Medicine Prices, Availability,

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Medicine Prices, Availability, Affordability and
Price Components in Kazakhstan,
Kyrgystan, Tajikistan Uzbekistan
Margaret Ewen Health Action International
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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

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Medicine Prices a new approach to measurement

• Launched WHA 2003
• Measures medicine
• prices
• availability
• affordability
• component costs
• 55 surveys to date in all regions of the
  world

www.haiweb.org/medicineprices
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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

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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

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Median price ratio, public sector, glibenclamide
5mg tabs
Public sector Procurement price Public sector Procurement price Public sector Patient price Public sector Patient price
Originator brand Lowest priced generic Originator brand Lowest priced generic
Kazakhstan Nov04 3.85 4.84
Kyrgyzstan Feb05 No data collected No data collected
Tajikistan Feb05 No data collected No data collected 2.38
Uzbekistan Dec04 2.41 No data collected No data collected
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Median price ratio, public sector, ciprofloxacin
500mg
Public sector Procurement price Public sector Procurement price Public sector Patient price Public sector Patient price
Originator brand Lowest priced generic Originator brand Lowest priced generic
Kazakhstan 6 0.79
Kyrgystan 1.03
Tajikistan 1.84
Uzbekistan 2.8
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Patient prices, private retail pharmacies
fluconazole 150mg tabs
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Patient prices, private retail pharmacies
co-trimoxazole paed susp. 840mg/ml
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Availability amitriptyline 25mg tabs
Public sector Public sector Private sector Private sector
Originator Generic Originator Generic
Kazakhstan 0 0 0 40
Kyrgyzstan 0 53
Tajikistan 0 5 0 5
Uzbekistan 0 73
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Affordability captopril 25mg x 2 tab/day 30
days treatment, private retail pharmacies
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Taxes duties on medicines
Kazakhstan Kyrgyzstan Tajikistan Uzbekistan
Value Added Tax (VAT) 20 20
Import tax 0.15
Customs Duty 5 0-10a
Customs Procedure 0.15 0.15
Central Government Tax 5
City Tax 1b
Retail Tax 4.08c
Cumulative Taxes and Duties 0.15 4.24 27 26-39
Net Income Taxd 30 20 20 12
Other Taxes 1.5e

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
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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.

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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