Medicine Prices a new approach to measurement Kirsten

Medicine Prices: a new approach to measurement Kirsten Myhr WHO/HAI project on medicine prices

Outline § Manual and website launched May 2003 § Main parts of the manual § Recommended survey method § Workbook § Issues and challenges

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Main components of the methodology § Collecting data on the prices and availability of medicines § Assessing affordability § Identifying the components of medicine prices

Main content of manual § § § Overview of a survey Planning a survey Data collection centrally and in the field Data entry, analysis and interpretation International price comparisons Exploring possible policy options and lines of action § CD-rom with forms and automated workbook

Survey tools § Systematic sampling of medicine outlets in at least 4 areas, minimum of 10 pharmacies per area § Prices of 30 preselected commonly used medicines in at least public and private sectors § Predetermined dose forms, strengths and recommended pack sizes § Supplementary lists encouraged, adapted to local needs § Innovator brand generic (most sold and lowest price) prices sampled § Local prices compared to international reference prices § All components of price from manufacturer to retailer identified § Affordability assessed for 10 preselected courses of treatment

Sectors/sampling § Systematic sampling of medicine outlets in at least 4 areas, minimum of 10 outlets per area § Public sector procurement and patient prices § Private sector retail pharmacies § Other sector, such as church mission sector, insurance, other NGO

List(s) of medicines § Prices of 30 preselected commonly used medicines § Supplementary list encouraged, adapted to local needs § For all medicines prices of innovator brand, most sold generic and lowest price generic are collected § For all medicines availability is checked

Current list of core medicines This is where a large graphic or chart can go.

International Reference Price (IRP) § The IRP chosen is the median price in the MSH catalogue of prices from profit and non -profit international suppliers to public sector § Countries may use another set of IRPs available on the web, e. g. Australian PBSprices § Conversion of local prices to USD § The workbook calculates ratios of local prices to the IRP

Innovator brand versus generic median price ratios captopril 25 mg tabs, retail pharmacies median price ratio

Availability § Availability is checked for the medicines surveyed, results from the pilots showed: § For several medicines, the availability of expensive innovator brands was high while the availability of cheaper generic equivalents was low. § In some cases: - no generics found for newer medicines not under patent e. g. ciprofloxacin in Cameroon and the Philippines - no generics found for older products e. g. beclometasone inhaler in the Philippines

Affordability – standard treatment

Affordability § For 10 preselected conditions, affordability is calculated as number of days the lowest paid government worker will have to work to pay for one treatment course

Affordability – days’ wages, lowest paid govt. worker, needed to buy 30 days’ ulcer treatment with ranitidine

Pharmaceutical sector form § The manual also encourages the use of an enclosed form with questions on issues concerning the pharmaceutical sector which could be helpful in analysing the data in order to better explain certain findings

Issues and challenges § To define a global core list § To find an international reference price list that contains both patented and not patented medicines § To find manufacturers’ selling prices and reliable information on all components – will be studied § To evaluate the impact of pack size differences – will be studied

Issues and challenges. . § Price volatility – will be studied § Discounts, rebates etc. – will be studied § What are people actually paying? – will be studied § To ensure good data quality § developing algorithm to use