A Guide to in HPN Vol' 1, Issue 6

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A Guide to in HPN Vol. 1, Issue 6

• Orville Solon
• April 17, 2008

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Background to the Quest - 1(for Quality
Affordable Medicines)

• Health is a product of health care and non-health
  care factors (genes, age, lifestyle)
• Health care ranges from prevention to cure
• Appropriate curative care requires setting the
  right combination of diagnostics, treatment and
  drug prescription
• This is the realm of health regulations.

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Background to the Quest - 2(for Quality
Affordable Medicines)

• If drugs and medicines are required, we ask if
  these are available or accessible.
• If accessible, we ask whether these are
  affordable.
• If not affordable, we determine whether it is
  income or price or both that prevent access.
• If prices are the main obstacle, we enter the
  realm of economic regulation.

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The Frame and Cast of Characters
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Both health regulation and economic regulation
policies are proposed by HPN-V1-I6 Health
regulations clinical practice guidelines,
quality standards, etc. Economic regulation
competition promotion, price referencing, etc.
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Challenges to the Quest (1)
Low incomes Irrational drug use self
medication, OTC, popularity of supplements No
information on quality
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Challenges to the Quest (2)
While generics use has increased, branded remains
preferred. But more importantly, compliance to
standards in clinical practice remains low.
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In a survey of 1500 physicians in the
Visayas Half the docs correctly diagnosed Pn
and AGE for children under 5 Only 40
administered the right drug or class of
drugs. The remainder actually recommended a drug
that is contraindicated or unnecessary (i.e.
antibiotics)
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Challenges to the Quest (3)
Cost of running a network facility significantly
decreases with the size of a network. Mercury
captures 67 of the retail trade The potential
of the public facility network largely remains
untapped
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Structure of the retail trade Free-standing
drugstores 88 (of which 75 is
Mercury Private hospital-based drugstores
10 Public hospital-based drugstores 2
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Challenges to the Quest (4)

• Interlocking interests between manufacturers and
  distributors creates greater potential for
  vertical control over the industry
• Credible threat to contest the market can help
  minimize the exercise of market power
• Public procurement is fragmented
• PITC imports only accounts for 2 of market
• While funding remains limited, the PDI list is
  expanding

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Zuellig Pharma distributes around 80 of drugs
sold in the market Interphil Laboratories
handles 80 of toll manufacturing Zuellig Group
of Companies is majority stockholder of Interphil
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Challenges to the Quest (5)
Patents are the current means used to secure
innovation But innovator drugs continue to hold
market leadership even after it goes off
patent Limited capacity to set, signal and
enforce drug quality and safety standards is a
choke point for greater competition in the
off-patent drug market
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A Second Look at HPN V1-I6 Recommendations (1)
Given limited resources, focus efforts to Rx
needs of specific target beneficiaries (e.g.
mothers and children among the poor)
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Address consumer behavior
Address physician practices
Promote alternative retail networks
Moderate the exercise of market power
Promote competition in off-patent s sub-market
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A Second Look at HPN V1-I6 Recommendations (2)
Focus on Rx Needs of Mothers, Neonates, Children
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• TO ADDRESS CONSUMER CONCERNS
• Target BCC campaigns against self- medication and
  OTC
• Introduce cost-effective alternatives to
  supplements (i.e. PITAHC)
• Provide observable, reliable quality signals
  (i.e. BFAD seal)
• TO ADDRESS PHYSICIANS CONCERNS
• Monitor compliance to CPGs
• Use P4P mechanisms to reward good Rx behavior

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A Second Look at HPN V1-I6 Recommendations (3)
Focus on Rx Needs of Mothers, Neonates, Children
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• TO ADDRESS RETAILING CONCERNS
• Build the public facility network into a parallel
  retail chain
• Anchoring the BNB and the P100 initiatives on
  public facilities also offer the best protection
  for consumers
• TO ADDRESS MANUFACTURING DISTRIBUTION CONCERNS
• Focus PDI/PITC work on drugs essential to MNCH
• Strengthen capacities in BFAD that contribute to
  competition promotion