WHO & HAI Pricing, Availability and Affordability of Mecines in the WHO-EMRO region

Publication date: 2007

Prices, availability and affordability of medicines in the WHO-EMRO region A synthesis report of medicine price surveys in WHO-EMRO countries Douglas Ball, WHO/HAI consultant WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Background Oct ’03 – Cairo presurvey workshop 10 EMRO countries (Egypt, Jordan, Kuwait, Lebanon, Oman, Palestine, Pakistan, Sudan, Syria, Yemen) Feb ’04 – Tunis francophone workshop Tunisia, Morocco 12 surveys completed or nearly so Jordan, Kuwait, Lebanon, Morocco, Pakistan, Sudan (4 surveys in separate states), Syria, Tunisia and Yemen 2 ‘desk surveys’ without site visits Egypt and UAE (Abu Dhabi) WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Medicine price surveys in EMRO region What has been done? What can be learnt? In each country By comparing countries Synthesis report comparing results across countries Policy report – Samia Saad WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * International comparisons Jordan, Kuwait, Lebanon, Morocco, Pakistan, Sudan (Khartoum), Syria Data which had been ‘cleared’ by December 2006 Egypt and UAE as case studies (annex in report) Comparison of data using all medicines (core+supplementary) No correction for exchange rate fluctuations, purchasing power parities, national development, reference price year, other factors Presented for information and discussion purposes. Some differences to presentations Working document WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * What is acceptable?! Availability >80% Price public procurement price: MPR ≤ 1 public sector – patient price: MPR ≤ 1.5 [private retail patient price: MPR ≤ 2.5] Affordability <1 day WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Socioeconomic indicators Jo Ku Le Mo Pa Su Sy Pop. 5.5m 2.9m 4.4m 29.9m 155m 34.5m 18.1m pcGDP ($) 1,877 16,535 5,611 1,431 550 489 1,141 pcTHE ($) 177 579 573 72 13 21 59 Drs /10,000 24 18 24 6 8 6 14 P’cists /10,000 13 5 8 2 3 0.2 7 WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Overview of surveys Date No. of meds Total (core) Public sector Private sector MSH IRPs Jordan 2004 29 (23) 18 20 2003 Kuwait 2004 29 (21) 25 25 2002 Lebanon 2004 32 (26) 20 40 2002 Morocco 2004 34 (25) 20 20 2003 Pakistan 2004 29 (29) 30 48 2003 Sudan 2005 41 (22) 20 20 2004 Syria 2003 27 (22) - 57 2002 WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Supplementary medicines Median 6 supp. meds; Range = 0 – 19 Only medicines in >1 country were: Diltiazem 60mg tab. Fluconazole 150mg cap Methyldopa 250mg tab. Ibuprofen 200 mg tab. Paracetamol 500mg tab. Loratadine 10 mg tab. Amoxicillin 500mg cap./tab. Furosemide 40mg tab. WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Availability Not the same medicine basket in each country Pay for medicines WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Availability PUBLIC Jo Ku Le Mo Pa Su Sy Glibenclamide 78 72 12 100 40 100 * Salbutamol inh 6 88IB 12 95 3 35 * PRIVATE Glibenclamide 95 100IB 98IB 100 96IB 100 98 Salbutamol inh 80IB 96IB 98 100 90IB 80 93 WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Procurement - MPRs But is it available? WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Public sector - MPRs Few IBs LPGs Su Jo Glibenclamide 0.9 5.9 Salbutamol inh - 0.9 WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Private sector - MPRs WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Private sector - MPRs LPGs Jo Ku Le Mo Pa Su Sy Glibenclamide 18.5 50.8 6.0 16.7 3.6 7.0 2.5 Salbutamol inh 1.1 7.9IB 2.7 2.9 0.7 1.6 1.2 WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Brand premiums - private WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Brand premium - glibenclamide Glibenclamide Jo Ku Le Mo Pa Su Sy IB MPR 38.4 55.5 29.3 39.7 5.9 - - LPG MPR 18.5 50.8 6.0 16.7 3.6 7.0 2.5 Brand Premium 2.1 1.1 4.9 2.4 1.6 - - WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Affordability Just showing private sector affordability Medicines free in public sector in most countries (except Jordan, Sudan) But availability poor in public sector! How much is one days’ wage [to you]? US$300/month = $10/day WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Affordability – salbutamol inh Low MPR but poor affordability WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Affordability - glibenclamide WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Affordability - carbamazepine WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Price components *includes 5-10% distribution costs Many fixed % Port/ Cl’ance Other fees Tax Agent Pharmacy Cum. Markup Jo ND ND ND (19%) (26%) ND Ku - - - 35% 26% 70% Le (imported) 11.5% - - 10% 30% 60% Le (local) - - - 10% 30% - Mo (imported) Fixed fee - 7% 10% 30% 53% Mo (local) Fixed fee 10% - 10% 30% 81% Pa (local) - 11% - 7-12%* 15% 35% Su 11.53% 8% - 15% 20% 67% Sy (local) - - - (36%) 8-30% - WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Conclusions (1) Availability of meds is low in public sector Procurement is efficient in most countries (not all) with some unnecessary procurement of IBs Public patient prices not always low and can be substantial supply chain add-on costs WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Conclusions (2) Private patient prices generally high and small brand premium in some countries Affordability OK from public facilities but medicines not always available Price components add to MSP and fixed percentage markups encourage selling more expensive items WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Recommendations (1) All EMRO countries should do a MP survey Disseminate results to public and civic orgs Regional collaboration on med price info Database? Share markups, policy options. National medicine policies should address pricing Review existing pharmaceutical policies (NMP?) WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Recommendations (2) Pooled procurement mechanisms Public procurement  private pharmacies Eliminate customs duties on [essential] meds Examine other charges and taxes Encourage generic prescribing/dispensing Regressive %ages, fixed dispensing fees Regulate drug promotion Investigate public availability (EML meds) Drug supply management Anything to add? WHO-EMRO workshop Jan '07 WHO-EMRO workshop Jan '07 * Thanks All survey managers and their teams Marg Ewen and HAI consultants Zafar Mirza and Mohammed BinShahna Richard Laing and others at WHO WHO-EMRO workshop Jan '07 * * * * * * * * * * * * * * * * * * * * * * * * * *

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