|Parallel session PS28, Monday, May 26 2008, 16:00-17:30, Room 17|
|Chair(s): Richard Laing, Medical Officer, Policy, Access and Rational Use, Medicine Policy and Standards, WHO, Switzerland|
|A Comparative Assessment of Medicines Financing Systems|
|Jinani Jayasekera, Health Action International - Asia Pacific, Colombo, Sri Lanka|
|Analysis of Price Components of Essential Medicines in India: Policy Options for Improving Access to Medicines|
|Anita Kotwani, Department of Pharmacology, Vallabhbhai Patel Chest Institute, India|
|Medicine Prices, Availability and Affordability|
|Margaret Ewen, Health Action International, Amsterdam, The Netherlands|
|Evidence-Based Pharmaceutical Policy: Public Procurement Databases Provide Insight to Global Antiretroviral Prices|
|Brenda Waning, Center for International Health and Development, Boston University School of Public Health, Massachusetts College of Pharmacy and Health, USA|
Submitted by: Irene Amodei (ICVolunteers)
What affects medicine pricing? Which policies and programmes could lower prices and improve access to essential medicines? How do we measure the impact of these interventions? These crucial questions were addressed by a panel of experts, on the basis of the most recent - and often surprising - evidence. And sometimes evidence can trigger changes.
"Equity, affordability and delivery of essential medicines depend on the different financing mechanism adopted" pointed out Jinani Jayasekera, from Health Action International Asia-Pacific. A comparative assessment of the four basic alternative systems - out of pocket payment (the most regressive one), general taxation, mandated social health insurance and voluntary private or commercial health insurance - demonstrates, in fact, that the most appropriate financing mechanism must deliver medicines free of charge and includes prepayment or contributions, pooling of funds, cross-subsidizing and a sharing of risk. Responding to these principles, only the second and third system, or a suitable combination of both, represents a viable option to ensure equitable and sustainable access to medicines.
An analytical and detailed study presented by Anita Kotwani, of the Department of Pharmacology of Vallabhbhai Patel Chest Institute revealed which are the price components along the supply chain in the public and private sector in Delhi. Even if India has a prolific generic industry with hundreds of generic equivalents, brand loyalty still affects the market and "branded" medicines remain more popular and the most sold, undermining "real" competition. In addition, responsibility for medicine pricing is fragmented and distributed across different ministries. This makes delivery from suppliers to the public sector unreliable and pricing control very difficult - most of the essential medicines (over 350) are not under price control. The manufacturers' production chains lacks transparency and trade schemes "side step" pharmaceutical pricing: retail mark-ups were therefore found to be higher then the established margin, while wholesale mark-ups matched the established rates more closely.
The "big picture" of medicine prices and medicine availability in developed and transitional countries was illustrated by Margaret Ewen, from Health Action International (HAI), Netherlands. He presented the outcome of a price measurement manual (www.haiweb.org/medicineprices) published by HAI and the World Health Organisation as a result of over 55 surveys undertaken in all regions of the world, examining medicine prices, the availability of 30-50 medicines and the affordability of 10 standard treatments in the public and private sector. The manual shows that many governments are buying expensive original brands instead of cheaper generic equivalents; that lower procurement prices are not always passed on to patients in public facilities; that mark-ups and other charges can increase prices by three to five times and finally that considerable variation exists between countries. But even if the adage "One size fits all" is not applicable to prices, there are still some policy options to lower prices. For instance, taxes on essential medicines could be stopped, pharmacists' remuneration could be controlled, consideration could be given to regulating prices where there is little competition and doctors and consumers could be educated on the availability and acceptability of generics. "Information is probably available, but often it is not accessible", was the comment from the audience. Trying to make information more user-friendly is another issue that has to be addressed.
"Most policy options and programme decisions are based on assumption!" commented last speaker Brenda Waning, from the Center for International Health and Development of Boston. "We often ignore the impact of these policies in terms of the reduction of medicine prices." So, there is an urgent need for consensus to mandate public disclosure of procurement data. Public procurement data can, in fact, inform policy and programme decisions at donor and country level. The evidence-based study about global antiretroviral (ARV) prices presented by Mrs. Waning provided some interesting and uncommon insight, such as that prices paid for ARV commonly vary more then five-fold across countries, that volumes of ARVs purchased by countries bear no relationship to prices paid (suggesting that pool procurement arrangements may not result in lower prices) and that differential prices for branded ARVs are seldom cheaper than generics, due to the absence of global demand and generic competition.