E-DRUG: Sri Lanka Regulatory Authority assures price control (7)
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Dear Mr Pascal Verhoeven
Thank you for the long reply - that was two good cups of Lao coffee! My
short reply (one cup of Ceylon Tea) focusing on Regulation of Medicines for
Affordable Prices in Low and Middle Income Countries (LMICs).
You bring out through your comments and examples, an issue which is
particular to LMICs that must be addressed. The problem does not exist in
High Income Countries (HICs). Therefore LMICs have to develop/find
solutions specific to them.
- Pricing of Medicines - HICs
How prescription only medicines are paid for in HICs has to be understood
first (apologies for repetition to those who already know). There is a
comprehensive health care system where the patient/consumer pays a
regulated amount (prescription fee etc. usually small) and does not bear
the full cost the medicine. The patient/consumer therefore does not feel
the full cost of the medicine. The comprehensive health care systems
(powerful enough to challenge the pharmaceutical industry) negotiates the
price and the availability of generics is a strong bargaining point.
Medicines prices are NOT a hot topic in HICs (there are some exceptions -
USA). Medicines use outside the system (that is the Private Sector), is
small.
- Pricing of Medicines - LMICs
So to LMICs where comprehensive health care systems are rare - the
'protection of the system' is non-existent and a huge Private Sector that
exists. The consumer/patient pays (Out of Pocket) what is demanded in the
Pharmacy. It is the consumer/patient vs the pharmaceutical industry/trade
which is the very unequal battle that the consumer/patient inevitably loses
and pays.
- What price Mebendazole?
In this situation, how can the Medicines Regulatory Authorities ensure the
consumer/patient gets a reasonable price? To take the example of
mebendazole - is it reasonable to set a maximum retail price in Sri Lanka
of LKR 10.00? This must also ensure that the low priced mebendazole are not
floated up to LKR 10.00.
- Enabling Choice for the Rich at the Costs of Basics for the Poor
Setting the maximum retail price at LKR 10.00 would effectively take away
the choice of those who can afford LKR 40.00 as that product would not be
available. Is that fair? In isolation the answer is 'No' but in the broader Public Health, it is a Strong 'Yes'. Why? Medicines are a very price insensitive market and if prescribed, those in the low socio economic
groups will buy the expensive (LKR 40.00) product (often depriving
themselves of other essentials such as food). Enabling choice for the Rich
cannot be at the cost of the basics for the poor.
- So until there are Comprehensive Health Care systems in LMICs
Medicines Regulatory Authorities in LMICs have the responsibility of
regulating medicines prices in the Private Sector to ensure affordability.
That it is not done in the HICs is not an argument not to do it. The
circumstances are very different. However it is within the central
objective of Public Health - affordable medicines relevant to health care
needs.
Professor Krisantha Weerasuriya
<krisantha@gmail.com>