Medicine Prices: a new approach to measurement

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Medicine Prices a new approach to
measurement Kirsten MyhrWHO/HAI project on
medicine prices
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Outline

• Manual and website launched May 2003
• Main parts of the manual
• Recommended survey method
• Workbook
• Issues and challenges

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Main components of the methodology

• Collecting data on the prices and availability of
  medicines
• Assessing affordability
• Identifying the components of medicine prices

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Main content of manual

• Overview of a survey
• Planning a survey
• Data collection centrally and in the field
• Data entry, analysis and interpretation
• International price comparisons
• Exploring possible policy options and lines of
  action
• CD-rom with forms and automated workbook

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Survey tools

• Systematic sampling of medicine outlets in at
  least 4 areas, minimum of 10 pharmacies per area
• Prices of 30 preselected commonly used medicines
  in at least public and private sectors
• Predetermined dose forms, strengths and
  recommended pack sizes
• Supplementary lists encouraged, adapted to local
  needs
• Innovator brand and generic (most sold and lowest
  price) prices sampled
• Local prices compared to international reference
  prices
• All components of price from manufacturer to
  retailer identified
• Affordability assessed for 10 preselected courses
  of treatment

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Sectors/sampling

• Systematic sampling of medicine outlets in at
  least 4 areas, minimum of 10 outlets per area
• Public sector procurement and patient prices
• Private sector retail pharmacies
• Other sector, such as church mission sector,
  insurance, other NGO

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List(s) of medicines

• Prices of 30 preselected commonly used medicines
• Supplementary list encouraged, adapted to local
  needs
• For all medicines prices of innovator brand, most
  sold generic and lowest price generic are
  collected
• For all medicines availability is checked

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Current list of core medicines
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International Reference Price (IRP)

• The IRP chosen is the median price in the MSH
  catalogue of prices from profit and non-profit
  international suppliers to public sector
• Countries may use another set of IRPs available
  on the web, e.g. Australian PBS-prices
• Conversion of local prices to USD
• The workbook calculates ratios of local prices to
  the IRP

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Innovator brand versus generic median price
ratios captopril 25mg tabs, retail pharmacies
median price ratio
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Availability

• Availability is checked for the medicines
  surveyed, results from the pilots showed
• For several medicines, the availability of
  expensive innovator brands was high while the
  availability of cheaper generic equivalents was
  low.
• In some cases
• - no generics found for newer medicines not
  under patent
• e.g. ciprofloxacin in Cameroon and the
  Philippines
• - no generics found for older products
• e.g. beclometasone inhaler in the Philippines

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Affordability standard treatment
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Affordability

• For 10 preselected conditions, affordability is
  calculated as number of days the lowest paid
  government worker will have to work to pay for
  one treatment course

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Affordability days wages, lowest paid govt.
worker, needed to buy 30 days ulcer
treatment with ranitidine
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Pharmaceutical sector form

• The manual also encourages the use of an enclosed
  form with questions on issues concerning the
  pharmaceutical sector which could be helpful in
  analysing the data in order to better explain
  certain findings

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Issues and challenges

• To define a global core list
• To find an international reference price list
  that contains both patented and not patented
  medicines
• To find manufacturers selling prices and
  reliable information on all components will be
  studied
• To evaluate the impact of pack size differences
  will be studied

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Issues and challenges ....

• Price volatility will be studied
• Discounts, rebates etc. will be studied
• What are people actually paying? will be
  studied
• To ensure good data quality
• developing algorithm to use