Transcript Medicine Prices, Availability, Affordability and Price Components in Kazakhstan, Kyrgystan, Tajikistan Uzbekistan

Medicine Prices, Availability,
Affordability and Price Components
in
Kazakhstan, Kyrgystan,
Tajikistan & Uzbekistan
Margaret Ewen
Health 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
Medicine Prices
a new approach to measurement
•
Launched WHA 2003
•
Measures medicine
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


•
prices
availability
affordability
component costs
55+ surveys to date in all
regions of the world
www.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
Median price ratio, public sector, glibenclamide 5mg tabs
Public sector
Procurement price
Originator
brand
Kazakhstan Nov04
Lowest
priced
generic
3.85
Kyrgyzstan Feb05
Tajikistan Feb05
Uzbekistan Dec04
Public sector
Patient price
Originator
brand
Lowest
priced
generic
4.84
No data collected
No data collected
2.41
2.38
No data collected
Median price ratio, public sector, ciprofloxacin 500mg
Public sector
Procurement price
Kazakhstan
Kyrgystan
Originator
brand
Lowest
priced
generic
6
0.79
Originator
brand
Lowest
priced
generic
1.03
Tajikistan
Uzbekistan
Public sector
Patient price
1.84
2.8
Patient prices, private retail pharmacies
fluconazole 150mg tabs
Kazakhstan
Lowest priced generic
Kyrgyzstan
Originator brand
Tajikistan
Uzbekistan
0
20
40
60
80
100
median price ratio
120
140
160
Patient prices, private retail pharmacies
co-trimoxazole paed susp. 8+40mg/ml
Kyrgyzstan
Lowest priced generic
Originator brand
Tajikistan
Uzbekistan
0
5
10
median price ratio
15
20
Availability: amitriptyline 25mg tabs
Public sector
Kazakhstan
Originator
Generic
Originator
Generic
0%
0%
0%
40%
0%
53%
0%
5%
0%
73%
Kyrgyzstan
Tajikistan
Uzbekistan
Private sector
0%
5%
Affordability: captopril 25mg x 2 tab/day
30 days treatment, private retail pharmacies
Lowest priced generic
Kazakhstan
Originator brand
Kyrgyzstan
Tajikistan
Uzbekistan
0
5
10
15
20
days' wages
25
30
35
Taxes & duties on medicines
Kazakhstan
Kyrgyzstan
Value Added Tax (VAT)
Import tax
20%
20%
5%
0-10%a
0.15%
0.15%
Central Government Tax
5%
1%b
City Tax
4.08%c
Retail Tax
Cumulative Taxes and Duties
Net Income Taxd
Other Taxes
Uzbekistan
0.15%
Customs Duty
Customs Procedure
Tajikistan
0.15%
4.24%
27%
26-39%
30%
20%
20%
12%
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…
• 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.
Multiple policy options
• 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