E-DRUG: Malaysia Medicines Price, Availability, Affordability and Price Structure
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Malaysia pricing report
I would encourage all E-Druggers to review the report on the price of
medicines in Malaysia recently posted on the HAI web site at
http://www.haiweb.org/medicineprices/surveys/200410MY/survey_report.pdf
The report is written by a team made up of ZAHEER-UD-DIN BABAR, MOHAMED IZHAM MOHAMED IBRAHIM, HARPAL SINGH, and NADEEM IRFAN BUKHARI.
This is a very comprehensive report looking at price, availability, affordability and price components, in the public and in two private sectors. They have looked at both private pharmacies and dispensing doctors. The prices for the public sector were reasonable being in general 2.4 times the reference prices for innovator brands (IB)and for different generics between 1.56 and 1.09 times the reference prices.
For the private sector the prices in both the private pharmacies and the
dispensing doctors the innovator brands were 15-16 times reference and
the generics were about 6.5 to 7.5 times the reference prices. Availability of the surveyed products was generally fairly low though it did appear that the dispensing doctors were more likely to have generics available. Affordability was a problem with many people having to pay the equivalent of 2-7 days wages for a course of therapy.
The most interesting part of the report is Chapter 4 (page 26) in which
they look at price components. They looked at the price components of
atenolol, omeprazole and losartan.
What they show is that for public procurement the base price
(Manufacturers Sale Price and CIF) components amounts to between 69 and
81% with the total markups ranging from 26 to 46% for atenolol. For the
Private Pharmacies the base price only amounts to between 40 and 56% of
the final price with markups amounting to 150% for generic and 80% for
innovator atenolol. The situation in the Dispensing Doctor sector is
even more striking with the base price of generic atenolol being only
30% and 43% for the innovator brand of the total price. The combined
markups are 234% for the generic and 129% for the innovator brand. The
final price of the generic version is still less than the innovator brand but the profit margin is substantial.
What this study shows is that in an unregulated market such as Malaysia
the mark up on generics is much greater than for the innovator brands and that the final cost paid by the consumer may be two or three times the base price. In these circumstances reducing the base price without controlling mark ups may only increase the profits for the wholesalers, retailers and particularly the dispensing doctors.
Bearing in mind the work done by Birna Trap and others on the
prescribing patterns of dispensing doctors we may have a situation in
which dispensing doctors prescribe worse and overcharge more than would
happen to patients who attended a non dispensing doctor and purchased
generics from a pharmacy. (See http://mednet2.who.int/edmonitor/32/32_4.pdf)
Over the next few months we expect to see many more reports of price surveys being posted on the HAI web site. They are likely to be very
interesting - as this one is.
My congratulations to the team for teasing out the details of the price
components. This can be difficult to do but they seem to have done a very good job with this.
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Richard Laing (Medical Officer)
Policy, Access and Rational Use,
Medicine Policy and Standards,
World Health Organization
CH-1211 Geneva 27, Switzerland
Tel 41 22 791 4533
Fax 41 22791 4167
E-mail laingr@who.int