E-DRUG: The frustration of high medicine prices (2)
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Further to the message from Martin Auton concerning the articles from Scrip, the actual articles are posted below - Thanks Martin.
[Permission for posting of the articles on e-drug has been provided by
the World Editor at Scrip: Elizabeth Sukkar]
The frustration of high medicine prices
04 September 2009
Elizabeth Sukkar
There are ongoing concerns about the high price of medicines in
developing countries. Two recent surveys, taken in Vietnam and Thailand,
show that medicines in the public and private sectors are still
unaffordable to many people in those countries (scripnews.com, September
4th, 2009).
What is interesting about these two surveys is that they used the same
methodology - developed by the World Health Organization (WHO) and
Health Action International (HAI) - to determine medicine prices.
The methodology was first published as a manual in 2003, following
concerns from NGOs in the late 1990s. They had pointed out that prices
were high in developing countries, but the methodologies used were not
robust enough. WHO and HAI developed a standardised method to measure
patient prices and government procurement prices so that comparisons
could be made across sectors, both within a country and internationally.
The manual has been widely used, with 58 surveys completed across the
globe and 16 in the pipeline. Some of the countries that have used the
manual include China (two surveys), India (seven), Sudan (four), Kuwait,
Peru, South Africa (one province), Ghana and Cameroon. A number of
surveys are nearing completion in Latin America - namely Colombia,
Bolivia, Nicaragua, Ecuador, and a state in Brazil.
Most of the surveys have been undertaken or involve ministries of health
(the Thailand survey serves as an example here), but some are done by
academics, civil society organisations, and sometimes a mix of these
(for example, the Kenyan price survey involved the MoH and a civil
society group).
Thankfully, most of the surveys have been published which helps improve
transparency on the price of medicines; only a few countries have not
given permission to publish findings. "We need to know what people pay
for medicines and how affordable treatments really are," says HAI's Marg
Ewen, who is closely involved in the development of the manual.
The manual addresses four issues: medicine prices, affordability,
availability and price components (mark-ups and other charges in the
supply chain). In the most recent edition, revised last year, some minor
changes were made such as the number of regions and medicines to survey.
"High drug prices" can make good headlines, but some quarters may
question the quality of these surveys. HAI and WHO however do offer
countries technical support so that data checking and quality assurance
play an important part.
But what next? After a country does a survey and finds high drug prices
and/or poor availability, it needs to bring in the necessary policy
changes to make medicines affordable and available, be it encouraging
the use of generics, or controlling mark-ups by pharmacies and
wholesalers. The WHO and HAI are responding to requests from countries
and are now developing guidance on various price policies.
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Vietnam's medicine prices are too high
04 September 2009
Elizabeth Sukkar
The prices of medicines in Vietnam are too high, and they are low in
availability, especially in the public sector, a new study finds.
Vietnam, the fifth most populous country in the Far East, with 86.9
million people, spends some 6.6% of its GDP on health, with the
government only contributing 32% of this; the remainder comes from
patients through out-of-pocket expenses, making access to healthcare
unaffordable for low-income groups. Significantly, some 53.3% of health
spending is on medicines.
Researchers from the school of public health and community medicine at
the University of New South Wales and the Hanoi University of Pharmacy
in Vietnam and others surveyed the price, availability and affordability
of 42 medicines in drug outlets and pharmacies in five regions in
Vietnam (Southern Med Review, vol 2, issue 2, September 2009).
They found that the public sector procurement prices were 8.29 times the
international reference price for 23 branded medicines and 1.82 times
the international reference price for 33 lowest-priced generic
equivalents.
The mean availability of branded medicines and lowest priced generic
equivalents was 19.6% and 33.6% respectively in the public sector; 34.7
and 58.1% respectively in the private sector, and 10.9% and 40.4%
respectively for insured patients in the not-for-profit public sector.
Overall, all sectors showed greater availability of lowest-priced
generic equivalents than branded medicines; there were a few exceptions
such as atenolol, nifedipine and salbutamol inhaler.
The researchers also make an international comparison for 15 out of the
42 medicines.
They say that while other low income countries have an average public
procurement price 17% higher than the international reference prices for
lowest-priced generic equivalents, the Western Pacific region and
Vietnam both had procurement prices averaging 44-45% more than the
international reference price.
The researchers also found that the mean percentage availability of the
sample of 15 lowest-priced generic equivalents in Vietnam was 34.8% in
the public sector and 56.0% in the private sector, similar to the
average of country-level mean percentage availability of medicines
across other low-income countries (as defined by the World Bank).
To make public facilities a primary treatment option for the poor,
Vietnam must reduce medicine prices in this sector by improving
procurement efficiency, ensuring and promoting low-priced generics, and
regulating reasonable mark-ups, the study advises.
The researchers say the study is significant as it provides the most
thorough picture of medicines prices in Vietnam to date, using
standardised World Health Organization/ Health Action International
methodology.
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Thailand FDA survey finds high drug prices
04 September 2009
Elizabeth Sukkar
Officials from Thailand's food and drug administration (FDA) say there
is a need to improve the country's drug pricing system, after a survey
of medicine outlets found no logic to the prices of drugs.
"There is no national pricing policy in Thailand to regulate medicine
prices. Different prices for the same medicine were found, also high
prices were observed for the innovator brand medicines," says a new
study, written by researchers at Thailand's Mahidol University and
officials from the FDA (Southern Med Review, vol 2, issue 2, September
2009).
The study's authors say the government should employ appropriate pricing
strategies and implement a price regulation scheme at every level of the
supply chain. "Price regulations, such as maximum selling prices or
maximum wholesale/retail mark-ups, should be implemented and enforced.
There should be an organisation to set and monitor medicine prices."
The team surveyed the prices of 43 medicines in 41 medicines outlets (20
hospitals and 21 pharmacies) in Bangkok and three randomly selected
districts. The study was funded by the FDA.
Medicine prices were expressed as medicine price ratios (MPR) relative
to a standard set of international reference prices; an MPR of 2 would
mean that the medicine price is twice that of the international
reference price.
In terms of public sector procurement prices, the survey found that
overall the MPR was 1.46 for public sector generics and 3.3 for
innovator brands. Some innovator brands were being procured at very high
prices, such as captopril (MPR 12.10), phenytoin (MPR11.08) and
azithromycin (MPR 6.54). Some generics were also being procured at high
prices, such as azithromycin (MPR 3.07), captopril (MPR 2.88) and
nifedipine retard (MPR 2.6).
As a result of no direct medicine pricing policy, the study found that
different public hospitals bought the same product at different prices.
The study also found that among different public hospitals, the same
products were sold to patients at different prices.
The study also compared the public sector patient prices with public
sector procurement prices. For eight branded medicines, patients paid
32% more than the government procurement price; for 31 generics,
patients paid up to 75% more.
Private sector prices. In the private sector, the study found that the
lowest-priced generic equivalents were bought at an MPR of 1.48,
compared with the very high ratio of 9.67 for branded medicines. In
terms of what patients paid in the private sector, the lowest price
generic equivalent was sold to patients at an MPR of 3.31 and innovator
brands at 11.6.
Overall, for 17 innovator brands, patients were charged about 20% more
than the procurement price, while across 22 lowest-priced generics, the
mark-up was 124%.
The procurement prices in the public sectors were lower than the private
sectors for branded drugs and generics. This was due to public hospitals
buying medicines through group purchasing mechanisms. The survey used
the World Health Organization/Health Action International medicine price
methodology.
Martin Auton, Global Projects Officer (Pricing)
HAI Global
Overtoom 60/III
1054 HK Amsterdam
The Netherlands
Tel: +31 20 683 3684
Fax: +31 20 685 5002
Email: martin@haiweb.org