presented by:
Richard Laing World Health Organization, Geneva
Margaret Ewen, Health Action International EuropeRichard Laing, Gilles Forte, World Health OrganizationCo-ordinators, WHO/HAI Project on Medicine Prices
Chennai December 2005
Uganda pharmaceutical baseline surveySept 2002
WHO/HAI Project on Medicine Prices
• Developed a methodology for collecting and analysing the prices of medicines, affordability, availability and component costs in various sectors and regions in a country
• Data freely accessible on HAI’s web site so international price comparisons are possible www.haiweb.org/medicineprices
• A monthly monitoring tool, measuring prices, availability and affordability, is currently being piloted - will complement the survey tool
Surveys: underway or completed
Middle East: Lebanon, Jordan, Kuwait, Syria, Sudan,Africa: Tunisia, Algeria, Morocco, Mali, Chad, Uganda,
South Africa, Tanzania, Kenya, Ethiopia, Zimbabwe, Mozambique, Nigeria, Ghana, Cameroon, Senegal
Asia/Pacific: Pakistan, Indonesia, Philippines, Malaysia, Fiji, China (Shandong), Vietnam, India - West Bengal, Haryana, Karnataka, Maharashtra (2), Chennai, Rajasthan
Central Asia: Mongolia, Kazakhstan,Tajikistan, Kyrgyzstan, Uzbekistan
Other: Peru, Dominican Republic, Bosnia Herzegovina
43 surveys in 37 countries + 9 pilot studies
Surveys included in secondary analysis
AFRO: Cameroon, Chad, Ghana, Kenya, Mali, South Africa (Kwazulu Natal State), Uganda
AM/PAHO: Brazil (Rio State), PeruEMRO: Kuwait, Lebanon, MoroccoEURO: Armenia, Kazakhstan, TajikistanSEARO: India - West Bengal, Haryana, Karnataka,
Maharashtra (2), Chennai, Rajasthan, Indonesia, Sri Lanka
WPRO: China (Shandong), Fiji, Malaysia, Mongolia, Philippines
Comparing Prices across Countries
• Only valid to compare median MPRs for price or availability if identical or very similar basket of medicines compared
• Better to compare MPRs of individual identical medicines (same dose and dosage form)
• For comparing affordability need to compare identical treatment regimens
• For price components categorize additional charges carefully
Data slides…..
Glibenclamide 5mg tabs
Government procurement: prices & availability
Public sector: patient prices & availability
Private retail pharmacy: patient prices & availability
Affordability
Combination therapy: glibenclamide + metformin
Price components
Glibenclamide 5mg tabs (generics), government procurement prices
Public Procurement (generic only)
0 1 2 3 4 5 6
Chad (2002)Mali (2004)
Uganda (2004)
Kuwait (2004)Lebanon (2004)
Morocco (2004)
Kazakhstan (2004)
India/Chennai (2004)India/Haryana (2004)
India/Karnataka (2004)India/Mah. Nagpur
India/Maharashtra (2004)India/Rajasthan (2003)
Indonesia (2004)
China/Shandong (2004)Fiji (2004)
Mongolia (2004)
Glibenclamide 5mg tabs, public sector patient prices
Availability: Glibenclamide 5mg tabs, public sector facilities
Public Sector Facilities
0 20 40 60 80 100
Cameroon (2002)Chad (2004)
Ghana (2002)Mali (2004)
Uganda (2004)
Peru (2002)
Kuwait (2004)Lebanon (2004)Morocco (2004)
Tajikistan (2005)
India/Chennai (2004)India/Haryana (2004)
India/Karnataka (2004)India/Mah.Nagpur
India/Maharashtra (2004)India/Rajasthan (2003)
India/West Bengal (2004)Indonesia (2004)
China/Shandong (2004)Mongolia (2004)
Philippines (2002)
Innovator
Generic
Median for Generic : 38%
Median for Innovator : 0%
Glibenclamide 5mg tabs, patient prices, private retail pharmacies
Private Sector Retail Pharmacy Price
0 20 40 60 80
Cameroon (2002)Chad (2002)
Ghana (2002)Mali (2004)
Uganda (2004)
Peru (2002)
Kuwait (2004)Lebanon (2004)
Morocco (2004)
Kazakhstan (2004)Tajikistan (2005)
India/Chennai (2004)India/Haryana (2004)
India/Karnataka (2004)India/Mah. Nagpur (2005)India/Maharashtra (2004)
India/Rajasthan (2003)India/West Bengal (2004)
Indonesia (2004)
Fiji (2004)Mongolia (2004)
Philippines (2002)Innovator Generic
MPR (corrected with IPR MSH 2003)
Affordability: one month’s treatment, glibenclamide 5mg twice daily, public sector, lowest paid unskilled govt worker
Affordability: one month’s treatment, glibenclamide 5mg twice daily, private retail pharmacies
Private Sector Facilities
0 2 4 6 8 10
Cameroon (2002)Chad (2004)
Ghana (2002)Mali (2004)
Peru (2002)
Kuwait (2004)Lebanon (2004)Morocco (2004)
Kazakhstan(2004)Tajikistan (2005)
India/Chennai (2004)India/Haryana (2004)
India/Karnataka (2004)India/Mah.Nagpur
India/Maharashtra (2004)India/Rajasthan (2003)
India/West Bengal (2004)Indonesia (2004)
Fiji (2004)Malaysia (2004)Mongolia (2004)
Philippines (2002) Innovator Generic
Days' Wages
Affordability: glibenclamide 5mg x2 daily + metformin 500mg x3 daily for a month, private pharmacies
Price issues
• Some huge differences within countries between innovator brand and generic prices: ”brand premiums”
– Is this a problem for patients? YES where:
– the generic is not available– the medicine is patented and faces no competition– the brand is sold to increase profits– medicine prescribed by brand name and substitution not
permitted• Some large differences within countries between brand & generic
prices, and the international reference price• The wide variation in retail price for the same product across
countries• Public sector sometimes purchasing expensive innovator brands
Affordability
• Not only is the innovator brand unaffordable in many countries, but sometimes also the generic
• Affordability could be improved through:– availability of generics in the public sector (in most but not
all countries)– therapeutic selection
• In some countries such as Tajikistan prices can be acceptable but wages are extremely low so medicines are unaffordable
Availability issues
• Some cases, based on facilities surveyed:- no generics found for older products e.g. beclometasone inhaler in Philippines (2002 & 2005)
valproic acid in Malaysia
- some important medicines not found at alle.g. phenytoin in Tajikistan
• In many countries where medicines are free in the public sector, availability is extremely low
• In private sector high priced innovator may be only product available
Manufacturer’s selling price vs Add-on costs (cumulative) private sector
Karnataka, brand aciclovir
Manufacturer's price Add on costs
Karnataka, generic aciclovir
Manufacturer's price Add-on costs
Mongolia, brand ceftriaxone inj
CIF Add-on costs
Mongolia, generic omeprazole
CIF Add-on costs
Malaysia 2003
Add-on component costsshown as actual costs, private sector
0 20 40 60 80 100 120
Mongolia import brand
Mongolia import generic
Karnataka brand obs. max
Karnataka generic obs. max
Chad import brand & generic
Kyrgyzstan import brand
Kyrgyzstan import generic
Kuwait
Lebanon import
Peru import generic obs. max
percentages
customs, fees,insurance, clearance import taximporters' mark-up wholesale mark-upretail mark-up VAT/other
Add-ons – do they matter?
• add-ons vary tremendously both in type and quantity e.g. in some states in India <40%, in Peru > 100 %
• pharmacy profits largely based on mark-upsvariable range – 15% to 55%, Malaysia and Uganda > 100%
• governments in some countries are taxing the sick by applying high import taxes and adding VAT/GST
Peru - 12% import tax and 18% VAT are addedTajikistan - removing taxes & duties would reduce total additional costs from 82%
to 32%
• a small component cost applied early in the distribution chain can contribute significantly to the final price
• as most add-ons are applied as percentages, the higher the manufacturer’s price, the higher the price to the patient
Both manufacturers’ prices and add-on costs need to be lower to improve access to essential medcines
Possible options to lower prices
• EDLs – purchase low priced quality generics for off-patent meds• Regional pooled procurement with open tenders• Patented meds – equitable prices, use the flexibilities of trade
agreements to introduce generics while patent is in force• Aid generic competition eg fast-tracking, waive registration fees• Stop taxing essential medicines• Where there is little competition, goverments should consider
regulating prices - from manufacturers’ selling price to margins in wholesale and retail.
• Pharmacists remuneration – linked to service not value of medicine• If mark-ups needed, stimulate dispensing of cheaper generics • Standard treatment guidelines• Educate doctors and consumers on availability and acceptability of
generics• Prescribe by INN and have a generic substitution policy• Separate prescribing and dispensing
Medicine Prices web-site:
www.haiweb.org/medicineprices