The Rajasthan, India Experience

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The Rajasthan, India Experience Anita
Kotwani, Department of Pharmacology, Maulana Azad
Medical College,New Delhi, India
DSPRUD
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Introduction

• The study was carried out on a methodology
  described in the Manual - The Prices of
  Medicines A new approach to measurement (WHO -
  HAI, 2003).
• Survey was conducted from April through June
  2003.
• Study conducted by Delhi Society for Promotion of
  Rational Use of Drugs(DSPRUD)
• Presentation includes the study done, problems
  encountered and tips for a smooth survey.

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28 States and 7 UT Population 1,027,015,247
This is where a large graphic or chart can go.
of people below Poverty line 23.33
Per Capita Income Rs. 10754(225)
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Area Selected

• Rajasthan is the state chosen as it has urban,
  semi-urban and rural areas. EDL available, made
  in 2000, contains 311 drugs, for public sector
  only.
• Medicines are not given free to all citizens, but
  only to BPL card holders, widow, senior citizen,
  Ex-service men.
• No central procurement system, but centralized
  rate approval, with preference to state
  government pharmaceutical undertaking, next PSU
  and for remaining open tender.

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Sampling

• 4 Geographical areas main urban centre, Jaipur
  and 3 other administrative areas- Ajmer, Bikaner
  and Kota
• Survey measures prices of medicines in 3 sectors
  
• Public sector
• Private Sector
• Other sector Co-operative
• In each area, 1 main public health facility and 4
  other public health facilities, hence, 5 public
  health facilities, 5 private pharmacies and 5
  from other sector.
• A total of 20 public facilities, 20 private
  pharmacies and 20 outlets from other sector were
  surveyed.

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Selecting Medicines

• Core List Out of 30, strength for 3 medicines
  not available. Artesunate, Diclofenac and
  Fluconazole. So core Drugs 27.
• Supplementary List - Diclofenac (50mg) and
  Fluconazole (150mg) added to supplementary list.
  Total drugs in supplementary list 15. For 6
  medicines MSH price not available so 9
  supplementary medicines were analysed.

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Finalizing the MPDC Form

• For each medicine, there are 3 Rows and 9
  columns.
• Row 1 Innovator Brand
• Row 2 Most Sold Generic
• Row 3 Lowest Priced Generic
• Confirmation of Innovator Brand
• Survey for Most Sold Generic equivalent
• Training of Data Collectors and Pilot study done.

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Component of Medicine Price Affordability

• Meeting and discussion with officials of pricing
  authority and other government and other
  officials.
• Pay of lowest paid unskilled government worker
  Rs. 4900 p.m ( 102.5 )

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Results

• Data entry done in the especially designed
  computerized WHO/HAI Medicine Pricing Workbook.
• Work book automatically generates summary tables.
• Exchange rate is entered on the first day of data
  collection on the international medicine
  reference price data page.
• The MSH reference prices have been selected for
  comparing 27 core drugs and 9 supplementary
  drugs.

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• Government of Rajasthan is purchasing medicines
  at a reasonable price for poor patients.
• In the private sector almost half the medicines
  surveyed are priced less than twice the IRP.
• In private sector, prices of the lowest priced
  medicines available are nearly the same as most
  sold medicines.
• Availability in the public sector is low.
• Availability of drugs for HIV/AIDS is poor in
  private sector as well.
• The cost of drug treatment for pneumonia
  (amoxycillin) for 7 days is half a day salary for
  the lowest paid government worker.

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Problems encountered

• Confirmation of innovator brand and manufacturing
  company. Merging up of various pharmaceutical
  companies in India led to some confusion, brand
  names for a few medicines were different
  inquired from NPPA and other officials in the
  country. Finally the go ahead was obtained from
  the technical advisor of the project.
• Difficulty in finding the MSG. A survey was
  conducted to find out the MSG.

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• Supplementary list and Reference price. Data was
  collected for 15 medicines in the supplementary
  list. But the MSH price for 6 medicines was not
  available, so results for 9 supplementary drugs
  have been analysed.
• Timing of the survey. Survey was conducted in
  peak summer.It was difficult for data collectors
  to travel and collect data, survey took more time
  to complete. I had to make visits in extremely
  hot temperatures.

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Points to be kept in mind before conducting the
survey

• Read the manual thoroughly and carefully at least
  twice and before actually conducting any
  component of methodology, recheck from the
  manual.
• Do not undertake the survey in the extremes of
  weather or when there are many public holidays.
• Before starting the survey, gather baseline
  information on drug policy and medicine
  distribution in the respective country.
• Identify clearly the three sectors, public,
  private and other sector.

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• Before conducting the survey, four geographical
  areas and three sectors should be clearly
  defined.
• Finalizing the Medicine Price Data Collection
  Form is very important and should be made with
  utmost care.
• For the core list of drugs, strength and dosage
  form should be the same as mentioned in the
  manual.
• Select the supplementary medicines to be surveyed
  whose MSH/Reference price is available.
• Confirm the innovator brand and manufacturing
  company in your country.

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• Find out the MSG from an authentic source
  otherwise conduct a survey. Fill the name and
  company manufacturing it before giving the forms
  to data collectors.
• Select data collectors with either previous
  experience or such personnel who can approach
  various pharmacies.
• Field supervisor/Principal investigator to check
  the completeness of the forms.
• Identify the government officials from whom
  information on price regulation can be taken.
• Data entry, reentry to be done carefully.