Medicine Prices, Availability, Medicine Prices, Availability, Affordability and Price Components Affordability and Price Components in Kazakhstan, Kyrgystan, Tajikistan & Uzbekistan Margaret Ewen Health Action International
Jan 02, 2016
Medicine Prices, Availability, Medicine Prices, Availability,
Affordability and Price ComponentsAffordability and Price Componentsin
Kazakhstan, Kyrgystan,
Tajikistan & Uzbekistan
Margaret EwenHealth Action International
WHO/HAI Project on Medicine Prices & Availability
improve the availability and affordability of essential medicines
• Develop a reliable methodology for collecting and analysing price and availability data across healthcare sectors in a country
• Price transparency; survey data on a freely accessible website allowing international comparisons
• Advocate for appropriate pricing policies and monitor their impact
• Launched WHA 2003
• Measures medicine prices availability affordability component costs
• 55+ surveys to date in all regions of the world
Medicine PricesMedicine Pricesa new approach to measurementa new approach to measurement
www.haiweb.org/medicinepriceswww.haiweb.org/medicineprices
Methodology - Data collection
• Systematic sampling: now at least 6 regions, minimum of 5 pharmacies/facilities per sector per region
• Public sector facilities, private retail pharmacies and ‘other’ sectors (e.g. dispensing doctors or NGO sector)
• Prices of 30 pre-selected commonly used medicines – now14 global + 16 regional
• Predetermined dose form & strength, & recommended pack size
• Supplementary medicines highly encouraged, adapted to local needs
• Prices of originator brand and lowest price generic• All components of price from manufacturer to retailer
identified
Data analysis
• Price calculated as Median Price Ratio (MPR)
local price compared to MSH International
Drug Price Indicator Guide (procurement prices offered to developing countries)
• Availability calculated as number of facilities having that product on the day of data collection (%)
• Affordability assessed for ten pre-selected courses of treatment compared to daily wage of lowest paid unskilled government worker
Public sector Procurement price
Public sectorPatient price
Originator brand
Lowest priced
generic
Originator brand
Lowest priced
generic
Kazakhstan Nov04 3.85 4.84
Kyrgyzstan Feb05 No data collected
Tajikistan Feb05 No data collected 2.38
Uzbekistan Dec04 2.41 No data collected
Median price ratio, public sector, glibenclamide 5mg tabsMedian price ratio, public sector, glibenclamide 5mg tabs
Public sector Procurement price
Public sectorPatient price
Originator brand
Lowest priced
generic
Originator brand
Lowest priced
generic
Kazakhstan 6 0.79
Kyrgystan 1.03
Tajikistan 1.84
Uzbekistan 2.8
Median price ratio, public sector, ciprofloxacin 500mgMedian price ratio, public sector, ciprofloxacin 500mg
Patient prices, private retail pharmacies Patient prices, private retail pharmacies fluconazole 150mg tabsfluconazole 150mg tabs
0 20 40 60 80 100 120 140 160
Uzbekistan
Tajikistan
Kyrgyzstan
Kazakhstan
median price ratio
Lowest priced generic
Originator brand
Patient prices, private retail pharmacies Patient prices, private retail pharmacies co-trimoxazole paed susp. 8+40mg/mlco-trimoxazole paed susp. 8+40mg/ml
0 5 10 15 20
Uzbekistan
Tajikistan
Kyrgyzstan
median price ratio
Lowest priced generic
Originator brand
Public sector Private sector
Originator Generic Originator Generic
Kazakhstan 0% 0% 0% 40%
Kyrgyzstan 0% 53%
Tajikistan 0% 5% 0% 5%
Uzbekistan 0% 73%
Availability: amitriptyline 25mg tabsAvailability: amitriptyline 25mg tabs
Affordability: captopril 25mg x 2 tab/day Affordability: captopril 25mg x 2 tab/day 30 days treatment, private retail pharmacies30 days treatment, private retail pharmacies
0 5 10 15 20 25 30 35
Uzbekistan
Tajikistan
Kyrgyzstan
Kazakhstan
days' wages
Lowest priced generic
Originator brand
Taxes & duties on medicinesTaxes & duties on medicines
Kazakhstan Kyrgyzstan Tajikistan Uzbekistan
Value Added Tax (VAT) 20% 20%
Import tax 0.15%
Customs Duty 5% 0-10%a
Customs Procedure 0.15% 0.15%
Central Government Tax 5%
City Tax 1%b
Retail Tax 4.08%c
Cumulative Taxes and Duties 0.15% 4.24% 27% 26-39%
Net Income Taxd 30% 20% 20% 12%
Other Taxes 1.5%e
a. Preferential rates for certain countries (e.g., Ukraine, Russia)b. The 1% Dushanbe city tax is applied at the retail point. c. Includes 4% retail sales tax, 0.08% road tax, d. Taxes paid on net profits only e. Emergency tax from gross revenues
Policy options include…Policy options include…
• Off-patent medicines - purchase low priced quality generics, public and private sector
• Patented medicines – equitable prices, use the flexibilities of trade agreements to introduce generics while a patent is in force, internal reference pricing
• Where there is little competition, consider regulating prices - from manufacturers’ selling price to margins in wholesale and retail.
• Aid generic competition eg fast-tracking, waive registration fees
• Permit generic substitution and provide incentives for the dispensing of generics
• Educate doctors and consumers on availability and acceptability of generics, and publicise the price of generics
• Stop taxing essential medicines • Separate prescribing and dispensing
Multiple policy optionsMultiple policy options