Medicine Prices, Availability, Medicine Prices, Availability,

Affordability and Price ComponentsAffordability and Price Componentsin

Kazakhstan, Kyrgystan,

Tajikistan & Uzbekistan

Margaret EwenHealth 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

• Launched WHA 2003

• Measures medicine prices availability affordability component costs

• 55+ surveys to date in all regions of the world

Medicine PricesMedicine Pricesa new approach to measurementa new approach to measurement

www.haiweb.org/medicinepriceswww.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

Public sector Procurement price

Public sectorPatient price

Originator brand

Lowest priced

generic

Originator brand

Lowest priced

generic

Kazakhstan Nov04 3.85 4.84

Kyrgyzstan Feb05 No data collected

Tajikistan Feb05 No data collected 2.38

Uzbekistan Dec04 2.41 No data collected

Median price ratio, public sector, glibenclamide 5mg tabsMedian price ratio, public sector, glibenclamide 5mg tabs

Public sector Procurement price

Public sectorPatient price

Originator brand

Lowest priced

generic

Originator brand

Lowest priced

generic

Kazakhstan 6 0.79

Kyrgystan 1.03

Tajikistan 1.84

Uzbekistan 2.8

Median price ratio, public sector, ciprofloxacin 500mgMedian price ratio, public sector, ciprofloxacin 500mg

Patient prices, private retail pharmacies Patient prices, private retail pharmacies fluconazole 150mg tabsfluconazole 150mg tabs

0 20 40 60 80 100 120 140 160

Uzbekistan

Tajikistan

Kyrgyzstan

Kazakhstan

median price ratio

Lowest priced generic

Originator brand

Patient prices, private retail pharmacies Patient prices, private retail pharmacies co-trimoxazole paed susp. 8+40mg/mlco-trimoxazole paed susp. 8+40mg/ml

0 5 10 15 20

Uzbekistan

Tajikistan

Kyrgyzstan

median price ratio

Lowest priced generic

Originator brand

Public sector Private sector

Originator Generic Originator Generic

Kazakhstan 0% 0% 0% 40%

Kyrgyzstan 0% 53%

Tajikistan 0% 5% 0% 5%

Uzbekistan 0% 73%

Availability: amitriptyline 25mg tabsAvailability: amitriptyline 25mg tabs

Affordability: captopril 25mg x 2 tab/day Affordability: captopril 25mg x 2 tab/day 30 days treatment, private retail pharmacies30 days treatment, private retail pharmacies

0 5 10 15 20 25 30 35

Uzbekistan

Tajikistan

Kyrgyzstan

Kazakhstan

days' wages

Lowest priced generic

Originator brand

Taxes & duties on medicinesTaxes & duties on medicines

Kazakhstan Kyrgyzstan Tajikistan Uzbekistan

Value Added Tax (VAT) 20% 20%

Import tax 0.15%

Customs Duty 5% 0-10%a

Customs Procedure 0.15% 0.15%

Central Government Tax 5%

City Tax 1%b

Retail Tax 4.08%c

Cumulative Taxes and Duties 0.15% 4.24% 27% 26-39%

Net Income Taxd 30% 20% 20% 12%

Other Taxes 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…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.

• 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

Multiple policy optionsMultiple policy options