Top Banner
National experiences of regular price monitoring Klara Tisocki , WHO/HAI medicine price project Towards equitable and affordable medicine prices policy in Jordan, Dead Sea, Jordan, 4 - 5 December 2007
27

National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Mar 27, 2015

Download

Documents

Autumn McCurdy
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

National experiences of regular price monitoring

Klara Tisocki , WHO/HAI medicine price project

Towards equitable and affordable medicine prices policy in Jordan, Dead Sea, Jordan, 4 - 5 December 2007

Page 2: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

OutlineWhy monitor medicine prices

Practical approach to price monitoring

National price monitoring - Results from Malaysia and Kenya

Lesson learnt

Critical elements for MPS

Page 3: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Failings of “free markets” for medicines

A “perfect” free market (where supply - demand set prices) requires perfect information, direct interchange between buyer and seller, no barriers to going into business.

Pharmaceutical markets are imperfect - they “fail” because: -information asymmetry: companies > doctors > patients

- competition failure: market power due to patents, brand loyalty, etc.

- externalities: treating your tuberculosis also helps me

Often essential state interventions are needed for pharmaceuticals because failings of free markets

Page 4: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Examples of interventions to correct free market failings for medicines

Page 5: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Need for price monitoring Regulatory frameworks

a) Supporting evidence informed decision/policy making to achieve national health goals

b) Monitoring adherence to price regulations, if exist

c) Measuring impact of policy changes

Supply chain management

d) Creating price transparency to increase competition/ negotiation power and procurement efficiency

Consumer protection

e) Protection from excessive prices

f) Increasing public access to price information – Correcting price information asymmetry

g) Providing evidence for advocacy

Page 6: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Increasing price transparency along the supply chain

Ex–factory or Ex-Manufacturer price

Wholesale prices (private distribution - Catalogue/List price vs. discounted price/ rebates/ free goods)

Procurement price (public procurement centralized vs. local)

Contract prices with purchaser i.e. insurer social health/ private health insurance(

Reimbursement prices claims/ co-payments

Public health facility patient prices

Pharmacy Retail price / Dispensing doctor price

Not-for-profit access point price (non-governmental, or faith-based not-for-profit health facilities)

Page 7: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

How to get all these price information ?

Massive amount of data is required to fully understand price structures/ changes

Objective of price monitoring system must be clear on priorities of what need to be monitored

Developing countries

- patients often pay full cost out of pocket ,

- the final patient price - main target

Page 8: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Practical approach to price monitoring

WHO/HAI medicine price surveys –post survey recommendation: need for price

monitoring

Need for simple, low cost, low tech, sustainable methodology to monitor prices

Page 9: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

The WHO/HAI Medicine Price Monitoring Method

Design: longitudinal study

Facilities: Systematic sampling of

-40) 20 private + 20 public (facilities in urban and

-40) 20 private + 20 public (facilities in rural areas

Indicator medicines:

30 locally commonly used medicines in specified dosage form and strength, recommended (or other) package size

Price of lowest cost product physically available at the facility is collected

Data collected in every 3 months, 4 data point/year

Data analysis: Pre-programmed Excel workbook, for data entry and analysis

Output: Regular Price report containing Median Unit Price, Max. Min, price variations over time, availability and affordability

Page 10: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Results from pilot countries

KENYA UGANDA MALAYSIA

Page 11: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

KENYA - method

Geographical Areas, 4 regions

96 facilities surveyed in the 4 regions. 8 facilities from each sector (Public, Private, Mission) in each region

Private pharmacies and mission facilities are 10km from the public facilities

34 medicines monitored – patient prices only

Data collection quarterly

Data collectors-Pharmacists/Pharmacy technicians/consumers based at the regional levels

Page 12: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Kenya results

Overall private sector medicines prices were 36% higher than prices in the public health facilities ,

Overall mission sector prices were 31% higher than those in the public sector.

Urban vs. rural comparisons revealed the following:

a) Prices in urban mission facilities were 50% higher than those in rural mission facilities

b) Prices in rural private pharmacies were 35% higher than those in rural mission facilities

Page 13: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

. Trends in availability April, July, October 2006 and January 2007 in the public sector facilities surveyed

2835

21 18

3 4

68

91

6 40

5

28

50 50

59

5042

54

6456

65 6468

75

8579

95

0

10

20

30

40

50

60

70

80

90

100

Apr-06 Jul-06 Oct-06 Jan-07

Month

Perc

enta

ge a

vaila

bilit

y

Amoxicillin/clavulanic 125/31mg/mL Artemether/lumefantrine 20/120mgAtenolol 50mg Metformin 500mgLamivudine/stavudine/nevirapine 150/40/200mg Omeprazole 20mgSulfadoxine/pyrimethamine 500/25mg

Page 14: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Trends in availability April, July, October 2006 and January 2007 in the mission sector facilities surveyed

31

40 3844

3136

58 61

23

32

21

39

5864 63

39

50

68

58

67

23

4

25 28

73

96

63

83

0

10

20

30

40

50

60

70

80

90

100

Apr-06 Jul-06 Oct-06 Jan-07

Month

Per

cent

age

avai

labi

lity

Amoxicillin/clavulanic 125/31mg/mL Artemether/lumefantrine 20/120mgAtenolol 50mg Metformin 500mgLamivudine/stavudine/nevirapine 150/40/200mg Omeprazole 20mgSulfadoxine/pyrimethamine 500/25mg

Page 15: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Malaysia -methodMedicine selectionGroup 1- 30 medicinesCommonly used medicines for the treatment of prevalent conditions (except psychotropics) included in either MOH formulary or WHO/HAI core monitoring list

Group 2 – 28 medicinesNewly registered patented medicines before & after inclusion into MOH Drug Formulary

Group 3 – 10 medicinesSpecialized single source products that are usually expensive & used in government hospitals with specialists, university & private hospitals

Patient and procurement prices collected

Page 16: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Malaysia – results Availability of commonly used medicines

High availability of commonly used medicines in both sectorsPublic sector- 92%Private sector- 83%

Public sector stocks only few original products (33%) and relies mainly on generics (82%)

Private pharmacies stock both original products and generics with good availability in both West (66%) and East (66%) Malaysia

Gross retail prices of selected commonly used medicines in the private sector were found to be generally high at the median of 4 times higher than IRP11 while in the public sector, medicine prices were reasonable at the median of 1.3 times higher than IRP.

Page 17: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

17

Price Variation between East and West Malaysia

Medicine Prices are slightly higher in East than West Malaysia

1 % higher for public sector

9% higher for private sector

Sector

Median Price Ratio (MPR)Between East and West Malaysia

MinimumMedianMaximum

Public (Wholesale)0.381.011.03

Private (Retail)0.931.095.85

Page 18: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

18

Wholesale Price Variation between Public and Private: LP, APPL & Tender

• Local Purchase (LP) prices in public sector are generally 63% cheaper than wholesale price in private sector

• APPL & Tender prices in public sector are generally 60% cheaper than wholesale price in private sector

Medicines bought by LP

Median Price Ratio (MPR) Between Public (Wholesale) and Private (Wholesale)

MinimumMedianMaximum

Overall0.120.370.56

Original Brand0.530.550.56

Generics0.120.200.37

APPL & Tender

Median Price Ratio (MPR) Between Public (Wholesale) and Private (Wholesale)

MinimumMedianMaximum

Overall0.090.400.96

Original Brand0.180.180.96

Generics0.090.410.86

Page 19: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Lessons learntSetting up a national price monitoring system requires high degree of customization – no uniform method to fit all

Setting objectives clearly is a critical step

Sampling strategy of medicines and data collection method will highly depend on settings + objectives

Operationalizing data collection into routine work can help with sustainability

Page 20: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Where to start ?What are your specific objectives and desired outputs ?

Is there a policy/ regulation in place mandating specific price monitoring activities, giving authority/responsibilities ?

What resources are available to sustain on long term a national MPMS ?

What capacity to collect and analyse medicine prices and provide accurate, reliable price statistics is already in place

in your country?

If no previous analysis has been done what data is available, how can it be accessed what resources needed for correct

collection and analysis?

Page 21: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Product selection

Main principle: Prices of a fixed representative basket of medicines monitored

Sampling: non-probability sampling with selection criteria

public health importance/therapeutic value, “best-sellers or high consumption items, highest value (expenditure/ procurement value) based on ABC analysis, prescription or non-prescription status, innovator brands or generic ,

Sample size: may depend on type of basket

Product description elements, INN name, brand name, strength, dosage form, type, package size,

manufacturer’s name etc .

Page 22: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Data sources selection and sampling

Central data sources: i.e. manufacturer importation or release price, procurement price, wholesale prices, health insurance claim database

Outlet-based i.e. point of purchase data collection in retail pharmacies, government health facilities, dispensing doctors surgery, mission hospitals etc.

Data source sampling: Probability sampling is recommended

Should consider urban rural geography, regionsUse relevant sampling frames like registry of private retail pharmacies, list of government health facilities, registry of dispensing doctors, etc.

Page 23: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

What prices to monitor ?

Ex –factory or Ex-Manufacturer price

Procurement price

Wholesale price

Reimbursement prices

Pharmacy Retail price

Prices paid by patients at other access points (not for profit access)

.

Page 24: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Price collection methodFrequency: monthly ----------- annually

Collection procedure:

-central data collection: from manufacturers, procurement agencies, data submitted in pre-formatted spreadsheets, by fax, letters, by e-mail or online

automated systems .

- outlets based data collection: trained price collectors and physical check of price tags or invoices/receipts is the most accurate way of recording

actual prices paid by patients .

-alternative techniques: price collection by letter, over the phone, by e-mail, fax, and sms text messages, submitted by outlets on-line via secure website, from controlled national retail price lists or price list issued for

government facilities -

Must be verified by random visits to actual pharmacy or medical outlets .

Page 25: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Data analysis and construction of a price index, when trends analyzed

Input of qualified price index statistician needed

Different mathematical formulae can be employed in construction of price index

calculations .Lowe indices

Laspeyres index

Paasche index

Young index, etc.

Page 26: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

Publishing and information dissemination on medicine price changes

What results to report (level of details)Who are the audiences

Which presentation format to use

What dissemination techniques to use (media, electronic internet, free bulletin, restricted reports etc.)

Timeliness

Access to data by different stakeholders (confidentiality)

Medicine Price Index can attract high publicity if it has credibility and regularly available

Page 27: National experiences of regular price monitoring Klara Tisocki, WHO/HAI medicine price project Towards equitable and affordable medicine prices policy.

SummaryNational price monitoring system

Should be placed in a regulatory/policy framework (operationalized for sustainability i.e. mandate, authority to collect prices, budget to support)

Should have clear objectives and desired outputs

If possible, should be based on analysis of existing data (central data collection/automation)

Should have a well designed, robust method for data collection and analysis that can provide reliable information in a consistent manner