websites reporting medicine prices: a comparative analysis

Websites reporting medicine prices:

a comparative analysis

Ms Saskia van Dongen 1

1 Department of Pharmaceutical Sciences, Utrecht University, the Netherlands; Intern at Essential Medicines and Pharmaceutical Policies department, World Health Organization, Geneva, Switzerland

Websites reporting medicine prices: a comparative analysis S.A.M. van Dongen – December 2010 2

Internship period: 1 March 2010 to 31 August 2010

Revision of report 1 September 2010 to 31 December 2010

WHO Examiners: Ms Alexandra Cameron Dr Richard Laing

Utrecht University Examiner: Dr Aukje Mantel-Teeuwisse


EXECUTIVE SUMMARY

In recent years, many commercial and non-commercial websites reporting medicine price have

become available on the internet. However, both the quality of these websites, and the availability

of descriptive information about the prices to allow appropriate interpretation, can limit their

usefulness. I conducted a qualitative analysis of 71 non-commercial, publicly available websites

from both national (n=50) and international (n=21) price sources. Of all websites the quality of the

site in general and the quality of the price data reported were assessed, using general and price

specific criteria. Most of the websites were fast and user-friendly, but many received a low score

for important criteria such as publication of the date of the last update of site and price

information, and search ability within the price information. Various types of medicine prices were

reported (e.g. ex-factory, procurement, wholesale, reimbursement, retail/patient prices) therefore

a specific checklist for every price type was designed to assess the comprehensiveness of the

price information. It was found that the websites often published price information that lacked key

information to perform valid international price comparisons. For example, to improve the

interpretability of price data it is recommended that websites publish information on the

components of each price (e.g. if VAT/GST is included or not, and if so the amount of the tax).

Other recommendations based on the results included the listing of medicines by INN name

(rather than by brand name) and the exchange rate to US $ applicable at the date of price

information posting.

Secondly, a quantitative analysis of medicine prices found on national websites was conducted to

assess the feasibility of comparing web-based medicine price information from different sources.

The analysis was performed on the prices of 7 medicines selected for their wide range of

therapeutic effects and the expected high availability of price data (e.g. amitriptyline 25mg,

atenolol 50mg, ciprofloxacin 500mg, glibenclamide 5mg, omeprazole 20mg, salbutamol

100mcg/dose and simvastatin 20mg). Actual price information can be compared across various

price sources but a lack of comparability of price data components across sites limits the

usefulness of these price comparisons. Therefore data was adjusted (e.g. taxes and other fees

excluded) where possible to improve the comparability of price data reported from different

sources; the seven medicine comparisons conducted in this study showed however that this is

very demanding work.

More extensive comparisons using all national websites would be even more demanding;

therefore, the use of international websites such as the Hungarian CEDD website should be

considered for price comparisons. In addition, although a comparison of prices is possible using a

small selection of national websites, a reasonable outcome can only be expected when using

multiple sites. However, large variations were still found in the prices of individual medicines; this


variation was often greatest for procurement, reimbursement and retail/patient prices. While some

price variation would be expected due to comparability issues, these and other national issues

alone would not account for the large scale price variation found in the 7 medicines comparison

study. With the exception of Tamil Nadu procurement prices (reporting 5 out of the 7 medicines),

there was no consistency as to which website reported the lowest prices. In addition, there was

little correlation between national GDP (Gross Domestic Product) per capita and prices. Thus, it

can be concluded that prices for the same products vary widely across countries, even within

similar countries (e.g. similar WHO region and country income class).

Looking at the price comparisons in general as well as their results it is surprising that although

medicine price information appears to be widely available on the internet, great variations in

prices still exist.

As a last step, two brand medicines were compared to their generic therapeutic equivalent

substance to investigate the potential cost savings of generic therapeutic substitution. Lipitor

20mg (atorvastatin) was compared to simvastatin 20mg, while Nexium 20mg (esomeprazole) was

compared to omeprazole 20mg. it was seen that all of the prices of Lipitor and Nexium were far

higher. In fact, differences up to 214-fold for Lipitor compared to simvastatin and differences up to

41.1 for Nexium compared to omeprazole were reported. While Lipitor and Nexium may be

marginally more effective when the same doses are compared these differences are in the range

of 20 to 50 % and not many fold differences as were found for the prices. These substantial price

variations clearly showed the potential cost savings of generic therapeutic substitution of

simvastatin for Lipitor and omeprazole for Nexium.


Table of Contents

EXECUTIVE SUMMARY ..................................................................................................................3

I - INTRODUCTION ....................................................................................................................... 11

II - BACKGROUND ........................................................................................................................ 11

III - OBJECTIVE / HYPOTHESIS / EXPECTED OUTCOMES ...................................................... 16

IV - METHODS .............................................................................................................................. 17

IV - 1. Literature review .............................................................................................................. 17

IV - 2. Identification of websites ................................................................................................. 17

IV - 3. Qualitative analysis of websites ...................................................................................... 18

Criteria for assessing site quality for undertaking international price comparisons .............. 18

Criteria for assessing price information for undertaking international price comparisons .... 19

IV - 4. Quantitative analysis of price information ....................................................................... 22

V - RESULTS ................................................................................................................................. 25

V - 1. Qualitative Analysis .......................................................................................................... 25

V - 1.1 NATIONAL WEBSITES ............................................................................................. 27

V - 1. 2 PRICE GUIDES........................................................................................................ 49

V - 2. Quantitative Analysis ........................................................................................................ 61

Amitriptyline 25mg capsules/tablets ..................................................................................... 63

Atenolol 50mg capsules/tablets ............................................................................................ 67

Ciprofloxacin 500mg capsules/tablets .................................................................................. 71

Glibenclamide 5mg capsules/tablet. ..................................................................................... 77

Omeprazole 20mg capsules/tablets ..................................................................................... 81

Salbutamol 100mcg/dose inhaler ......................................................................................... 87

Simvastatin 20mg capsules/tablets ...................................................................................... 91

Comparison of therapeutic equivalent substances .................................................................... 97

Atorvastatin 20mg vs. Simvastatin 20mg.............................................................................. 97

Esomeprazole 20mg vs. Omeprazole 20mg ........................................................................ 99


VI - DISCUSSION ........................................................................................................................ 101

VII - RECOMMENDATIONS ........................................................................................................ 109

Recommendations for webmasters on general site quality ..................................................... 109

Recommendations for users of websites for price comparisons ............................................. 112

Recommendations for users of websites for price comparisons ............................................. 113

VIII - CONCLUSION .................................................................................................................... 115

REFERENCES ............................................................................................................................ 117

ANNEX I Descriptive characteristics for websites reporting medicine prices ......................... 119

ANNEX II .................................................................................................................................. 120

NATIONAL MEDICINE PRICE SOURCES.............................................................................. 120

ANNEX IIIa ............................................................................................................................... 123

INTERNATIONAL MEDICINE PRICE GUIDES ....................................................................... 123

ANNEX IIIb ............................................................................................................................... 124

INTERNATIONAL MEDICINE PRICELIST SOURCES ........................................................... 124

ANNEX IV Qualitative Country Annex ..................................................................................... 125

African Regional Office (AFRO) ............................................................................................... 125

SOUTH AFRICA ................................................................................................................. 125

ANNEX V Qualitative Country Annex ...................................................................................... 131

The Americas Regional Office (AMRO) ................................................................................... 131

BRAZIL ............................................................................................................................... 131

CANADA ............................................................................................................................. 133

UNITED STATES ................................................................................................................ 137

ANNEX VI Qualitative Country Annex ..................................................................................... 145

Eastern Mediterranean Regional Office (EMRO) .................................................................... 145

BAHRAIN ............................................................................................................................ 145

IRAN.................................................................................................................................... 147

JORDAN ............................................................................................................................. 149

LEBANON ........................................................................................................................... 151


MOROCCO ......................................................................................................................... 153

OMAN ................................................................................................................................. 155

SUDAN ............................................................................................................................... 157

TUNISIA .............................................................................................................................. 159

ANNEX VII Qualitative Country Annex .................................................................................... 161

European Regional Office (EURO) .......................................................................................... 161

AUSTRIA ............................................................................................................................ 161

BELGIUM ............................................................................................................................ 163

CZECH REPUBLIC ............................................................................................................. 165

DENMARK .......................................................................................................................... 169

FINLAND ............................................................................................................................. 173

FRANCE ............................................................................................................................. 175

GERMANY .......................................................................................................................... 179

HUNGARY .......................................................................................................................... 181

IRELAND ............................................................................................................................ 183

ITALY .................................................................................................................................. 185

LATVIA ................................................................................................................................ 187

LITHUANIA ......................................................................................................................... 189

NETHERLANDS ................................................................................................................. 191

NORWAY ............................................................................................................................ 193

POLAND ............................................................................................................................. 199

PORTUGAL ........................................................................................................................ 201

SLOVAKIA .......................................................................................................................... 205

SLOVENIA .......................................................................................................................... 207

SPAIN ................................................................................................................................. 209

SWEDEN ............................................................................................................................ 213

UNITED KINGDOM ............................................................................................................ 215

ANNEX VIII Qualitative Country Annex ................................................................................... 225


South East Asia Regional Office (SEARO) .............................................................................. 225

INDIA................................................................................................................................... 225

ANNEX IX Qualitative Country Annex ..................................................................................... 229

Western Pacific Regional Office (WPRO) ................................................................................ 229

AUSTRALIA ........................................................................................................................ 229

NEW ZEALAND .................................................................................................................. 231

ANNEX X Qualitative Price Guides Annex .................................................................................. 233

Global Fund to fight AIDS, Tuberculosis and Malaria & AIDS Medicines and Diagnostic Services ................................................................................................................................... 233

ANNEX XI Qualitative Price Guides Annex ................................................................................. 237

Clinton Foundation & Médecins Sans Frontières .................................................................... 237

Clinton Foundation .............................................................................................................. 237

Médecins Sans Frontières (Doctors Without Borders) ....................................................... 239

ANNEX XII Qualitative Price Guides Annex ................................................................................ 241

Common European Drug Database, Management Sciences for Health & Österreichisches Bundesinstitut für Gesundheitswesen...................................................................................... 241

Common European Drug Database ................................................................................... 241

Österreichisches Bundesinstitut für Gesundheitswesen .................................................... 245

ANNEX XIII Qualitative Price Guides Annex ............................................................................... 247

International Trade Centre, WHO databases, Health Action International & UNICEF ............ 247

International Trade Centre .................................................................................................. 247

WHO databases ................................................................................................................ 248

World Health Organization AFRO ....................................................................................... 249

Health Action International .................................................................................................. 255

UNICEF ............................................................................................................................... 259

ANNEX XIV: Amitriptyline 25mg cap/tab ..................................................................................... 262

ANNEX XV: Atenolol 50mg cap/tab............................................................................................. 274

ANNEX XVI: Ciprofloxacin 500mg cap/tab .................................................................................. 286

ANNEX XVII: Glibenclamide 5mg cap/tab ................................................................................... 300


ANNEX XVIII: Omeprazole 20mg cap/tab ................................................................................... 312

ANNEX XIX: Salbutamol inhaler 100mcg/dose ........................................................................... 326

ANNEX XX: Simvastatin 20mg cap/tab ....................................................................................... 340

ANNEX XXI: Atorvastatin 20mg cap/tab...................................................................................... 354

ANNEX XXII: Esomeprazole 20mg cap/tab ................................................................................ 360


I - INTRODUCTION Medicine prices are an important public health issue as concerns about constrained healthcare

resources, particularly in developing countries, remain. Further, the majority of populations in low-

and middle-income countries have to pay for medicines out-of-pocket, and as such unaffordable

prices can be a significant barrier to accessing appropriate care. (1, 2) Transparent information

about medicine prices is important to inform decision-making on the part of governments, patients

and others. For example, access to national medicine price information can assist governments in

purchase negotiations and can be used for external reference pricing, whereby the criterion (or

one of the criteria) for setting the national regulated price is based on the prices in other

countries.

Systematic comparisons of medicine prices are lacking and as a result data needed to guide

national policies on medicine pricing are insufficient. (1, 2) Western countries have been forced to

contain health spending by the recent economic crisis and improved management of medicine

prices is an important contribution to containing health costs. For example, the PHARMAC

system in New Zealand has shown that it is possible to manage medicine prices and at the same

time improve access to medicines. (2) In addition, information on medicine prices, especially

reimbursement prices, should be easily available for consumers since these expenses directly

affect their healthcare. (3, 4)

An increasing number of national and international websites reporting medicine price information

is currently available on the internet. Although the publication of these prices is a great step

forward in improving transparency between, in particular, individual countries; the usefulness of

the price information is sometimes limited by the general site quality as well as the absence of

detailed price characteristics to allow appropriate interpretation of the published prices.

To assess the quality of both the site in general and the price information specific, a

comprehensive review of medicine prices available on the internet will be conducted. Many

organizations and individuals have previously reviewed other health-related informational

websites including websites of Medicine Regulatory Authorities (MRA). A study on price reporting

websites has however, to date not been conducted. This new study will investigate the availability

of medicine price information and analyse the price information reported in a qualitative and

quantitative way.

Websites from national and international sources reporting non-commercial medicine price

information will be identified through web based searches. On the thus identified websites a

comparative analysis will be performed by scoring the websites using sets of predefined criteria

that address general and price-specific issues. Lastly, a quantitative analysis will be performed for

selected medicines to assess whether the identified websites are suitable for international price

comparisons.


As a result, the interpretability of the price data for the user is assessed, thereby providing insight

into the usefulness of web-based medicine price data for international price comparisons. Finally,

recommendations for webmasters, price database authors and users of the websites will be

provided.


II - BACKGROUND

The internet can be a valuable tool for patients, health professionals and pharmaceutical

companies to obtain information on healthcare, including pharmaceutical products. One important

aspect of pharmaceuticals that can be found on the internet is information on medicine prices.

However the quality of information on the internet is variable and must be interpreted with

caution. In recent years there has been an emergence of many types of medicine price

information on websites from various sources including national and international websites as

well as commercial websites. These price reports are a great step forward in improving

transparency; however the usefulness of the information can be limited by the general quality of

the website as well as the unavailability of information to allow appropriate interpretation of the

prices reported. This is of importance since only good quality websites allow users to properly

interpret and utilize the reported medicine prices. (5, 6) Further, these websites are being

consulted for international price comparisons even when that is not their primary objective (most

national websites reporting medicine prices were not created for conducting international

comparisons). Comprehensiveness of the descriptive information accompanying price data

should therefore be considered as a major criterion when evaluating websites, regardless of the

publisher and the website's primary objective. The quality of the website, however, cannot be

seen as an indication of the quality of the price information and vice versa. Therefore both

general and price-specific criteria are needed to conduct a thorough evaluation of a website

reporting medicine prices.

Another issue related to web-based medicine price information is the degree of comparability

across sources. This is particularly relevant in the context of external reference pricing, as many

countries are using websites as a source of price data. A key issue affecting comparability of

medicine prices is the lack of information about the price components or add-on costs that are

included or excluded from the price. For example, purchase prices may be Ex-Factory or may

include insurance and freight costs (CIF), while patient prices may or may not include Value

Added Tax. Another problem is the broad range of products reported for a single medicine, for

example, different manufacturers, dosage forms, strengths and package sizes. (3, 4) A further

issue is that the market dynamics of a medicine differ from one country to another. In addition, the

add-on costs (e.g. mark-ups, duties and taxes) can be different across countries and influence

the comparison. (7) Despite these challenges, several international price comparisons have been

conducted. (8) For example, in 2008 a study conducted in Norway (9) compared medicine prices

in this country with those in nine other countries (Austria, Belgium, Denmark, Finland, Germany,

Ireland, the Netherlands, Sweden and the United Kingdom). A range of strategies were used to

improve the comparability of price across countries. Volume-weighted average prices per dose

were calculated for each substance, as were the wholesale and pharmacy margins. Price indices


were calculated for all substances, patent protected substances, and non-patent protected

substances. The statistical significance of the cross-country price differences was tested with

regression analysis, where various factors such as pack size were controlled for. (9)

To improve the availability of comparable medicine price information, WHO and Health Action

International have developed a standard survey methodology for collecting data on medicine

prices and availability at the facility level (as well as public procurement prices which are usually

collected centrally). (7) Through the application of standard methods and commonality in the

medicines used across countries, comparability of the results is enhanced and international

comparisons are possible. (8) While the WHO/HAI database of medicine price information

remains an important web-based resource, other web-based sources of quoted medicine prices

are also being used for comparisons and as such, an assessment of the degree of comparability

across these various sources is warranted.

To date no comprehensive review of medicine prices available on the internet has been

conducted. In fact, limited work has been undertaken to assess web-based pharmaceutical

information in general. Studies undertaken by the WHO in 2001 and 2009 have reviewed

websites of Medicines Regulatory Authorities (MRAs). But these studies were primarily designed

for information management directors and website administrators of MRAs and did not address

the issue of pharmaceutical prices. (5, 6)

Criteria for assessing websites reporting medicine prices

Many organizations and individuals have published criteria to evaluate health-related information

on the internet. (3, 5, 10, 11) As concluded by Kim et al. (3, 5, 10, 11) many authors agree on key

criteria for assessing health-related websites. The most frequently-cited criteria are those dealing

with content, design and aesthetics of the site, disclosure of authors, sponsors or developers,

currency of information (includes frequency of update, freshness, maintenance of site), authority

of source, ease of use and access, and accessibility and availability. However, since most of the

criteria for health-related sites are general, they can only be used to assess the general quality of

pricing websites. The evaluation of medicine pricing websites also needs more specific criteria

related to the price data being reported. However, while several studies have described the

challenges of comparing medicine prices from different sources, they do not suggest criteria for

evaluating the quality of price data from different sources.(3, 4, 12)

As part of the analysis of national MRA websites, a set of criteria was developed for assessing

site quality. These criteria have some relevance to websites reporting medicine prices and are a

useful starting point for the development of an assessment framework. The first (pilot) study on

the evaluation of medicine regulatory websites was done by Jambert (5) in 2001. Her general

purpose was to propose a WHO Model website as a guide for MRAs in order to offer internet


users improved quality and increased availability of health information. (5, 6) Jambert (5)

developed a list of criteria designed to serve as the 'gold standard' to analyse MRA websites,

consisting of 6 general and 18 specific criteria. These 24 criteria were set up as a checklist to

assess the quality of information on a MRA website. A scoring system ranging from 0 to 2

(0=inadequate, 1=intermediate, 2=good) was used to weight each criterion. The general criteria

used were: user friendliness, navigability, speed, site map, search and update. The specific

criteria developed focussed on the provided information about the MRA organization itself,

available medicinal products in the country, the distribution chain of pharmaceuticals, and about

some basic statistics in country profile (e.g. medicine consumption data, population data, income

statistics, and health and health system statistics).

Vitry et al. (11) followed up on this study in 2008 and studied the MRA websites from USA,

Canada, UK, France, Australia, New Zealand, and the European Medicines Agency (EMEA) in

order to assess the availability of information. However, the criteria used to score the websites,

while based on those of Jambert, differed from the 2001 study. They organized 16 specific criteria

into 3 domains: information on marketed medicines, information on assessment of medicines and

information on medicine safety. No general assessment of website quality was made.

In 2009 Cornips et al. (6) updated the study conducted by Jambert (5) and reviewed the progress

made on MRA websites between 2001 and 2009. They used the criteria developed by Jambert in

2001 to assess the quality and types of information provided on the websites. The only change

they made in the general criteria was a separate assessment of language as a criterion (this was

previously grouped under user-friendliness). Cornips et al. added this criterion to emphasize the

importance of the availability of information in both English and the national language.


III - OBJECTIVE / HYPOTHESIS / EXPECTED OUTCOMES

This study investigates the extent and nature of medicine price information available on the

internet to serve multiple purposes. The interpretability of the price data for the user is assessed,

thereby providing insight into the usefulness of web-based medicine price data for international

price comparisons. As a first step, a comprehensive search was conducted to identify websites

from national and international sources that contain non-commercial medicine price information.

Websites that display factory price lists and commercial website selling to individuals were

considered to be outside the scope of the study and were therefore excluded from the search. A

series of descriptive characteristics was used to classify the websites and the type of medicine

price information they contain. Secondly, a comparative analysis was performed by scoring

websites using a set of criteria that address both general and price-specific issues. Finally, a

quantitative analysis was carried out for selected medicines to assess the degree of comparability

across various sources of price information.

The primary outcome of the study is a comprehensive list of national/international websites

reporting medicine price information with a comparative analysis that will enable better

interpretation of the various sources by their users. The comparative analysis also includes an

assessment of the feasibility of comparing web-based medicine pricing information from different

sources. In order to achieve the outcomes described above, the following research questions

were investigated:

o Which countries have a website with information on medicine prices? What other not-for-

profit sources of medicine price information are available?

o What kind of websites display information on medicine prices (national, international,

commercial websites)?

o What type of medicine price information is available on the internet (manufacturer,

supplier, procurement, wholesale, reimbursement, patient)?

o What type of product and supplier characteristics is provided to accompany the price

information (e.g. quality certifications)?

o To what degree can cross-country price comparisons be made by using price information

available on the internet?

As external reference pricing is often based on price data available on websites, a secondary

outcome of this study is to provide general guidance on what to look for when obtaining price

information of websites for the purpose of international price comparisons. Based on this,

recommendations will be given on what to take in consideration when scoping for external

reference prices. This advice could also serve as guidance for publishers of medicine prices that

want to make their website useful for international price comparisons.


IV - METHODS

IV - 1. Literature review

As a first step, a literature review was conducted to support the development of criteria for

assessing websites reporting medicine prices. PubMed and WHOLIS databases (WHO library

database) were used to identify relevant id literature by using one or more of the following search

terms: health website, medicine price, drug costs (MeSH term), comparative analysis, criteria for

evaluation, website evaluation, price evaluation, price comparisons, country comparisons,

reimbursement, wholesale, patient.

IV - 2. Identification of websites

To identify websites reporting medicine prices a comprehensive search was conducted. The

initial scope for this identification process was web-based searches through search engine

Google (www.google.com). The outcome of this search was a list of websites from various

sources, including governments (MRA, Ministry of Health (MoH)), health organizations,

foundations, global agencies and health insurance agencies. The following terms were searched

in English, French and Spanish:

� medicine prices / prix des medicaments / precios de los medicamentos

� country names

� ministry of health / ministère de santé / ministerio de salud / saude

� health insurance / assurance maladie / seguro de salud

� pharmaceutical agency / pharmaceutiques agence / agencia farmacéutica

� medicine database / medicine database / base de datos de medicina

� pharmacy / pharmacie / farmacia

� wholesaler / grossistes / mayorista

� medicine authority regulator / autoridad de medicamentos / autorité des

medicaments;

Other searches included identification through WHO contacts, which resulted in a list of price

sources on existing websites that was already published on the website of Health Action

International. A number of websites found through the Google searches was already present on

this list; however a few new websites were added to the list.

All websites identified through this search were included in the qualitative and/or quantitative

analysis based on a set of defined criteria. Only current price reporting websites were included,

meaning that they published recent price information (2008 to 2010). Excluded from analysis


were websites with manufacturer or retail price lists and commercial websites that sell to

individuals. In addition to the general exclusion criteria, one specific criterion was added to select

appropriate sites for the qualitative analysis. Only publicly available websites were included;

websites asking for an entry fee to access price information were excluded.

IV - 3. Qualitative analysis of websites

A series of descriptive characteristics was used to classify the websites and the type of medicine

price information they contain (e.g. ex-factory, procurement, wholesale, reimbursement, retail).

The websites were classified according to their source (e.g. government, international non-profit)

in order to assess if quality varies between sources (Annex I).

Once the websites were classified, a comparative analysis was performed by scoring the national

websites using a set of criteria that addressed both general and price-specific issues. The scoring

system developed attributes specific scores based on pre-defined site characteristics to minimize

individual interpretation. The scoring system used to assess site quality is provided in Table 1. In

case of questionable findings, Ms. Alexandra Cameron was consulted and uncertainties were

discussed to ensure a consistent framework for assessing websites. The results of the qualitative

analysis of the site quality were grouped according to WHO region to see if there are any regional

trends.

Criteria for assessing site quality for undertaking international price comparisons

Table 1 : Overview of scoring system site quality

Site quality 0 1 2 User-friendliness Unclear layout and

undesired advertisements Unclear layout or undesired advertisements

Clear layout and no undesired advertisements

Update: site & price information

No information on update or last update longer than 1 year ago

Last update between 1 and 12 months ago

Last update within 1 month

Site map / Search No site map, nor general search engine

Site map or general search engine

Site map and general search engine

Basis for access Access fee to be paid No access fee, but registration required

No access fee, no registration required

Accessibility of information

Price information available after more than 10 clicks, no search ability within price information, no download/print version

Price information available after 5 to 10 clicks, no search ability within price information, download or print version

Price information available with no more than 5 clicks, search ability within price information, download and print version

Speed to search page

Download time at 56 K per second is more than 60 seconds

Download time at 56 K per second is 30 to 60 seconds

Download time at 56 K per seconds is less than 30 seconds

Author information No disclosure of source reputation nor up to date contact information for price author

Disclosure of source reputation or up to date contact information for price author

Disclosure of source reputation and up to date contact information for price


author Links No price reporting links,

no other useful links or expired links

Some useful links, no price reporting links and/or some expired links

Price reporting links, other useful links and no expired links

The quality of a website can not be interchanged with the quality of the price information reported.

As such, in addition to the criteria described in Table 1, a separate set of criteria was needed to

evaluate the quality of the price data being reported. Information describing the type of price data

being reported is an important indicator of quality as it enables users to clearly understand the

prices they are accessing. For example, price components such as distribution margins, sales

taxes or patient co-payments are an important factor in achieving reliable price comparisons, but

are not always included in the price published. Therefore, additional information on whether or not

these components are included is necessary. (13) Good quality price information should show

additional price information to enhance price comparisons. To address this issue a checklist for

assessing the quality of the price information has been designed for each price type (e.g. ex-

factory, procurement) (Table 2 to 6).

Criteria for assessing price information for undertaking international price comparisons

Do the prices reported include the following information? Yes / No

Table 2 : Ex-factory / manufacturer prices

Ex-factory price YES NO SPECIFICATIONS

Country: Website: INN name & dosage form & strength Brand name & manufacturer Packaging specifications & size INCO term (CIF, FOB, DDP; exports only)

Exchange rate (if not national currency) Date of price information Price type (actual, list, indicative, discount or average prices)

Quality (e.g. registration number) Pharmacopoeial specifications (USP, BP, EP, other)


Table 3: Procurement prices

Procurement price YES NO SPECIFICATIONS

Country: Website: INN name & dosage form & strength Brand name & manufacturer Packaging specifications & size INCO term (CIF, FOB, DDP; exports only)

Supplier (e.g. manufacturer, wholesaler, local agent) Volume purchased Purchase terms (e.g. national or international prequalification, open or closed tender, direct procurement from non-profit supplier; 1-,2- or 3-year contract)

Payment terms / timelines (e.g. emergency order) Date of price information Date of procurement award (procurement cycle) Exchange rate at time of award Quality (e.g. registration number) Pharmacopoeial specifications (USP, BP, EP, other)

Taxes & duties & other charges

Table 4 : Wholesale prices Wholesaler price YES NO SPECIFICATIONS

Country: Website: INN name & dosage form & strength Brand name & manufacturer Packaging specifications & size Volume (minimum purchase) Exchange rate (if not national currency) Date of price information Price type (actual, list, indicative, discount or average prices)

Taxes & duties & other charges

Table 5 : Reimbursement prices

Reimbursement price YES NO SPECIFICATIONS

Country: Website: INN name & dosage form & strength Brand name & manufacturer Packaging specifications & size Exchange rate (if not national currency) Date of price information Taxes & duties & other charges Price incl. co-payments Price incl. dispensing fee


Table 6 : Retail / Patient prices Retail / Patient price YES NO SPECIFICATIONS

Country: Website: INN name & dosage form & strength Brand name & manufacturer Exchange rate (if not national currency) Date of price information Taxes & duties & other charges Price incl. co-payments Price incl. dispensing fee


IV - 4. Quantitative analysis of price information

A quantitative analysis was conducted to assess the feasibility of comparing web-based medicine

pricing information from different sources. All price data used was publicly available on the

national websites of 50 sources (Annex II). The analysis was performed on the price data of 7 of

the 14 medicines collected globally in WHO/HAI surveys. These 7 medicines are: amitriptyline

25mg cap/tab, atenolol 50mg cap/tab, ciprofloxacin 500mg cap/tab, glibenclamide 5mg cap/tab,

omeprazole 20mg cap/tab, salbutamol 100mcg/dose inhaler and simvastatin 20mg cap/tab.

These medicines were chosen to reflect a range of therapeutic categories and a high availability

of price data was expected.

Five different price types were collected from the national websites: ex-factory/manufacturer,

procurement, wholesale, reimbursement and retail/patient. Several data limitations could lead to

comparability issues, and as such results provide only a general indication of price variations

across countries. To improve the comparability of price across different sources, all prices were

adjusted for 5 criteria:

1. Exchange rate specific for date of price information (if not in US$);

Prices found on the websites have been changed into US dollars (US$) using an

exchange rate specific for the date of the price information provided. If the date of price

information is unknown, the average exchange rate for 2008 was used to improve the

comparability with the MSH 2008 prices.

2. INCO term (CIF, FOB, DDP);

Ex-factory and procurement prices were to be adjusted to a single INCO term to improve

comparability between sources, however none of the sources specified its INCO term

which made it impossible to adjust for this criterion.

3. Reimbursement price calculated based on retail/patient prices;

The retail/patient prices reported on some of the websites, also provided information on

the amount that would be reimbursed (percentage). When this was the case, the

reimbursed price was calculated based on the retail/patient price (100%).

4. Dispensing fee excluded for reimbursement and retail/patient prices;

Where reimbursement or retail/patient prices included a dispensing fee and the amount of

this fee was specified, it was deducted from the price.

5. VAT/GST excluded for reimbursement and retail/patient prices;

Where reimbursement or retail/patient prices included a Value Added Tax (VAT) / Goods

and Services Tax (GST) it was deducted from the price according to the percentage

mentioned on the price source website or a country specific governmental website.

Price adjustments were made whenever sufficient information was available to do so; however in

some cases websites did not include the necessary data to perform the adjustments.


To compare prices across different sources, the MSH (Management Sciences for Health)

reference prices were used to calculate a ratio, that is, the ratio of the national price to the MSH

price. The reference prices were obtained from the most recent (2008) MSH International Drug

Price Indicator Guide, which reports price data from 2007. The mean and median value of the

prices and MSH price ratio were calculated if more than 3 prices were available for the price type.

The median shows the value around which most of the prices are centered; the mean provides

information on the average value which is usually slightly higher than the median due to outliers

in the dataset. The ratio of the highest price to the lowest price (high/low (H/L) ratio) has also

been calculated. It is an important parameter, as it shows the variation in prices across sources,

though comparability issues must be taken into account (e.g. some prices include VAT while

others do not).

For all 7 medicines the originator brand products have been excluded from the price comparison;

however branded generics were included when INN (unbranded) generics were unavailable.

Originator brand products were excluded because the calculated MSH price ratios would not be

comparable to generic products. Furthermore, the differences between countries would be too

great because some countries only published the prices of INN generics and would thus have

much lower prices and MSH price ratios than the countries with originator brand products.

In addition to the quantitative analysis of the 7 medicines described above, two branded

medicines were compared to their generic therapeutic equivalents to emphasize the importance

of generic substitution. The prices of the branded medicine Lipitor (Pfizer) 20mg cap/tab were

compared to the INN generic simvastatin 20mg cap/tab; while Nexium (Astra Zeneca) 20mg was

compared to the INN generic omeprazole 20mg cap/tab. Because for both medicines a MSH

reference price was not available, the local prices of simvastatin or omeprazole respectively, were

used as a reference.

Instead of a MSH price ratio, this time a country price ratio was calculated, that is, the price of

Lipitor or Nexium in country A divided by the price of simvastatin or omeprazole in country A.

All branded atorvastatin products manufactured by Pfizer were included (e.g. Lipitor, Sortis, Tahor

and Torvast) and the same method was used for esomeprazole products manufactured by Astra

Zeneca (e.g. Nexium, Nexiam and Inexium).


V - RESULTS

V - 1. Qualitative Analysis As a first step comprehensive lists of national and international websites reporting medicine price

information were drafted after identification of the websites through primarily web based

searches.

Many publicly available websites reporting medicine prices from both national and international

sources were identified (Annex II to Annex IIIb). In total 50 national price source websites were

found, representing 36 countries worldwide (for Canada, France, India, Norway, Portugal, South

Africa, Spain, the UK and the USA two or more medicine pricing websites were found). In

addition, 21 international price source websites were collected. Out of these international

websites, 14 websites were identified as international price guides and the remaining 7 websites

were listed as international (non-profit) supplier price lists. The source of the website, general

information and the type of price information they contained, were determined for each of the

websites. A comparative qualitative analysis was then performed by scoring the identified national

websites on the designed general and price-specific criteria. A complete overview of both the

general and price-specific quality tables can be found in Annex IV to XIII (results per WHO region

and per organization).

Below, the national websites are grouped according to WHO region (AFRO, AMRO, EMRO,

EURO, SEARO and WPRO), section V - 1.1. All countries were also analysed according to their

World Bank Income Group. A textual description of price quality available per WHO region is

listed after the site quality comparison of the region.

The international websites are grouped in order to keep a clear overview when comparing all

results to each other (section V - 1.2). The Global Fund to fight AIDS, Tuberculosis and Malaria

(GF) was grouped with the AIDS Medicines and Diagnostic Services (AMDS) because both report

prices of antiretrovirals (ARVs), anti-tuberculosis and anti-malaria medicines. The Clinton

Foundation (CF) and Médecins Sans Frontières (MSF) were linked for similar reasons, both

websites report ARV medicines. The websites of the Common European Drug Database (CEDD),

Management Sciences for Health (MSH) and the Österreichises Bundesinstitut für

Gesundheitswesen (ÖBIG) were grouped because all three sources are important multi country

price information websites. Lastly, the pricing websites of the World Health Organization (WHO)

regions (e.g. AFRO and PAHO) and departments (e.g. Malaria Price Information Services) were

grouped with the pricing websites of the International Trade Centre (ITC - MNS report), Health

Action International (HAI - Global Database) and the United Nations Children's Fund (UNICEF).


V - 1.1 NATIONAL WEBSITES

African Regional Office (AFRO)

Table 7: Summary of qualitative analysis of websites reporting medicine prices in AFRO countries

COUNTRY World

Bank

income

group

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed

to

search

page

Author

info

Links

South

Africa

MP

MoH

UMI

2

0

1

2

1

2

2

1

South

Africa

DMP

MoH

UMI

2

1

1

2

1

2

2

1

South

Africa

TAC

TAC

UMI

2

1

1

2

1 /

1.3

2

2

1

MP = Manufacturer Pricelists; DMP = Database Medicine Prices; TAC = Treatment Action Campaign; MoH = Ministry of

Health; UMI = upper-middle-income

User-friendliness

All South African websites receive the highest score on this criterion.

The homepage of the Ministry of Health website (MP and DMP link) lacks clarity as it contains

several different formats and colors, but this page changes into a screen with a clear layout after

one click. The price information is presented in a clear layout and therefore the website still gets

the highest score. The entire contents of all three websites are available in English.


The date that the general site was last updated was not found on any of the three websites.

However, all websites clearly list the last update of the price information. The TAC website had

updated its price information less than 1 month ago, as had the database with medicine prices on

the website of the Ministry of Health (MoH). The manufacturer pricelists on the MoH website were

last updated over one year ago.

Site map / search

The TAC website shows a clear overview of the site in a useful site map, while the MoH website

does not have a site map. But the MoH website has, in contrast to the TAC site, a useful search


engine. It enables searches by INN name, and the search results link to documents with

background information and prices for the selected medicine.

Basis for access

Both websites provide medicine price information free of charge and without the need for

registration.


Starting at the homepage of each website, price information can be accessed in less than 10

mouse clicks. The websites therefore score well on this indicator of information accessibility.

None of the websites provide a search option within their price information. On the MoH website

prices are listed by manufacturer name and not by INN name. It is therefore difficult to obtain

information on similar medicines and to compare the prices of the same medicine across different

manufacturers. On the TAC website medicines are listed in an A-Z index by INN name, but

searches are still not possible.

With respect to the formats available for price information, the TAC website provides private

sector single exit prices in an online version, a print version and as a download. However, the

public sector price list is only available online and as a print version. The price lists on the MoH

website can be downloaded, but a direct print version is not available.


The download time at 56K per second was less than 30 seconds for all three price links.

Information is therefore obtainable in a reasonable timeframe.

Author information

The MoH website provides information on the background, mission and view of the Ministry.

Contact information for all Ministry employees is available online and in addition, a document

containing a 'Call for submissions on the schedule of medicine prices' is posted in the same

window as the prices and contains contact information of the responsible authors.

The TAC website also discloses its source and lists the contact information of all employees,

including that of the authors responsible for price documentation.

Links

None of the websites include links to other websites reporting medicine prices. The TAC website

provides links to some relevant national websites; the MoH website provides links to useful

national and provincial health websites, as well as international and HIV/AIDS-related websites.

Available price information

Ex-factory / manufacturer price

The website of the Ministry of Health shows this price information for several manufacturers. All

prices are listed by both brand name and INN name and all are shown in the national currency

South African Rand. The prices can be accessed through manufacturer lists (reference price list)


or through the general medicine database (actual prices). The reference price list is valid in a

given timeframe; the actual prices are updated at the beginning of each month.

Procurement price

The TAC website publishes procurement prices in the national currency South African Rand. All

prices are listed by both INN name and brand name and for every medicine the supplier, package

specifications and volume purchased are known. All tender prices represent a 24 month contract

with the listed supplier; price details such as logistics fee and VAT (14%) are shown in specified

amounts, all published procurement prices are exclusive of this fee and VAT.

Wholesale price

In the general medicine database (actual prices) on the Ministry of Health website, wholesale

prices are listed next to the manufacturer prices. All prices are listed by both brand name and INN

name and all are shown in the national currency South African Rand. The database shows the

Single Exit Price (SEP), which is the wholesale price, is calculated by adding the logistics fee and

VAT (14%) to the ex-factory price. Both logistics fee and VAT are shown in specified amounts.


The Americas Regional Office (AMRO)

Table 8: Summary of qualitative analysis of websites reporting medicine prices in AMRO countries

COUNTRY World

Bank

Income

Group

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed

to

search

page

Author

info

Links

Brazil MoH

UMI 2 0 1 2 1.3 2 0 0

Canada PMPRB MoH cooperation

HI 2 1 1 2 1.3 1 2 0

Canada OPDP MoH

HI 2 1.5 1 2 1.7 2 2 1

USA PBM DVA

HI 2 2 2 2 1 2 2 0

USA CMS DHH

HI 2 1.5 1 2 1 2 2 0

USA CHFS Kentucky CHFS

HI 2 2 2 2 1 1 2 1

USA CDC Vaccine DHH

HI 2 2 2 2 0.7 2 1 1

MoH = Ministry of Health; PMPRB = Patented Medicine Prices Review Board; OPDP = Ontario Public Drug Programs; PBM = Pharmacy Benefits Management Services; DVA = Department of Veterans Affairs; CMS = Centers for Medicare & Medicaid Services; DHH = Department of Health & Human Services; CHFS = Cabinet for Health and Family Services; CDC = Centers for Disease Control and Prevention; UMI = Upper Middle Income; HI = High Income; User-friendliness

For AMRO 7 websites were reviewed, representing Brazil (1), Canada (2) and the United States

of America (4). All these websites are given a high score on user-friendliness.

The Brazilian website is available in Spanish, Portuguese and English; both Canadian websites

are available in English and French. The entire contents of all three USA websites are available in

English; the CDC website is also partly available in Spanish (only CDC homepage, not price list).

Furthermore, the website front can also change to the following languages (menu options and a

selection of information in this language, but not all menu options available): Chinese, French,

Russian, Portuguese, German, Italian, Vietnamese, Haitian Creole, Korean, Tagalog (Filipino).

Update: site & price

The USA websites of PBM, CHFS and CDC are awarded with the highest score on this criterion.

Both the website in general and the price information are updated at least once every month.

The 1,5 score for Canada OPDP and USA CMS is for the same reason, the last update of price

information is between 1 month and 1 year ago on both websites. The Canadian PMPRB website

regularly updates its website in general, but price information of patented medicines is collected

during the introductory period just after receiving patent, therefore different price data are listed.


Since most data is from several years ago, the criterion update is rewarded with a combined

score of 1. For Brazil no information on either updates of the site in general or updates of prices

are listed.

Site map / search

Out of the 7 websites, 3 USA websites (PBM, CHFS and CDC Vaccine) contain both a site map

and a useful search engine. On the USA CDC Vaccine website a site map is available on the

website and an A-Z index with all contents. Searches on INN name are not applicable in this case

because only vaccine names are listed, a search on vaccine name is possible and search results

include background articles and a direct link to the price database. On the other 2 USA websites

searches on INN name are possible, they do however not link directly to price information.

The remaining 4 websites are all rewarded with score 1 for the same reason, on none of these

websites a site map can be found, but they all do have a useful search engine. The search

engine on the Brazilian website provides searches on item type (medicines, hospital medical

equipment, medicinal gases, nutrition - food, health services); searches by INN name are not

possible, but the search results are listed as an A-Z index on INN name.

The site map button of the Canadian OPDB websites links to another site, but there's no sitemap

on this homepage and no additional information on Ontario Drug Benefit (ODB) program. The

website does enable searches by INN name and by brand name.

Basis for access

All websites provide medicine price information free of charge and without the need for

registration.


The price information on 6 websites is available in less than 10 mouse clicks.

The Brazilian website and both Canadian websites provide a search option within the price

information. The search results on the Brazilian website can be listed as an A-Z index by INN

name, classification, institution or as a report with minimum and maximum prices. On the Canada

PMRB website an A-Z index of patented medicines can be searched through searches by INN

name on top of the page in the search box. The Canadian OPDP website contains an e-

Formulary in which can be searched by INN name, brand name or Canadian medicine code.

On none of the website it is possible to both download and print the price information. Both

Canadian websites and 3 USA websites (PBM, CMS and CHFS) provide a download option, but

a direct print of the price information is not possible.


The download time at 56K per second was less than 60 seconds for all websites. For Brazil,

Canada OPDB, USA PBM, USA CMS and USA CDC Vaccine this download time was even less

than 30 seconds.


Author information

Both Canadian websites and 3 USA websites (PBM, CMS and CHFS) give full disclosure of the

source/author of the website in general and list specific contact information for the price

information author(s). On the websites of USA CDC also full disclosure of the source/author of

the website in general is given, but no specific contact information for the price information

author(s) is listed.

Links

None of the websites show links to other price reporting websites. The websites of Canada

OPDB, USA CHFS and USA CDC Vaccine do however display some useful national and

international links to health related or governmental websites.


Ex-factory / manufacturer price

The Canadian PMPRB website is the only one in the AMRO region which publishes this price.

Prices are initially listed on brand name, since this website shows price information of patented

drugs in Canada. All prices are in Canada's local currency Canadian Dollars (CA$). Both actual

(buyer/supplier source) and indicative prices (estimated price) are listed for each medicine; all

prices are collected during the introductory period just after receiving patent, therefore different

price data are listed.

Procurement price

Brazil and two USA websites (PBM and CDC Vaccine) in the AMRO region publish this price. On

all three websites prices are listed by both brand name and INN name and all are shown in the

country's local currency (Brazilian Real (BRL) and US Dollars (US$), respectively).

Supplier, package specifications, volume purchased and the date of price information (individual

date per medicine for Brazil) are listed, other characteristics, such as INCO term and taxes, are

not specified. The prices on both USA websites are tender prices and provide information on the

contracts with suppliers and buyers.

Reimbursement price

The Canadian OPDB website and the two remaining USA websites (CMS and CHFS) publish

reimbursement prices. All prices are listed by both brand name and INN name (indexed on INN

name) and all are shown in the country's local currency (Canadian Dollars (CA$) and US Dollars

(US$), respectively). On the website of Canada the drug benefit price and the amount reimbursed

are listed, the difference between these numbers can be seen as co-payment. Details on taxes

and dispensing fee are not clearly listed per medicines. For the USA websites specifications on

the inclusion of taxes, co-payment and dispensing fee are unknown.


Eastern Mediterranean Regional Office (EMRO) Table 9: Summary of qualitative analysis of websites reporting medicine prices in EMRO countries

COUNTRY World

Bank

income

group

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed

to

search

page

Author

info

Links

Bahrain

MoH

HI 2 0.5 1 2 1.3 1 2 1

Iran

MoH

LMI 2 0.5 1 2 1.3 1 1 1

Jordan

FDA

LMI 2 0 0 1 1.3 2 0 0

Lebanon

MoH

UMI 2 1.5 2 1 2 1 2 1

Morocco

ANAM

LMI 2 1 2 2 2 1 1 1

Oman

MoH

UMI 2 1 1 2 1.7 2 2 0

Sudan

NMPB

LI 2 0.5 0 2 1.3 2 1 0

Tunisia

MoH

LMI 2 1 0 2 1.7 2 2 1

MoH = Ministry of Health; FDA = Food and Drug Administration; ANAM = National Agency of Health Insurance; NMPB = National Medicines & Poisons Board;

User-friendliness

All countries are rewarded with a high score on this criterion. All websites display a clear layout;

as an example, the Lebanon MoH website has all menu options in a panel on the left, with

subcategories for each menu option that open to the right of the menu panel. As a result, options

are clearly and logically presented and navigation through the website is simple and

straightforward. Another example is the Sudan pricing link, whose start screen includes a search

box which allows users to access price information without navigating through the website. It also

includes general information that clearly describes the contents of the database (only in Arabic).


Of the websites from the EMRO region, Lebanon has the highest score on this criterion. Its

website is updated daily; however the last update of the price information was more than one

month ago, resulting in a combined score of 1.5 for this criterion. The Iran, Jordan, Morocco,

Oman and Sudan websites did not display the last update of the general website. The websites of

Iran and Morocco display the date of creation/copyright of the website, but this does not give any

insight on the last update. With the exception of Bahrain and Tunisia, all websites provide the


date and/or last update of the price information. The price data from Iran, Lebanon, Morocco and

Oman had all been last updated in the first quarter of this year (2010).

Site map / search

Morocco received the top score for this criterion; its website has a clear sitemap which shows

users how to navigate through various menu options. In addition it includes a search box for the

general website. With the exception of Lebanon and Morocco, none of the websites have both a

site map and a general search engine. The Oman site contains a search box for the general

website, but unfortunately the search engine was not operating at the time of access. Websites

from Bahrain and Iran do not have a site map, but do contain a search box for the general

website.

Basis for access

With the exception of Jordan, all websites provide medicine price information free of charge and

without the need for registration. The basis for access varied across sources. The Jordan website

is accessible free of charge, however registration is required to access the price information. The

website provides a guest account so that anyone can access price information; the registration

feature is used to keep users up to date on changes and additional information.

Lebanon's website does not require a fee or registration to access the medicine price information;

however registration is necessary to access additional information such as exchange rates used

for imported pharmaceuticals. Moreover, after registration you need to request permission to see

this additional information on the price database.


Of the websites from the EMRO region, price information is available in less than 10 mouse

clicks. The websites therefore score well on this indicator of information accessibility.

The Bahrain website is an example of a site where pricing information is easily accessible; it

includes a search function for price data. The price database consists of an A-Z index by brand

name and a search box; however searches are only possible by brand name and not by INN

name. The price information on the websites from Iran, Jordan, Lebanon, Tunisia, Sudan, Oman

and Morocco all allow prices to be searched by INN name, and some also allow searching by

trade/brand name, ATC code, therapeutic class, price date, manufacturer, country of origin, and

sales agent. If you click on one of the search results on the Morocco website, you are linked to a

table with all possible hits for this medicine (all brands, generic and originator). The prices on the

Lebanese website can be searched by brand name (originator) and INN name; however search

results are not combined as they are on the Moroccan site. For example, the search term

amoxicillin only provides results for generic products, while search term amoxil only provides

results for the originator brand. A bonus feature on the Morocco website is a drop-down tab below


the searches box that shows examples of medicine names that match the search term. This is a

useful tool as it addresses the issues of typographical errors and name differences between

countries.

Of the EMRO websites, only Lebanon and Morocco have both a download and a print version of

the prices available. Both websites include a 'print screen' feature to their searches box, however

for Lebanon some important details (strength, pack size, dosage form, pharmacist margin) are

not printed when using this feature. Price information from Iran, Tunisia and Oman can be printed

per individual search item, while Sudan does not provide a print option. None of the websites

allow the complete database to be printed at once.


The download time at 56K per second was less than 60 seconds for all websites. Information is

therefore obtainable in a reasonable timeframe. For Jordan, Oman, Sudan and Tunisia the

download time was less than 30 seconds.

Author information

Bahrain, Lebanon, Oman and Tunisia give full disclosure of the source/author of the general

website and list specific contact information for those responsible for the price information. On the

websites from Iran, Morocco and Sudan, full disclosure of the source/author of the general

website is also provided, but no specific contact information for the price information author(s) is

listed.

Links

None of the websites include links to other price reporting websites. The websites from Bahrain,

Iran, Lebanon, Morocco and Tunisia do, however, display some useful national and international

links to health-related and/or government websites.


Procurement price

Sudan is the only country in EMRO that publishes the procurement price. The Sudan Index 2009

lists entry prices into the country for imported medicines and retail prices to the public for

medicines produced by national pharmaceutical manufacturers (both are procurement prices).

In the Sudan Index 2009, INN name, brand name, manufacturer, packaging specifications,

supplier and date of price information are all specified for each medicine. Prices are listed in

different currencies (e.g. US$, Euro (€), Iranian Rial), including different currencies within

countries, making it difficult to compare between companies and countries of origin.

Reimbursement price

Morocco is the only country in EMRO that publishes the reimbursement price. All prices are

published in the national currency (Moroccan Dirham). It is not specified if the reimbursement

prices listed include a dispensing fee.


Retail/Patient price

Bahrain, Iran, Jordan, Lebanon, Morocco, Oman and Tunisia all publish retail/patient prices on

their websites. All prices are again listed in national currencies (Bahraini Dinar, Iranian Rial,

Jordanian Dinar, Lebanese Pound, Moroccan Dirham, Omani Rial and Tunisian Dinar,

respectively). For Bahrain, Jordan, Lebanon and Tunisia the date of the price information is not

provided. The Lebanon retail prices include the dispensing fee, and the Moroccan website

includes information on patient co-payments, however for other countries no specifications on co-

payment and dispensing fee are provided. On the Iranian website for each individual medicine,

the date of the price information is provided.


European Regional Office (EURO)

Table 10: Summary of qualitative analysis of websites reporting medicine prices in EURO countries2

COUNTRY World

Bank

Income

Category

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed

to

search

page

Author

info

Links

Austria CEDD

HI 2 0.5 2 2 1.3 2 0 2

Belgium MoS

HI 1 2 2 2 1.7 2 2 1

Czech Republic CEDD

HI 2 0 2 2 1.3 2 0 2

Denmark DMA

HI 2 2 2 2 1.7 1 1 1

Finland CEDD

HI 2 0.5 2 2 1.3 2 0 2

France Codage NHI

HI 2 2 1 2 1.7 2 0 0

France CEPS MoH

HI 2 0 1 2 1.3 1 1 0

Germany MoH

HI 2 2 2 2 1 2 2 1

Hungary CEDD

UMI 2 0.5 2 2 1.3 2 0 2

Ireland CEDD

HI 2 0.5 2 2 1.3 2 0 2

Italy MoH

HI 2 0 2 2 1.3 2 1 1

Latvia CEDD

UMI 2 0.5 2 2 1.3 2 0 2

Lithuania CEDD

UMI 2 0 2 2 1.3 2 0 2

Netherlands CHI

HI 2 0 1 2 1.3 2 1 0

Norway CEDD

HI 2 0.5 2 2 1.3 2 0 2

Norway NMA

HI 2 1 2 2 1 1 2 0

Poland CEDD

UMI 2 0 2 2 1.3 2 0 2

Portugal originator MoH

HI 2 1 2 2 1.7 2 2 1

Portugal HI 2 2 2 2 1.3 2 2 1

2 # After the closing date of the qualitative analysis additional websites were identified for the Czech Republic and the United

Kingdom; for Belgium a separate database on the previously included website was identified. These three websites/databases are listed

and analyzed individually in the qualitative analysis annex but not included in the WHO regional analysis, as they became available after the closing date of this comparative analysis.


generic MoH Slovakia CEDD

UMI 2 0 2 2 1.3 2 0 2

Slovenia CEDD

HI 2 0 2 2 1.3 2 0 2

Spain AEMPS MoH

HI 2 0.5 2 2 1.7 1 2 1

Spain Vademecum UBM

HI 1 1 2 2 2 1 2 1

Sweden MoH

HI 2 1 2 2 2 2 1 1

United Kingdom Scottish Drug Tariff SG

HI 2 2 2 2 1 1 2 2

United Kingdom eMIT MoH

HI 2 1 1 2 1.7 0 2 0

United Kingdom Drug Tariff for England and Wales MoH

HI 2 1 1 2 1.7 2 2 0

United Kingdom BNF

HI 2 0.5 1 0/1 ? 1 2 0

CEDD = Common European Drug Database; MoS = Ministry of Social Affairs; DMA = Danish Medicines Agency; NHI = National Health Insurance; CEPS = Comité Economique des Produits de Santé; MoH = Ministry of Health; CHI = College for Health Insurances; NMA = Norwegian Medicines Agency; AEMPS = Agencia Española de Medicamentos y Productos Sanitarios; UBM = United Business Media Medica Spain; SG = Scottish Government; BNF = British National Formulary; HI = High Income; UMI = Upper Middle Income;

User-friendliness

For Europe 28 websites were reviewed, representing 21 countries. Out of all these websites, 26

are rewarded with a high score on user-friendliness. All these websites display a clear layout, as

an example, the Dutch, Danish and French CEPS website are theme sites specific for medicine

prices. The homepage screen is a search box and search results are displayed in a table with

clear layout. The websites of Italy, Norway NMA and both Portuguese websites are divided in

different sections dependent on the user of the website. Norway shows a section with general

information, a consumer part, a health professional part, a pharmacy and wholesaler part, and an

industries part. Italy and Portugal divide their websites into sections for patients and consumers,

for health professionals, for pharmaceutical companies (pharmacies and suppliers), and for the

industry (Portugal) or a pressroom (Italy). All websites are available in their national languages

(French and Dutch for Belgium); the entire contents of the Danish and German website are also


available in English. The CEDD website is an exception because it lists the prices of several

countries (Austria, Czech Republic, Finland, Hungary, Ireland, Latvia, Lithuania, Norway, Poland,

Slovakia, Slovenia). The website in general is in English, all product names and dosage form are

listed in the national language; all other characteristics are in English.


The websites of Belgium, Denmark, France Codage, Germany, Portugal generic and United

Kingdom Scottish Drug Tariff were awarded with the highest score on this criterion. On the

Danish website prices are updated every fortnight and reimbursement figures are updated daily.

For both the website in general and for the price information they clearly displayed the last update

and all these updates were carried out less than one month ago. For most websites it was

unknown when the website in general was last updated, resulting in a score of 1 or less.

Site map / search

22 out of the 28 websites contain both a site map and a useful search engine. The CEDD website

provides the option to search by country or by ATC code, the site map can also be organized by

country or ATC code. Most websites can be searched by INN name, but both French websites

even provide advanced search option in which can be searched on more criteria (e.g. brand

name, therapeutic indication, manufacturer). An additional feature on Italy's website is a pull-

down tab with medicine news (background information), specific for every INN name.

The website of Sweden provides a search on INN name and search results link to additional

information in background documents, but also a specific link displaying how many hits are found

in the pricing database (direct access link) is shown.

The remaining 6 websites are all rewarded with score 1 for the same reason, on none of these

websites a site map can be found, but they all do have a useful search engine.

Basis for access

All websites provide medicine price information free of charge and without the need for

registration. On the website of Portugal you do need to register to download the database.

The only exception is the website of the British National Formulary, this website is free to access

for residents of the United Kingdom and some developing countries (list on website), but all other

users need to register in order to get access to the price information.


The price information is available on all websites in less than 10 mouse clicks.

A total of 24 websites provide a search option within the price information, mostly on INN name. A

good feature on the CEDD website is the possibility to compare prices between different

countries based on their ATC code and the date of price information. Italy, Portugal and Spain

enable searches within prices on more than just INN names (e.g. product name, manufacturer,

ATC code, retail price and therapeutic group).

Only the website of Sweden and the Spain Vademecum website provide both a download and a


print version of the prices database. The websites of Belgium and Denmark and the UK Drug

Tariff England and Wales website provide a direct print option, but no download version of the

prices. For France Codage, Germany, Norway NMA, Portugal originator, Spain AEMPS, UK

Scottish Drug Tariff and UK eMIT this is the other way around, they have a download version

available, but no direct print option. The remaining 15 websites provide neither a print option nor

a download version.


The download time at 56K per second was less than 60 seconds for 27 websites. For 20 out of

these 27 websites this download time was even less than 30 seconds.

Author information

Belgium, Germany, Norway NMA, both Portuguese, both Spanish and all 4 UK websites give full

disclosure of the source/author of the website in general and list specific contact information for

the price information author(s). On the websites of Denmark, France CEPS, Italy, the Netherlands

and Sweden also full disclosure of the source/author of the website in general is given, but no

specific contact information for the price information author(s) is listed. The remaining 12

websites do not disclose the source/author of the websites or specific contact information for the

price author(s).

Links

The CEDD website (representing Austria, Czech Republic, Finland, Hungary, Ireland, Latvia,

Lithuania, Norway, Poland, Slovakia and Slovenia) and the website of UK Scottish Drug Tariff,

link to other price reporting websites. The websites of Belgium, Denmark, Germany, Italy,

Portugal (both) and Spain (both) don't list other price reporting websites, but do however display

some useful national and international links to health related or governmental websites.


On all 28 websites medicines are listed on INN name and all prices are shown in the national

currency. All prices on the CEDD website are shown in Euro's, regardless if this is the national

currency of the country published.

Ex-factory/manufacturer price

Austria, the Czech Republic, France Codage, Hungary, Lithuania, Slovakia and Spain

Vademecum publish ex-factory/manufacturer prices. All prices are presented in more or less the

same layout, none of the countries is clear on the INCO term, price type (e.g. actual, list,

discount), quality or pharmacopoeial specifications. All other characteristics for this price type are

clearly listed on each of the websites.

Procurement price

The websites of Denmark, Sweden and UK eMIT list procurement prices. Next to INN name,

brand name, pack size and date of price information, Denmark and Sweden do not list any


additional characteristics for these prices. The website of UK eMIT however gives insight on INN

name, pack size, volume purchased, date of price information and information on taxes & duties

& other charges.

Wholesale price

Austria, Finland, Hungary, Ireland, Latvia, Lithuania, Norway and Slovenia publish wholesale

prices on the CEDD website. Details on price type and taxes & duties & other charges are

unknown. Sweden and the Norwegian NMA website present wholesale prices as well, on these

websites information on taxes & duties & other charges is unknown.

Reimbursement Price

The amount reimbursed is published on the websites of Belgium, Denmark, France (both),

Germany, the Netherlands, Norway NMA, Portugal (both), UK Scottish Drug Tariff and UK Drug

Tariff for Wales and England. Denmark and the Netherlands have not included the dispensing fee

in this price, but for the other countries it's unclear if this fee is included or not. For Belgium and

both UK websites it is also unknown if VAT is included in the price.

Retail/Patient Price

A number of 18 European websites publish retail/patient prices, including 9 countries on the

CEDD website (Slovenia and Ireland don't list this price). For this price type it is unknown in most

cases whether or not the dispensing fee and co-payments are included. Other characteristics are

all clearly listed within the price overview or in texts supporting the price information.


South East Asia Regional Office (SEARO)

Table 11: Summary of qualitative analysis of websites reporting medicine prices in SEARO countries

COUNTRY World

Bank

income

group

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed

to

search

page

Author

info

Links

India

NPPA

MoCF

LI 2 0 2 2 1 2 1 1

India

TNMSC

MoH

LI 2 1 0 2 1 1 1 0

NPPA = National Pharmaceutical Pricing Authority; TNMSC = Tamil Nadu Medical Services Corporation Ltd. MoCF = Ministry of Chemicals and Fertilizers; MoH = Ministry of Health & Family Welfare; LI = low-income

User-friendliness

Both Indian websites are rewarded with the highest score on this criterion. Each displays a clear

layout, for example, it is easy to see where additional information on medicine prices can be

found. The entire contents of both websites are available in English and the NPPA website is also

available in Hindi.


There is no information available on the last update of either the NPPA or TNMSC website.

However, the TNMSC website does display the date the price data was last updated and this was

done less than one month ago; the site was therefore given a combined score of 1 for "update".

Site map / search

The NPPA website includes both a site map and a useful search engine, resulting in a maximum

score of 2. Searches can be performed by INN name and moreover, the search results link to

most recent documents with price information.

Basis for access


registration.


The price information is available on both websites in less than 10 mouse clicks. The websites

therefore score well on this indicator of information accessibility.

The NPPA website lists all price (?) information in an A-Z index, however there is no additional

option to search within price data. The TNMSC site does not include a search option for price

data. Prices are only available in a downloadable document and within this document they are

listed by product number (random alphabetical order).

On both websites price information is available in a downloadable format; however it is not

possible to print the prices directly from the websites.


Taking into account all criteria included in "accessibility of information", both websites are

rewarded with an average score of 1.


The download time at 56K per second was less than 60 seconds for both websites. Information is

therefore obtainable in a reasonable timeframe. For the NPPA website the download time was

even less than 30 seconds.

Author information

The NPPA website lists background information on the National Pharmaceutical Pricing Authority

(NPPA) and their Drug Pricing Control Order (DPCO), but no specific contact information for

those responsible for the price data. The TNMSC website lists background information on the

Tamil Nadu Medical Services Corporation (TNMSC), both generally and for their procurement

services, but no specific contact information is listed with respect to price data.

Links

Neither website includes links to other price reporting websites. The NPPA website does display

some useful links to related departments in the Ministry of Health and to Ministries of Health of

other countries.


Both websites list medicines by INN name and show prices in the national currency (Indian

Rupee, INR/Rs).

Procurement price

The TNMSC website contains a document called "Finalized rates and suppliers for the tender for

the supply of Drugs & Medicines to TNMSC for the year 2010-2011". This document lists the

procurement prices of generic products and includes information on packaging specifications,

suppliers and dates of price information.

Retail/Patient Price

The NPPA website includes a document with the prices of bulk medicines as well as an online

database containing the ceiling prices of scheduled formulations. The latter are maximum

retail/patient prices and are exclusive of excise duty and local taxes.


Western Pacific Regional Office (WPRO)

Table 12: Summary of qualitative analysis of websites reporting medicine prices in WPRO countries

COUNTRY World

Bank

Income

Group

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed

to

search

page

Author

info

Links

Australia

MoH

HI 2 2 2 2 1.7 2 2 1

New

Zealand

PMA

HI 2 2 2 2 1.7 2 2 1

MoH = Ministry of Health & Family Welfare; PMA = Pharmaceutical Management Agency; HI = high-income

User-friendliness

Australia and New Zealand are both rewarded with the highest score on this criterion.

On Australia's website three different versions of the Pharmaceutical Benefits Scheme (PBS) can

be accessed: one for consumers, one for health professionals and one for industry. Each is easily

accessible by clicking on the specific version in the menu. New Zealand has a similar layout with

different headings for accessing the Pharmaceutical Schedule for various users: patients &

consumers, health professionals, district health boards and pharmaceutical suppliers.

The entire contents of both websites are available in English; the New Zealand website is also

partly available in Maori.


General updates and updates of price information are carried out on a monthly basis on both

country websites. The Australian site displays the PBS Website Update in its general news feed,

and documents are available which provide detailed information on the changes that have been

made. One remark for the website of New Zealand is that the site map has been updated last on

13-11-2008, this doesn't match up to the website in general which is updated every month.

Site map / search

On both websites, site map are available and searches can be performed by INN name. Search

results link directly to price information for the selected medicine (originator brand and generics).

Basis for access

Both websites are accessible free-of-charge and registration is not required to access price

information.


The price information is available on each website in less than 10 mouse clicks. The websites


Both websites contain only information specific for the medicine price schedules and therefore the

general search engine can be used to search within the price information.


Information on Australia's PBS can be accessed through simple searches (e.g. INN name, brand

name), advanced searches, or by browsing through various menus (e.g. A-Z medicine listing,

body system, manufacturer name). Information is available as a searchable internet database

that provides a print version of the search results in table format, however it is not possible to

download the database. Information on New Zealand's schedule is also available as a searchable

internet database, but it is also available in a download format (pdf file). The schedule can also be

accessed through simple searches (INN name, brand name) or by browsing by body system. A

direct print of the search results is not possible.



therefore obtainable in a rapid timeframe.

Author information

Both websites include information on the background, mission and view of the host organization.

In addition, each provides contact information for the author of the price information.

Links

The Australian website provides useful links to Australian health-related websites, but does not

include links to other websites reporting medicine prices. New Zealand also does not include

these links as the site is very New Zealand-specific given their unique funding system. The site

does list a selection of links in a panel on the right hand side of the website, however these are

not clearly labeled and users must follow the links to ascertain the source/nature of the website.


All medicine prices are listed in the country's local currency (Australian Dollars (AU$) and New

Zealand Dollars (NZ$), respectively). Both websites update their prices at the beginning of each

month.

Ex-factory/manufacturer price

New Zealand publishes ex-factory/manufacturer prices and includes package specifications.

Prices are reported in units such as price per tablet, capsule, milliliter, etc. However, the website

is not clear on the INCO term, price type (e.g. actual, list, discount), quality or pharmacopoeial

specifications.

Reimbursement price

The Australian website does not provide information on package specifications, so it is

sometimes unclear how many tablets/capsules are contained in a pack. As a result, price data

can be difficult to interpret. For each medicine, the website lists the amount paid by the

government, the maximum paid by the patient, and the reimbursed amount. As such, it is easy to

ascertain whether the reimbursement price includes a co-payment. The website states that

maximum patient prices are inclusive of GST/VAT, however no such specifications are provided

for reimbursed prices. It is mentioned that this price includes all allowable pharmacist fees.


V - 1. 2 PRICE GUIDES

Global Fund to fight AIDS, Tuberculosis and Malaria & AIDS Medicines and

Diagnostic Services

The Global Fund to fight AIDS, Tuberculosis and Malaria (GF) was grouped with the AIDS

Medicines and Diagnostic Services (AMDS) because both do not report all globally available

medicines, but only the medicines important in their own field of work. Meaning that both websites

only report the (procurement) prices of antiretrovirals (ARVs), anti-tuberculosis and anti-malaria

medicines.

Table 13: Summary of qualitative analysis of Global Fund - Price & Quality Reporting Tool (GF - PQR) and

AIDS Medicines and Diagnostics Service - Global Price Reporting Mechanism (AMDS - GPRM) websites

PRICE

GUIDE

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed to

search

page

Author

info

Links

GF - PQR 2 1.5 2 2 2 1 2 2

AMDS -

GPRM

(WHO)

2 1.5 1 2 2 2 1 1

GF = Global Fund to fight AIDS, Tuberculosis and Malaria; PQR = Price & Quality Reporting; AMDS = AIDS Medicines

and Diagnostics Service; GPRM = Global Price Reporting Mechanism; WHO = World Health Organization

User-friendliness

Both the Global Fund PQR Tool (GF - PQR) website and the AIDS Medicines and Diagnostics

Service GPRM (AMDS - GPRM) website were given a high score on this criterion. They display a

clear layout; as an example, the GF website clearly divides its contents into 5 sections: ‘who we

are’, ‘saving lives’, ‘grant portfolio’, ‘applicants/implementers’ and ‘media center’. This facilitates

navigation through the individual pages and allows users to quickly find what they are looking for.

Both websites are available in English. All contents on the GF website in general are also

available in Spanish, French, Chinese, Arabic and Russian. The general WHO website is also

available in these languages, however the AMDS contents are only available in English.


Neither website displays the date of last update of the general website. Both list 2010 as their

date of copyright, but this does not give any insight on the last update. However, both websites

specify the date of last update of the medicine price information, and in both cases prices were

last updated less than one month from the date of access.

Site map / search

The GF website contains a site map in which the PQR tool is displayed as an active link, but the

site map is not clear on how to navigate within the PQR tool section. The AMDS website does not


contain a site map. Both websites provide useful general search engines, medicines can be

searched by INN name. The GPRM on the AMDS website and the PQR tool on the GF website

only list ARV, anti-TB and anti-malaria medicines therefore only INN names in these three

categories link to results. Search results on both websites link to background information and

news events on the medicine but do not link to price information.

Basis for access


registration.


On both websites medicine price information can be accessed in less than 10 mouse clicks. As

such both websites therefore score well on this indicator of information accessibility.

Both websites also provide medicine price information in an online database. The PQR tool on

the GF website, contains a product catalogue which lists prices and can be searched by purchase

order date, invoice date, last modified date, INCO term or therapeutic category. All search results

are alphabetically listed by INN name.

The prices in the Global Price Reporting Mechanism (GPRM) database of the AMDS website can

be searched by therapeutic category, INN name, dosage strength, dosage form, name and

country of manufacturer and purchase order date. All search results are alphabetically listed by

the name of the country that purchased the order.

The prices on both websites are published on the website and can be exported (complete

database or specific search results) into various formats (excel, pdf, other). There is no print

version of the price database or search results available on either the GF or AMDS websites.


The download time at 56K per second was less than 60 seconds on both websites. Medicine

price information can therefore be obtained in a reasonable timeframe. On the AMDS website

the download time was less than 30 seconds.

Author information

The GF website discloses the source/author by providing detailed background information on the

Global Fund and on the Price & Quality Reporting Tool. Contact information specific for the PQR

author is listed on the main webpage.

The AMDS website gives full disclosure of the source/author by providing detailed background

information on the Global Price Reporting Mechanism (GPRM). Contact information for the AMDS

is listed, but no contact information is specified for the price database author.

Links

The GF website displays some useful links, including links to the WHO GPRM. The AMDS does

not link to other price reporting websites but does link to other organizations working on

HIV/AIDS.


Clinton Foundation & Médecins Sans Frontières (Doctors Without Borders)

The Clinton Foundation (CF) and Médecins Sans Frontières (MSF) are reported together as both

websites report ARV medicines and several of the ex-factory prices reported on the MSF website

are reduced prices (for developing countries) negotiated by the Clinton Foundation at various

manufacturers. The way in which the prices are presented on the website are therefore

interesting to compare (same prices) to identify differences in how the same results could be best

presented.

Table 14: Summary of qualitative analysis of Clinton Foundation (CF) and Médecins Sans Frontières (MSF) websites

PRICE

GUIDE

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed to

search

page

Author

info

Links

CF 2 1 2 2 1 1 1 0

MSF 2 0.5 0 2 1.3 2 2 1

CF = Clinton Foundation; MSF = Médecins Sans Frontières;

User-friendliness

The Clinton Foundation (CF) and the Médecins Sans Frontières (MSF) website both receive a

high score on this criterion. They display a clear layout; as an example, the CF website is clearly

divided into 4 sections: ' what we do', 'explore our work', 'how you can help' and 'about the Clinton

Foundation'. This makes the website more accessible and facilitates navigation through the

webpage.

The entire contents of both websites are available in English.


Neither website displays the date of last update of the general website, though both specify the

date of last update of the price data reported. The price information on the CF website was

updated less than one month from the date of access, resulting in a combined score of 1 for this

criterion. The price information on the MSF website was last updated more than one month, but

less than one year from the date of access, resulting in a combined score of 0.5.

Site map / search

The CF website includes both a site map and a useful search engine. Medicines can be searched

by INN name, because only antiretroviral (ARV) medication is reported on this website, therefore

only the INN names of ARVs can be used to search the website. The search results link to both

the most recent and previous pricelists, background information on the medicine and

news/events.


Basis for access


registration


On both websites medicine price information can be accessed in less than 10 mouse clicks. The

websites therefore score well on this indicator of information accessibility.

The MSF website also provides a search option within the price information. All prices can be

viewed in a summary table; alternatively, prices can be searched by therapeutic class, INN name

(alphabetical list to select from) or manufacturer name (alphabetical list to select from).

The CF website includes a download version of the pricelist but no search option within this

document is provided. Prices are divided into 2 categories (adult products, pediatric products)

and are listed alphabetically by INN name. There is no print version of the pricelist on the CF

website, while the price database on the MSH website does not provide the option to download or

print either search results or the complete database.



therefore obtainable in a reasonable timeframe. The download time on the CF website was less

than 30 seconds.

Author information

The MSF website discloses the source/author by providing detailed background information on

HIV/AIDS treatment, on work done by MSF to date and on new projects and goals. In addition,

contact information specific to the MSF Campaign for Access to Essential Medicines is listed on

the main webpage.

The CF website publishes detailed background information on the Clinton Foundation and its

projects and initiatives’, including Clinton Health Access Initiative (CHAI), but no contact

information for CHAI is listed.

Links

Neither website includes links to other price reporting websites. However, the MSF website does

provide links to other organizations working on HIV/AIDS.


Common European Drug Database, Management Sciences for Health & Österreichisches Bundesinstitut für Gesundheitswesen (Austrian Federal Institute for Health Care)

The websites of the Common European Drug Database (CEDD), Management Sciences for

Health (MSH) and the Österreichises Bundesinstitut für Gesundheitswesen (ÖBIG) are grouped

because they all report the prices of various countries for all globally available medicines. All

three sources are important multi country price information websites.

Table 15: Summary of qualitative analysis of Common European Drug Database (CEDD), Management

Sciences for Health - International Drug Price Indicator Guide (MSH - IDPIG) and Österreichisches

Bundesinstitut für Gesundheitswesen - Pharma Price Information (ÖBIG - PPI) websites

PRICE

GUIDE

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed to

search

page

Author

info

Links

CEDD 2 0/0.5 2 2 1.3 2 2 2

MSH - IDPIG 2 0 1 2 1.7 2 1 2

ÖBIG - PPI 2 0/1 1 0 0.7 1 2 0

CEDD = Common European Drug Database; MSH = Management Sciences for Health; IDPIG = International Drug Price

Indicator; ÖBIG = Österreichisches Bundesinstitut für Gesundheitswesen; PPI = Pharma Price Information;

User-friendliness

All three website receive a high score on this criterion. They display a clear layout; as an

example, the ÖBIG website is clearly divided into 4 sections: ' about us’, 'areas ', 'subjects' and

‘products'. This makes the website more accessible and facilitates navigation' through the

webpage.

The entire contents of the MSH and ÖBIG websites are available in English. The MSH website is

also available in French and Spanish, while the ÖBIG website is also available in German. The

CEDD webpage differs in that product names and dosage forms are listed in the national

language of the purchasing country (German, Czech, Finnish, Hungarian, Irish, Latvian,

Lithuanian, Norwegian, Polish, Slovakian or Slovenian), while all other content is in English.


None of the websites provide information on the date of last update of the general website.

However, the CEDD and MSH - IDPIG website provide the date of last update of the price data

reported.

The price information on the CEDD website was updated less than one month ago for some

countries, while other countries last updated their information more than one year ago. The

website states:


“The National Health Insurance Fund Administration of Hungary (OEP) maintains the website

cedd.oep.hu; the general website characteristics are not influenced by the participating countries.

Unfortunately, the country specific database is not always up-to-date (meanwhile changes in

prices will not be instantly executed in the database). However, these data are based on the

information of the authorities of the participating countries. Meaning that the criteria price

information (e.g. updates) and author information are the responsibility of the individual countries

and not that of OEP.”

All price data on the MSH website is updated on a yearly basis. On the date of access, price data

was from 2008 and thus was last updated over one year ago.

The ÖBIG -PPI website conducts price queries upon request, this way always the most recent

data used, but it is unknown whether the most recent data is from more than one month ago or

more than one year ago. This site therefore receives a score of 0, 0.5 or 1 depending on the

currency of the price information used (0 if price data > 1year old; 0.5 if price data>1month to

1year old; 1 if price data<1month old).

Site map / search

The CEDD website includes both a site map and a useful search engine. Searches can be

performed by country (alphabetical listing by medicine name) or by the medicine specific

Anatomical Therapeutic Chemical (ATC) code.

The MSH website does not include a site map; however it does have a useful search engine in

which medicines can be searched by INN name and the search results link to the most recent

prices available for the medicine.

The ÖBIG website also contains a search engine, but searches by either INN name or brand

name are not possible because medicine price information is provided upon request and is not

published on the website.

Basis for access

The CEDD and MSH - IDPIG website provide medicine price information free of charge and

without the need for registration. On the OBIG - PPI website medicine prices are only accessible

after query request and payment (no internet database).


On all three websites medicine price information can be accessed in less than 10 mouse clicks

(for ÖBIG -PPI this is the query request page with an example document). The websites therefore

score well on this indicator of information accessibility.

Price information on the CEDD webpage can be searched by country name or by ATC code.

The medicines in the MSH - IDPIG online database can be searched alphabetically, by INN

name, or by WHO EML Therapeutic Class. The ÖBIG -PPI website does not contain an online

database; therefore the availability of a search option is not applicable.

On the MSH - IDPIG website, all prices can be viewed in a summary table or medicines can be


searched by therapeutic class, INN name (alphabetical list to choose from) or manufacturer name

(alphabetical list to choose from).

Of the three websites only the MSH - IDPIG price database enables a download of the complete

database in pdf format. Neither three websites provide a direct print option.


The download time at 56K per second was less than 60 seconds for all three websites.

Information is therefore obtainable in a reasonable timeframe. The download time on the CEDD

and MSH websites was less than 30 seconds.

Author information

The CEDD website discloses source information by providing an introduction on the CEDD

project and participating countries, as well as contact information for the CEDD author in the

National Health Insurance Fund Administration of Hungary (OEP).

The ÖBIG website provides both detailed background information on ÖBIG and its Pharma Price

Information service (PPI), and specific contact information for price (PPI) authors.

MSH publishes detailed background information on the International Drug Price Indicator Guide

(IDPIG) as well as general contact information for MSH, but no contact information is provided for

the authors of the medicine price data.

Links

Both the CEDD and MSH websites link to other price reporting websites, resulting in score 2 for

this criterion.


International Trade Centre & WHO databases & Health Action International &

UNICEF

The pricing websites of the World Health Organization (WHO) regions (e.g. AFRO and PAHO)

and departments (e.g. Malaria Price Information Services) are grouped with the pricing websites

of the International Trade Centre (ITC - MNS report), Health Action International (HAI - Global

Database) and the United Nations Children's Fund (UNICEF). The latter three websites contain

price information collected in collaboration with the WHO. Table 16: Summary of qualitative analysis of International Trade Centre Market News Service for

Pharmaceuticals (ITC – MNS), WHO medicine price databases, Health Action International (HAI) Global

Database and UNICEF websites3

AFRO = Africa Regional Office; EM = Essential Medicines; HAI = Health Action International; ITC = International Trace Centre; MNS = Market News Service; MPIS = Malaria Price Information Services; RBM = Roll Back Malaria Partnership Secretariat; WHO = World Health Organization; PSI = Population Services International; MSH = Management Sciences for Health; PAHO = Pan-American Health Organization; PSM = Procurement & Supply Management; UNICEF = United Nations Children's Fund; User-friendliness

All six website receive a high score on this criterion. They display a clear layout with a logical

presentation of all available information and without any undesired advertisements.

All websites and price documents/databases are published in English. The general website of

AFRO is also available in French and Portuguese. The MNS report on the ITC website is

available upon request in English, Spanish, Portuguese or Chinese. The contents of the Malaria

Price Information Services (MPIS) are published on the general WHO website, which is available

3After the closing date of the qualitative analysis an additional website was identified for Health Action International. This website is

listed and analyzed individually in the qualitative analysis annex but not included in the analysis above, as it became available after the closing date of this comparative analysis.

PRICE GUIDE

User-

friend-

liness

Update:

site &

price

Site

map /

Search

Basis

for

access

Accessi-

bility

of info

Speed to

search

page

Author

info

Links

AFRO - EM 2 0 2 2 1 2 1 2

HAI Global

Database

2 0 1 2 1.3 2 0 0

ITC - MNS 2 1 1 0 1 2 2 1

MPIS

RBM/WHO/

UNICEF/PSI/MSH

2 0 1 2 1 2 1 1

PAHO - PSM 2 0 2 2 1 2 1 1

UNICEF

WHO cooperation

2 2 1 2 1 2 2 1


in Arabic, Chinese, English, French, Russian and Spanish. The price document of MPIS is

available in English and French. The PAHO website is available in English and Spanish. The

general UNICEF website is also available in Arabic, Chinese, French and Spanish.


Only the UNICEF website provides information on the date of last update of the general website,

which was carried out less than one month from the date of access. The copyright dates are

noted on the AFRO (2009) and MPIS (2010) websites, but this does not say anything about the

currency of the site's contents. The ITC website has recently been renewed and the date of

creation is stated as 2010, but this also does not provide reliable insight into the last update of the

contents.

The price information on the ITC (bimonthly MNS report) and UNICEF websites was updated less

than one month from the date of access. On all other website the last update of price data was

more than one year ago. The HAI Global Database price information is based on previous

surveys in WHO regions or countries, the most recent survey used is dated December 2006.

Site map / search

The AFRO and PAHO websites include both a site map and useful search engine. Medicines can

be searched by INN name and search results link to background information and news events on

the medicine, but not to the price information.

The other websites also contain a useful search engine which enables medicines to be searched

by INN name. Search results on the ITC site link to the (sample) price document, background

information and news events on the medicine. On the other websites results do not link to prices.

Basis for access

With the exception of the ITC website, free access to price information is provided by all of the

websites and registration is not required. The bimonthly ITC MNS report on pharmaceutical

starting materials is free to access for users from developing countries, but users from developed

countries need a subscription to gain access to the reports.


On all websites the price information can be accessed in less than 10 mouse clicks. The websites


The price information on the AFRO, ITC, MPIS, PAHO and UNICEF websites is only available in

a download format and there is no search option within this document. All medicines are listed

alphabetically by INN name within this document (4 documents for PAHO: anti tuberculosis

medicines, anti malaria medicines, anti Chagas medicines, antiretrovirals (HIV/AIDS)). Essential

medicines within the UNICEF price document are divided into disease categories and within

these, medicine categories are listed alphabetically by INN name. A direct print option is not

available on any of the websites.

The HAI Global Database is an online database and can be searched by INN name, query type,


dosage strength, dosage form, public sector, private sector, reference data source and survey

(author name and publication date listed). It is not possible to view the entire database and a

download or print format of the price information is not provided on the website, however upon

request the data can be made available in a format that allows these functions.


The download time at 56K per second was less than 30 seconds for all websites. Information is

therefore obtainable in a good timeframe.

Author information

On the AFRO website, disclosure of the source/author of the AFRO website is provided through

detailed background information on the Essential Medicines programme. General contact

information for AFRO and specific contact information for agencies that provide price information

is listed; however upon checking it was found that not all this contact information was still up-to-

date.

On the HAI Global Database website no information is provided on the source/author of the

website, no background information or general information on HAI is listed and no contact

information for HAI is available. For each individual price survey however contact information is

listed, including methods, results and discussion of each survey.

On the ITC website, disclosure of the source/author is provided, including detailed background

information on ITC in general and on the Market News Services (MNS) which is responsible for

the PSM report. General contact information is listed, together with a contact form to fill in to

contact the MNS team. A listing of price information providers is available at the end of the report.

On the MPIS webpage detailed background information on Roll Back Malaria Partnership (RBM)

and contact information of all organizations working on this project is listed; however upon

checking it was found that not all this contact information was still up-to-date.

The PAHO website discloses its source/author with detailed background information on Strategic

Fund and direct contact information for the author of the price documents.

On the UNICEF website detailed background information (including methods, results, discussion

of survey used to collect medicine prices) on the price report and contact information of

responsible department of WHO and UNICEF are listed.

Links

Only the AFRO and UNICEF websites link to other price reporting websites; they also list some

useful links to other organizations working on essential medicines and to other websites of the

United Nations System of Organizations.

The ITC and MPIS websites list some useful links to related organizations working on essential

medicines. The PAHO website links to related organizations and governmental authorities and

news events.


V - 2. Quantitative Analysis

Web-based information can be used for external reference pricing, whereby the criterion (or one

of the criteria) for setting the national regulated price is based on the prices in other countries.

However, a lack of comparability of price data across sites may limit the usefulness of the

analysis. To assess the feasibility of comparing web-based medicine pricing information from

different sources, a quantitative analysis was carried out on 7 of the 14 medicines collected

globally in WHO/HAI surveys.

Almost all websites included in the qualitative analysis were also included in the quantitative

analysis. Although the same inclusion and exclusion criteria were applied (e.g. recent price

information, no entry fee, no commercial websites), nine websites included in the site and price

quality review were excluded from price comparisons.

For example, the United Kingdom the BNF website was not included in the price comparisons

because the price information was not free to access and thus was not publicly available.

Another primary reason for exclusion was that for some countries two or more sources reported

the same price information (some countries have multiple price source websites). When this was

the case, only the most recent price data source was included in the analysis (if the price date

was similar both sites were included. Exclusion because of duplicate price information was

initially the case for France (Codage and CEPS), Norway (CEDD and NMA), South Africa (MP

and DMP), Spain (AEMPS and Vademecum), the United Kingdom (reimbursement sources) and

the United States of America (reimbursement sources). Upon checking however, it was found that

the websites of the UK (Drug Tariff Scotland and Drug Tariff England & Wales) and USA

(MEDICAID and Kentucky MEDICAID) sometimes published different prices and therefore they

were all included in the analysis. For the remaining countries prices were double-checked on the

duplicate website, but the primary sources were as follows: France Codage, Norway NMA, South

Africa DMP and Spain AEMPS (abbreviations were derived from qualitative analysis).

For Canada and Portugal only one out of the two country price source websites was used,

because the other website only published originator brand products (which were excluded from

analysis). The primary sources for these countries were thus, Canada OPDP and Portugal

generic.

Lastly, the South African TAC website and the USA CDC website were not used in the price

comparisons, because neither published price information on any of the selected medicines on

their websites.

The remaining 41 national price sources were used for the international price comparisons of the

7 selected medicines. Price adjustments, as discussed in methods section, were made whenever

sufficient information was available to do so; however in some cases websites did not include the

necessary data to perform the adjustments.


Amitriptyline 25mg capsules/tablets Price information on amitriptyline 25mg cap/tab is available from 36 sources, representing 33

countries. Table 17 shows a summary of the results for all these countries. All ratios mentioned in

the text below represent the MSH price ratio, unless otherwise stated. This MSH price ratio is

calculated by dividing the price published by the source by the MSH reference price for

amitriptyline 25mg, which is 0.0059 US$ per capsule or tablet. Summary tables are provided for

all national sources as well as for sources in the EURO region. For the other WHO regions the

results are summarized in the text, as the number of sources was too low to enable a tabular

summary. But detailed tables with results for all regions can be found in Annex XIV.

Table 17: Ratio of national medicine price to MSH reference price for Amitriptyline 25mg cap/tab, all national sources #1

All National price sources (n=36)

Ex-factory / Manufacturer price

Procurement price

Wholesale price

Reimburse-ment price

Retail / Patient price

MSH ref. price (2008)

Amitriptyline 25mg 0.0059 US$ per cap/tab = MSH ratio 1.00

n = 9 n = 6 n = 11 n = 12 n = 21 Median Ratio 6.95 2.21 9.15 --- 9.15 Mean Ratio 6.76 3.23 7.07 --- 10.0 Lowest Ratio 2.54 0.41 2.37 2.78 1.47 Highest Ratio 10.3 10.0 10.7 69.5 16.3 High/Low Ratio 4.1 24.6 4.5 25.6 11.0

#1 Please see section IV.4 for all data limitations;

For amitriptyline 25 mg, the availability of price data varied across the different price types. The

price type with the largest number of prices found was retail/patient prices (n=21), while few price

points were found for ex-factory and procurement prices (n=9 and n=6, respectively).

Table 17 shows H/L ratios are below 10.0 for ex-factory and wholesale price types. The H/L ratios

for procurement and reimbursement prices are however more than twice as high (24.6 and 25.6,

respectively). Such large variations in price cannot be justified by comparability issues alone.

Looking at procurement it must be noted that India is the only country with a price below the MSH

reference price (MSH ratio 0.41). The detailed summary table (Annex XIV) shows Denmark has

the highest ratio - 10.0 times above the MSH reference price, and the other 4 procurement prices

are within the range 1.47 to 3.05. This establishes that the high H/L ratio is due to high prices in

Denmark. For reimbursement the high H/L ratio could be explained by the specific data limitations

for this price type, some sources report ceiling prices, while others report the lowest and highest

reimbursed prices. Taking the data limitations for this price type in account it is not possible to

calculate a median or mean ratio for this price type.

Furthermore it must be noted that none of the prices, except for the procurement prices from

India, were below the MSH reference price of 0.0059 US$. All calculated median and mean ratios

are relatively high; the median MSH ratios range from 2.21 (procurement) to 9.15 (wholesale and


retail/patient) and mean MSH ratios range from 3.23 (procurement) to 10.0 (retail/patient).

Ex-factory and wholesale prices have the lowest H/L ratio, meaning that these price types had the

lowest amount of variation across sources. However, in all cases prices were above the MSH

price. And while it is expected that retail prices will be higher than MSH prices as the latter do not

include local distribution costs, average retail prices of over ten times the MSH price are still

considered high.

Table 18: Ratio of national medicine price to MSH reference price for Amitriptyline 25mg cap/tab, EURO region#1

WHO Region EURO (n=21)


Procurement price

Wholesale price




Amitriptyline 25mg 0.0059 US$ per cap/tab = MSH ratio 1.00

n = 7 n = 2 n = 9 n = 7 n = 16 Median Ratio 6.95 --- 9.15 --- 9.92 Mean Ratio 6.90 5.74 6.99 --- 10.6 Lowest Ratio 2.54 1.47 2.37 2.78 4.92 Highest Ratio 10.3 10.0 10.7 50.8 16.3 High/Low Ratio 4.1 6.8 4.5 18.8 3.3


Table 18 shows the available data for the EURO region. A total of 21 sources, representing 20

countries, reported price information on amitriptyline 25mg capsules/tablets. None of the

countries has a price below the MSH reference price in any of the price categories. However, the

lowest ratios reported for wholesale and reimbursement in the EURO region (ratios 2.37 and

2.88, respectively) are also the lowest of all national price sources. For the ex-factory price

category 7 countries reported prices. France reports the highest price (MSH ratio 10.3), but this

price is only slightly higher than that of two other (also high-income) countries: Spain (ratio 10.0)

and Austria (ratio 9.15). Furthermore it should be noted that for this price type, high income

countries display a great variation in prices (ratios ranging from 4.24 to 10.3), while the upper-

middle income countries Lithuania and Slovakia report more comparable prices (ratio 2.54 and

4.92, respectively). The procurement prices from Denmark and the UK are above the MSH

reference price of 0.0059 US$. The Danish price is the highest of all national price sources with a

ratio of 10.0, while the UK price is the second lowest price of all national price sources (ratio

1.47). Nine countries report wholesale prices, 7 of them being high-income countries. With the

exception of Ireland (ratio 2.37) all high-income countries report high prices with rations ranging

from 6.95 (Hungary) to 9.32 (Finland). The upper-middle income countries Latvia and Lithuania

report substantially lower prices with ratios of 2.37 and 2.54, respectively. The low ratio for Latvia

is also the lowest of all national sources reporting wholesale prices. Reimbursement prices are

reported by 7 countries in the EURO region. Taking the data limitations for this price type into

account it is difficult to compare this price type between sources. All report their lowest and


highest reimbursed prices, leading to a great variation in MSH price ratios. Sixteen price sources

from EURO report retail/patient prices, all have prices higher than the MSH reference price. Only

Latvia and Lithuania (ratio 4.92 for both) report prices that are less than 5 times as high as the

reference price. All remaining 14 countries report prices of at least 5 times as high (ratios ranging

from 6.10 to 16.3); moreover for 8 countries (all high-income) the retail/patient price is more than

10 times as high as the reference price (ratios ranging from 10.7 to 16.3). These high ratios could

be partially explained by the fact that MSH prices do not include local distribution costs, but this

alone does not account for up to 16-fold differences.

For the AFRO region three data sources for South Africa are available; no other price sources

were found for countries in this region. Of the three price sources from South Africa, only one

provided actual price information on amitriptyline 25mg capsules/tablets. Both ex-factory and

wholesale prices reported are above the MSH reference price of 0.0059 US$ with ratios of 8.31

and 10.3, respectively. Looking across other upper-middle income countries, the South African

ex-factory price is relatively high (ratios ranging from 2.54 to 6.95). The same can be said of the

wholesale price reported compared to all other national sources from the upper-middle income

category (ratios ranging from 2.37 to 6.95).

For the AMRO region 7 sources are available, representing 3 countries. Of these sources, one

Brazilian, one Canadian and 3 USA websites reported price information on amitriptyline 25mg

capsules/tablets. The procurement prices from both Brazil and USA were above the MSH

reference price with ratios of 1.54 and 2.88, respectively. Both prices score just below average in

their price category with all national price sources. For reimbursement prices 3 prices were

reported one for Canada (ratio 12.9) and two for the USA (ratio 7.46 and 15.9). Taking the data

limitations for this price type into account it is difficult to compare this price type between sources.

Canada reports a price ceiling, leading to a high MSH price ratio compared to the USA source

and to the MSH reference price.

For the EMRO region 8 sources are available, representing 8 countries. Six of these countries

reported price information on amitriptyline 25mg capsules/tablets. All prices reported for the

countries in this region are above the MSH reference price of 0.0059 US$. For procurement

Sudan is the only country in the EMRO region reporting a price. With a ratio of 3.05 this price is

high for a low-income country (MSH ratio of India is only 0.41). It is the second highest price for

all national sources; due to Denmark (ratio 10.0), Sudan's procurement price is still below the

mean for all countries in its price category. Jordan’s wholesale price (ratio 4.58) is below the

mean (ratio 7.07) and median price (ratio 9.15) for all national price sources in this category. It is

however relatively high for a lower-middle income country, all other national sources in this

category are upper-middle and high-income countries and do not all have much higher prices,

some are even lower (ratios ranging from 2.37 to 10.7). This shows that lower-income countries,


like Jordan, sometimes pay more for medicines than high-income countries. The reimbursement

price for Morocco is the maximum reimbursed price (ratio 12.9), but little can be said about this

price type because of its data limitations. Six countries in the EMRO region reported retail/patient

prices. The price reported in Iran (ratio 1.47) is the lowest retail/patient price for amitriptyline

across all national price sources, while the Oman price (ratio 16.3) is the highest across all

national price sources. For Oman, as an upper-middle income country, it is notable that its price

is higher than that of all high-income countries. Out of the six countries reporting retail/patient

prices in the EMRO region, all lower-middle income countries (Iran, Jordan, Morocco and Tunisia)

have lower prices than Oman. It must be noted, however, that only the prices from Iran (ratio

1.47), Jordan (ratio 5.76) and Tunisia (ratio 4.24) are much lower; the price from Morocco (ratio

12.9) is closer to the price in Oman (ratio 16.3). One possible cause for this price variation could

be that it is unknown whether a dispensing fee and/or VAT/GST are included in each price; if

included the price may appear high in comparison to other retail prices that do not include these

costs. However this factor alone probably does not account for retail/patient prices that are up to

16 times higher than the MSH reference price.

For the SEARO region two data sources for India are available; no other price sources were

found for countries in this region. Of the two price sources from India, only one provided price

information on amitriptyline 25mg capsules/tablets. The procurement price reported by this

source is the lowest of all the national price sources. The MSH price ratio of 0.41 shows the

Indian procurement price is only about half the international reference price.

For the WPRO region only 2 countries provide price information on medicines. New Zealand

reported ex-factory price information and Australia reported reimbursement price information on

amitriptyline 25mg capsules/tablets. For ex-factory New Zealand reported the second lowest price

(MSH ratio 4.24) for all national price sources; representing the lowest price for all high income

countries in this price type. Taking the data limitations for reimbursement prices in account it is

difficult to compare this price type between sources. Australia reports a price ceiling (ratio 49.2 to

69.5) leading to a high MSH price ratio compared to other national sources and to the MSH

reference price. The ceiling price of Australia is the highest for this price type across all national

price sources.


Atenolol 50mg capsules/tablets

Price information on atenolol 50mg cap/tab is available from 37 sources, representing 34

countries. Table 19 shows a summary of the results for these countries. All ratios mentioned in


calculated by dividing the price published by the source by the MSH reference price for atenolol

50mg, which is 0.0161 US$ per capsule or tablet. For all national sources and for all sources in

the EURO region a summary table is printed below. For the other regions the summary consists

of text alone, because the number of sources was too low to establish a clear overview in a table.

But detailed tables with results for all regions can be found in the Annexes (Annex XV).

Table 19: Ratio of national medicine price to MSH reference price for Atenolol 50mg cap/tab, all national sources#1



Procurement price

Wholesale price




Atenolol 50mg 0.0161 US$ per cap/tab



For atenolol 50 mg, the availability of price data varied across the different price types. The price

type with the largest number of prices found was retail/patient prices (n=21), while few price

points were found for ex-factory and procurement prices (n=8 and n=6, respectively).

Table 19 shows H/L ratios are more than 10.0 for every price type, excpt for ex-

factory/manufacturer prices. In particular for procurement and retail/patient the H/L ratio is very

high (34.7 and 24.5, respectively). Such large variations in price cannot be justified by

comparability issues alone. Looking at procurement it must be noted that although the H/L is high,

the median ratio is below 1.00 and the average ratio is just above with 1.08. The detailed

summary table (Annex XV) shows that only Sudan has the highest ratio - 4.10 times above the

MSH reference price, and the other 5 procurement prices are lower than the MSH reference price

of 0.0161US$. The latter 5 procurement prices are from high-income countries, showing that low-

income countries like Sudan can sometimes pay more for medicines than high-income countries.

However, this trend is not observed for other low-income countries. The H/L ratio of retail/patient

prices was also considered high (24.5); this high ratio could partially be explained by the price of

Iran which was below the MSH reference price, in contrast to all other prices (ratios ranging from

1.86 to 16.8). However, while it is expected that retail prices will be higher than MSH prices, as

the latter do not include local distribution costs, average retail prices of over six times the MSH


price are considered high. Wholesale and reimbursement prices have the lowest H/L ratios (11.8

and 11.7, respectively), meaning that these price types had the lowest amount of variation across

sources. However, for both these types all prices were above the MSH price and little price points

were available for comparison.

Table 20: Ratio of national medicine price to MSH reference price for Atenolol 50mg cap/tab, EURO region#1



Procurement price

Wholesale price




Atenolol 50mg 0.0161 US$ per cap/tab = MSH ratio 1.00



Table 20 shows all available data for countries in the EURO region. For this region 22 sources,

representing 21 countries reported price information on atenolol 50mg capsules/tablets.

None of the countries in the ex-factory price category has a price below the MSH reference price

of 0.0161 US$. It should also be noted that for this price type, most high income countries (except

for New Zealand (ratio 0.56)) have higher prices (ratios ranging from 3.17 to 8.70) than the upper-

middle income countries (ratios ranging from 1.68 to 2.67). Hungary reported the second lowest

ex-factory price for all national price sources in this category (ratio 1.68). For procurement prices,

Denmark and the UK were below the MSH reference price of 0.0161 US$. Nine countries report

wholesale prices, three of them (Austria, Ireland, Slovenia) have much higher prices (ratio 6.83 to

12.4) than the other six countries (ratio 1.06 to 5.09). The other countries have price comparable

to the average across all national sources with prices about 3 times as high as the MSH

reference price. Reimbursement prices are reported by 8 countries in the EURO region. Taking

the data limitations for this price type in account it is difficult to compare this price type between

sources. All report their lowest and highest reimbursed prices, leading to a great variation in MSH

price ratios. Sixteen price sources from EURO report retail/patient prices, all have prices higher

than the MSH reference price of 0.0161 US$. For 4 countries this price is more than 5 times as

high as the MSH reference price: Austria 13.7, Finland 9.32, France 8.70 and Italy 9.32. These

big differences could be partially explained by the fact that MSH prices do not include local

distribution costs, but this alone probably does not account for 5-fold differences.


were found for countries in the AFRO region. Of the three price sources from South Africa, only

one provided actual price information on atenolol 50mg capsules/tablets. Both ex-factory and


wholesale price reported are above the MSH reference price of 0.0161 US$ with ratios of,

respectively 2.36 and 3.79. But both are below the ex-factory mean (ratio 4.11) and wholesale

mean (ratio 4.84) for all national sources. Thus, while the prices are relatively high compared to

MSH prices, they are not particularly high compared to all other national sources. Looking across

other upper-middle income countries, South African prices are comparable.

For the AMRO region 7 sources are available, representing 3 countries. One Brazilian, one

Canadian and 3 USA websites reported price information on atenolol 50mg capsules/tablets. The

procurement prices for both Brazil and USA were below the MSH reference price with ratios of,

respectively 0.46 and 0.52. For reimbursement 3 prices were reported, one for Canada (ratio

16.1) and two for the USA (ratio 2.17 and 3.11). Taking the data limitations for this price type in

account it is difficult to compare this price type between sources. Canada reports a price ceiling,

leading to a high MSH price ratio compared to the USA source and to the MSH reference price.

A total of 8 countries in the EMRO region publish price information on websites. Six of these

countries reported price information on atenolol 50mg capsules/tablets. For procurement Sudan

is the only country in the EMRO region reporting a price. With a ratio of 4.10 this procurement

price is the highest for all countries and the only one above the MSH reference price in its price

category. The wholesale price of Jordan is just above average across all countries, but higher

than for other lower-middle income countries. Five countries in the EMRO region reported

retail/patient prices. Iran was the only country for all national sources that reported a retail/patient

price below the MSH reference price (ratio 0.68). For Jordan, Lebanon and Oman this price is

comparable (ratios ranging from 5.22 to 7.45), while this price is substantially higher in Bahrain

(MSH ratio of 16.8). Bahrain had the highest retail/patient price for atenolol across all 37national

price sources. An explanation could be that it's unknown if a dispensing fee and VAT/GST are

included in this price; if included this price may appear high in comparison to retail prices that do

not include these costs. However this factor alone probably does not account for a price that is

more than double the average price across all countries.


found for countries in the SEARO region. Of the two price sources from India, only one provided

price information on atenolol 50mg capsules/tablets. The procurement price reported by this


Indian procurement price is only about one-eighth the international reference price.

For the WPRO region only 2 countries provide price information on atenolol 50mg

capsules/tablets. New Zealand reported the lowest ex-factory price for all national price sources

(MSH ratio 0.56). Moreover, it was the only country reporting a price below the MSH reference

price in its category; its price was only about half the international reference price. Australia


reported reimbursement price information on atenolol 50mg capsules/tablets. Taking the data

limitations for this price type in account it is difficult to compare this price type between sources.

Australia reports a price ceiling (ratio 19.3 to 25.5) leading to a high MSH price ratio compared to

other national sources and to the MSH reference price. The ceiling price of Australia is the

highest for this price type across all national price sources.


Ciprofloxacin 500mg capsules/tablets Price information on ciprofloxacin 500mp cap/tab is available from 39 sources, representing 36




ciprofloxacin 500mg, which is 0.0372 US$ per capsule or tablet. For all national sources and for

all sources in the EURO region a summary table is printed below. For the other regions the

summary consists of text alone, because the number of sources was too low to establish a clear

overview in a table. But detailed tables with results for all regions can be found in the Annexes

(Annex XVI).

Table 21: Ratio of national medicine price to MSH reference price for Ciprofloxacin 500mg cap/tab, all national sources #1



Procurement price

Wholesale price




Ciprofloxacin 500mg 0.0372 US$ per cap/tab = MSH ratio 1.00



For ciprofloxacin 500mg, the availability of price data was high, but it varied across the different

price types. The price type with the largest number of prices found was retail/patient prices

(n=24), while few price points were found for ex-factory and procurement prices (n=8 and n=6,

respectively). The numbers of wholesale and reimbursement prices is similar (n=11).

Table 21 shows all H/L ratios are above 10.0 for all price categories. The H/L ratios for wholesale,

reimbursement and retail/patient prices are as high as 15.0 or even higher (17.7, 15.0 and 19.7,

respectively). Meaning that the prices in all the categories display a great variation between them;

such large variations in price cannot be justified by comparability issues alone. In the

procurement price category, India is the only country with a price below the MSH reference price

(MSH ratio 0.51). The detailed summary table (Annex XVI) shows Denmark has the highest ratio

- 6.45 times above the MSH reference price, while the other 4 procurement prices are more

comparable with ratios ranging from 1.18 to 4.03.

What must be noted is that none of the prices in any of the categories, except for the

procurement price of India, was below the MSH reference price of 0.0372 US$; and that all prices

seem to be relatively high. Excluding the procurement price type, all median ratios for the

different price categories are within a range of 10.3 (ex-factory) to 13.0 (retail/patient).


Table 22: Ratio of national medicine price to MSH reference price for Ciprofloxacin 500mg cap/tab, EURO region#1



Procurement price

Wholesale price




Ciprofloxacin 500mg 0.0372 US$ per cap/tab = MSH ratio 1.00



Table 22 shows all available data for the EURO region. A total number of 22 sources,

representing 21 countries reported price information on ciprofloxacin 500mg capsules/tablets.

None of the countries has a price below the MSH reference price in any of the price categories.

All prices in countries are relatively high; the highest prices reported for this region are also the

highest of all national price sources, while only the wholesale price (MSH ratio 2.23) is the lowest

price in both the EURO region as for all national sources. Ex-factory and procurement prices

have the lowest H/L ratio, meaning that this price type had the lowest amount of variation across

sources. However, they also had the least price points available for comparison, so in this case

the low H/L ratio does not tell us as much. For the ex-factory price category 6 countries reported

prices. The prices of Austria and France (ratios 30.6 and 28.5, respectively) are remarkably

higher than the ex-factory prices reported by the other 4 countries in the EURO region (ratios

ranging from 4.57 to 12.4), but also compared to ex-factory prices reported by all other national

sources (ratios ranging from 2.69 to 12.4). Remarkable is that high-income country Spain reports

the second lowest ratio of 4.57 (after New Zealand (MSH ratio 2.69)), while the ratios of upper-

middle income countries Hungary, Lithuania and Slovakia are double as high as this lowest ratio

(ratios 9.41 and 12.4 and 11.3, respectively). The procurement prices of both Denmark and the

UK are above the MSH reference price of 0.0372 US$. The Danish price is the highest of all

national price sources with a ratio of 6.45, while the UK price is the second lowest price of all

national price sources (ratio 1.18). Nine countries report wholesale prices, 7 of them are high-

income countries. The two upper-middle income countries Latvia and Lithuania report almost the

same price with ratios of 13.2 and 13.4, respectively. The seven high-income report prices with a

great variation (ratios ranging from 2.23 to 39.5); the high outliers are Austria, Ireland, Norway

and Slovenia (ratios 34.1, 39.5, 32.8 and 27.9, respectively). Reimbursement prices are reported

by 7 countries in the EURO region. Taking the data limitations for this price type in account it is

difficult to compare this price type between sources. All report their lowest and highest

reimbursed prices, leading to a great variation in MSH price ratios. Sixteen price sources from

EURO report retail/patient prices, all have prices higher than the MSH reference price of 0.0372


US$. Twelve of these countries are high-income countries; the remaining four are upper-middle

income countries. The upper-middle income countries Latvia and Slovakia report the same price

(ratio 16.4), Lithuania and Poland report (slightly) lower prices (ratio 15.9 and 10.2, respectively).

All prices reported by the high-income countries display a great variation (ratios ranging from 3.76

(Netherlands) to 45.9 (Austria). All high ratios could be partially explained by the fact that MSH

prices do not include local distribution costs, but this alone probably does not account for an

average 19-fold difference. Austria, France and Italy report very high prices that are more than 40

times as high as the MSH reference price (ratios 45.9, 43.0 and 40.9, respectively).

Specifically looking at Austria and France, it must be noted that although their prices are already

high in each price category, the price differences between the sectors in the distribution chain are

also remarkably high. For Austria the ex-factory price is 1.14 US$ (ratio 30.6), the wholesale price

is 1.27 US$ (+0.13 US$) (ratio 34.1 (+3.5)) and the retail/patient price is 1.71 US$ (+0.56 US$) (ratio 45.9

(+15.3)). For France the ex-factory price is 1.06 US$ (ratio 28.5) and the retail/patient price is 1.60

US$ (+0.54US$) (ratio 43.0 (+14.5)). Both examples suggest that high add-on costs in the distribution

chain can also be a factor leading to high prices.



one provided actual price information on ciprofloxacin 500mg capsules/tablets. Both ex-factory

and wholesale price reported are above the MSH reference price of 0.0372 US$ with ratios of,

respectively 5.11 and 6.45. Looking across other upper-middle income countries, the South

African ex-factory price is low (ratios ranging from 9.41 to 12.4). The same can be said of the

wholesale price reported compared to all other national sources from the upper-middle income

class (ratios ranging from 10.2 to 13.4).


Brazilian, one Canadian and two USA websites reported price information on ciprofloxacin 500mg

capsules/tablets. The procurement prices for both Brazil and USA were above the MSH reference

price with ratios of, respectively 1.40 and 1.56. Both prices score just below average in their price

category with all national price sources. For reimbursement 2 prices were reported, one for

Canada (ratio 30.6) and one for the USA (ratio 12.1). Taking the data limitations for this price type

in account it is difficult to compare this price type between sources. Canada reports a price

ceiling, leading to a high MSH price ratio compared to the USA source and to the MSH reference

price.

For the EMRO region 8 sources are available, representing 8 countries. All eight countries

reported price information on ciprofloxacin 500mg capsules/tablets. All prices reported for the




high for a low-income country (MSH ratio of India is only 0.51). It is the second highest price for

all national sources and apart from Denmark (ratio 6.45) all the countries with a higher income

stay below Sudan's price (ratios ranging from 1.18 to 1.56). The wholesale price of Jordan (ratio

10.5) is below the mean (ratio 17.5) and median price (ratio 13.2) for all national price sources in

this category. The reimbursement price for Morocco is a range of the lowest and highest

reimbursed price (ratio 25.3 to 27.4), but not much can be said about this price type because of

its data limitations. Seven countries in the EMRO region reported retail/patient prices. The prices

of Bahrain and Morocco are the highest and were very much comparable (ratio 26.3 and 25.3,

respectively). This is remarkable looking at the income classes for the countries: Bahrain is high-

income and Morocco is lower-middle income. Moreover, the remaining five countries which

stayed below the price of Morocco include the upper-middle income countries Lebanon and

Oman (ratio 12.1 and 12.4, respectively). Showing countries with lower incomes, like Morocco,

sometimes pay more for medicines than countries with higher incomes. Iran reported the lowest

retail/patient price for all national sources (ratio 2.34). The prices reported by Jordan, Lebanon,

Oman and Tunisia were comparable (ratios 13.4, 12.1, 12.4 and 14.2, respectively). Once again it

must be noted that the lower-middle income countries Jordan and Tunisia reported higher prices

than the two upper-middle income countries, although the differences are small.

An explanation for the great variation in retail/patient prices between the countries in the EMRO

region, could be that it's unknown if a dispensing fee and VAT/GST are included in the prices; if

included this price may appear high in comparison to retail prices that do not include these costs.

However this factor alone probably does not account for a retail/patient price that is up to 26

times as high as the MSH reference price.


found for countries in the SEARO region. Both sources reported price information on ciprofloxacin

500mg capsules/tablets. The procurement price reported is the lowest of all the national price

sources and the only one in any of the categories that is below the MSH reference price of 0.0372

US$. The MSH price ratio of 0.51 shows the Indian procurement price is only about half the

international reference price. The retail/patient price is the second lowest of all the national price

sources with a ratio of 3.49. A remark for this price is that it's a ceiling price, the maximum price

allowed to be paid for this medicine. Although in their own price types they are both considered

low prices, the difference between them is high (ratio 0.51 vs. ratio 3.49).


reported ex-factory price information on ciprofloxacin 500mg capsules/tablets, while Australia

reported reimbursement price information. The ex-factory price of New Zealand was the lowest

for all national price sources in its category (MSH ratio 2.69). Remarkable is that high-income

country New Zealand reports the lowest ex-factory price ratio, while the upper-middle income


countries report price ratios of at least double as high (ratios ranging from 5.11 to 12.4). It is

difficult to compare the reimbursement price of Australia due to the data limitations for this price

type. Australia reports a price ceiling (ratio 27.4) leading to a high MSH price ratio compared to all

national sources and to the MSH reference price.


Glibenclamide 5mg capsules/tablets

Price information on glibenclamide 5mg cap/tab is available from 30 sources, representing 27

countries. Table 23 shows a summary of the results for all these countries. All ratios mentioned

in the text below represent the MSH price ratio, unless otherwise stated. This MSH price ratio is


glibenclamide 5mg, which is 0.0045 US$ per capsule or tablet. For all national sources and for all

sources in the EURO region a summary table is printed below. For the other regions the



(Annex XVII).

Table 23: Ratio of national medicine price to MSH reference price for Glibenclamide 5mg cap/tab, all national sources #1



Procurement price

Wholesale price




Glibenclamide 5mg 0.0045 US$ per cap/tab = MSH ratio 1.00



For glibenclamide 5 mg, the availability of price data was lower than for the other medicines

reviewed. The price type with the largest number of prices found was retail/patient prices (n=17),

while few price points were found for procurement and wholesale prices (n=5 and n=6,

respectively).

Table 23 shows H/L ratios are below 10.0 for the price types ex-factory, wholesale and

reimbursement. The H/L ratios for retail/patient prices and in particular for procurement prices are

however much higher (23.0 and 30.1, respectively). Such large variations in price cannot be

justified by comparability issues alone. In the procurement price category, India is the only

country with a price below the MSH reference price (MSH ratio 0.16). The detailed summary table

(Annex XVII) shows Sudan has the highest ratio - 4.89 times above the MSH reference price, and

the other 3 procurement prices are within the range 1.73 to 4.00. That Sudan as a low-income

country has the highest procurement price, as opposed to India who has the lowest price, is

remarkable.

Furthermore it must be noted that none of the prices, except for the procurement price of India,

was below the MSH reference price of 0.0045 US$, and that all prices seem to be relatively high.

Excluding the procurement price type, all median ratios for the different price categories are


within a range of 4.56 (ex-factory) to 13.0 (wholesale). A reason for this could be that

glibenclamide is not the first choice in anti-diabetes treatment, which might result in less generic

competition and thus higher price. A few sources only reported lower dosage strengths or the

originator brand, which was excluded in this research.

For retail/patient prices the high H/L ratio (23.0) could be explained by the data limitations. Taking

into account that it is not always certain whether or not VAT/GST and a dispensing fee are

included. While it is expected that retail prices will be higher than MSH prices, as the latter do not

include local distribution costs, average retail prices of over sixteen times the MSH price are

considered high.

Table 24: Ratio of national medicine price to MSH reference price for Glibenclamide 5mg cap/tab, EURO region#1



Procurement price

Wholesale price




Glibenclamide 5mg 0.0045 US$ per cap/tab = MSH ratio 1.00

n = 7 n = 1 n = 4 n = 5 n = 11 Median Ratio 4.44 --- 20.1 --- 14.9 Mean Ratio 9.40 --- 17.0 --- 15.3 Lowest Ratio 2.89 1.93 3.33 12.2 2.89 Highest Ratio 20.9 --- 24.4 48.9 35.6 High/Low Ratio 7.2 --- 7.3 4.0 12.3


Table 24 shows all available data for countries in the EURO region. For this region 15 sources,

representing 14 countries reported price information on glibenclamide 5mg capsules/tablets.

None of the countries has a price below the MSH reference price in any of the price categories.

However, the lowest ratios reported for wholesale, reimbursement and retail/patient in the EURO

region (ratios 3.33 and 12.2 and 2.89, respectively) are also the lowest of all national price

sources.

For the ex-factory price category 7 countries reported prices. It should be noted that for this price

type, high income countries display a great variation in prices (ratios ranging from 2.89 to 20.9),

while the upper-middle income countries report exactly the same price (ratio 3.11). The

procurement price for the UK is above the MSH reference price of 0.0045 US$ and represents

the median of all national price sources. Four countries report wholesale prices, three of them

(Austria, Ireland, Slovenia) have much higher prices (ratio 18.0 to 24.4) even far above the mean

(ratio 13.7) and median price (ratio 13.0) for all national price sources. Lithuania scores well with

a low ratio of 3.33. Reimbursement prices are reported by 5 countries in the EURO region. Taking



price ratios. Eleven price sources from EURO report retail/patient prices, all have prices higher


than the MSH reference price of 0.0045 US$. Remarkable is that all three upper-middle income

countries (Lithuania, Slovakia and Slovenia) report exactly the same price and with a ratio of 3.33

these are below the median price (ratio 12.6) and the mean price (ratio 16.4) for all national

sources. The Czech Republic has the second lowest ratio with 2.89. The remaining 8 countries

report much higher prices (ratios ranging from 6.89 to 35.6); these big differences could be

partially explained by the fact that MSH prices do not include local distribution costs, but this

alone probably does not account for up to 35-fold differences.



one provided actual price information on glibenclamide 5mg capsules/tablets. Both ex-factory and


respectively 4.67 and 6.22. But both are below the ex-factory mean (ratio 8.07) and wholesale

mean (ratio 13.7) for all national sources. The wholesale price is also below the median (ratio

13.0) for all national price sources. Thus, while the prices are relatively high compared to MSH

prices, they are not particularly high compared to all other national sources. Looking across other

upper-middle income countries, South African prices are relatively high.

For the AMRO region 7 sources are available, representing 3 countries. One Brazilian, one

Canadian and 3 USA websites reported price information on glibenclamide 5mg capsules/tablets.

The procurement prices for both Brazil and USA were above the MSH reference price with ratios

of, respectively 1.73 and 4.00. For reimbursement 3 prices were reported, one for Canada (ratio

13.8) and two for the USA (ratio 42.2 and 62.2). Taking the data limitations for this price type in

account it is difficult to compare this price type between sources. Canada reports a price ceiling,

leading to a high MSH price ratio compared to the USA source and to the MSH reference price.

Even so, it is still very remarkable that the ratios for the USA are this high.

For the EMRO region 8 sources are available, representing 8 countries. Seven of these countries

reported price information on glibenclamide 5mg capsules/tablets. All prices reported for the



the highest for all countries in its price category. Compared to all other countries reporting this

price Sudan’s price is not particularly high (ratios ranging from 1.73 to 4.00), however it is high

compared to other low-income countries. The wholesale price of Jordan (ratio 8.00) is below the

mean (ratio 13.7) and median price (ratio 13.0) for all national price sources in this category. The

reimbursement price for Morocco is a range of the lowest and highest reimbursed price (ratio 13.6

to 22.2), but not much can be said about this price type because of its data limitations. Six

countries in the EMRO region reported retail/patient prices. Iran reports the lowest price for all

national price sources (ratio 2.22). For Jordan, Morocco, Oman and Tunisia the prices are within


a range of six from each other (ratio 7.33 to 13.6), while this price is substantially higher in

Bahrain (MSH ratio of 51.1). Bahrain had the highest retail/patient price for glibenclamide across

all national price sources. An explanation could be that it's unknown if a dispensing fee and

VAT/GST are included in this price; if included this price may appear high in comparison to retail

prices that do not include these costs. However this factor alone probably does not account for

the Bahraini price, which is more than three times the average retail/patient price (ratio 15.5)

across all national price sources.



price information on glibenclamide 5mg capsules/tablets. The procurement price reported by this


Indian procurement price is only about one-sixth the international reference price.

For the WPRO region only 2 countries provide price information on medicines. Australia was the

only country reporting price information on glibenclamide 5mg capsules/tablets. Australia reported

a reimbursement price ceiling (ratio 26.7 to 33.3) leading to a high MSH price ratio. Taking the

data limitations for this price type in account it is difficult to compare this price type between

sources.


Omeprazole 20mg capsules/tablets

Price information on omeprazole 20mg cap/tab is available from 37 sources, representing 35




omeprazole 20mg, which is 0.0328 US$ per capsule or tablet. For all national sources and for all




(Annex XVIII).

Table 25: Ratio of national medicine price to MSH reference price for Omeprazole 20mg cap/tab, all national sources #1



Procurement price

Wholesale price




Omeprazole 20mg 0.0328 US$ per cap/tab = MSH ratio 1.00



For omeprazole 20mg, the availability of price data varied across the different price types. The

price type with the largest number of prices found was retail/patient prices (n=22), while less than

10 price points were found for ex-factory and procurement prices (n=8 and n=6, respectively).

Table 25 shows that only for the price type ex-factory the H/L ratio is below 10.0; all other H/L

ratios are much higher (ranging from 22.4 to 50.3). Meaning that large variation in price exists for

these price types. Such large variations in price cannot be justified by comparability issues alone.

Looking at procurement prices it must be noted that few price points are available (n=6). The

detailed summary table (Annex XVIII) shows that two outliers defined the high outcome of the H/L

ratio. Sudan reported the highest price (MSH ratio 4.88) the USA the second highest price (MSH

ratio 4.27), while the remaining four countries reported more comparable prices (ratios ranging

from 0.152 to 1.43). The high H/L ratio for wholesale can also be explained by the presence of

two outliers. Sweden reported the lowest wholesale price for omeprazole 20mg (MSH ratio 1.01)

and Ireland reported the highest price (ratio 32.6). The remaining nine countries reported

relatively high prices and also with great variation, but ratios ranged from 4.57 to 18.6; showing

that Sweden and Ireland can be seen as outliers. For reimbursement the high H/L ratio (50.3)

could be explained by the specific data limitations for this price type, some sources report ceiling


prices, while others report the lowest and highest reimbursed prices. Taking the data limitations

for this price type in account it is not possible to calculate a median or mean ratio for this price

type. For retail/patient prices the high H/L ratio (22.4) could also be explained by the data

limitations. Taking into account that it is not always certain whether or not VAT/GST and a

dispensing fee are included. It is expected that retail prices are higher than MSH prices, as the

latter do not include local distribution costs. The Netherlands reported the lowest price with a

MSH ratio of 1.01; Iran, Denmark and Sweden were only just above this price with price ratios of

2.10 and 2.32 (Denmark and Sweden). All other countries however, reported prices with ratios

ranging from 4.27 to 22.6; a high number of 8 countries reported prices of more than 15 times as

high as the MSH reference price.

Table 26: Ratio of national medicine price to MSH reference price for Omeprazole 20mg cap/tab, EURO region#1



Procurement price

Wholesale price




Omeprazole 20mg 0.0328 US$ per cap/tab = MSH ratio 1.00




representing 21 countries reported price information on omeprazole 20mg capsules/tablets. In all

five price categories none of the prices reported was below the MSH reference price. The lowest

prices reported for the price types wholesale, reimbursement and retail/patient in the EURO

region are also the lowest prices for all national price sources. However, the same can be said of

the highest price reported for ex-factory, wholesale and retail/patient in this region; these are also

the highest prices for all national sources. Ex-factory and procurement prices have the lowest H/L

ratio (5.3 and 1.2), meaning that this price type had the lowest amount of variation across

sources. However, for procurement only 2 price points were available for comparison, so in this

case the low H/L ratio does not tell us as much. The H/L ratios for the remaining three price types

are however much higher with values of 30.6 for wholesale, 33.0 for reimbursement and 22.4 for

retail/patient. Meaning that large variation in price exists for these three price types. Such large

variations in price cannot be justified by comparability issues alone. It must be remarked,

however that the availability of price points varies for these three price types varies (n=9, n=8 and

n=16). Although this does not influence the difference between the lowest and highest price, the

H/L ratio is a more reliable parameter when it's measured over a high number of price points.


For the ex-factory price category 6 countries reported prices. The price of Hungary (ratio 14.3) is

the highest price reported in the EURO region. The prices reported by Austria and France are just

below this price (ratios 11.0 and 12.5, respectively), while the remaining three countries Lithuania,

Slovakia and Spain reported much lower prices (ratios 6.40, 3.35 and 2.71, respectively). Looking

at the income categories of the six countries it's considered remarkable that the upper-middle

income country Hungary reported the highest price. Equally remarkable is the fact that high-

income country Spain reported the second lowest ex-factory price for all national price sources

(after high income country New Zealand). The procurement prices of both Denmark and the UK

are just above the MSH reference price of 0.0328 US$, with ratios of respectively, 1.43 and 1.22.

Compared to all other national price sources reporting this price, both countries score average.

Nine countries report wholesale prices; six of them are high-income countries. Both the lowest

and the highest wholesale price in the EURO region are reported by a high-income country;

Sweden reported the lowest price (ratio 1.07) and Ireland the highest price (ratio 32.6). The two

upper-middle income countries Latvia and Lithuania report comparable prices below the average

for this region (ratios 8.54 and 6.71, respectively; mean 11.5). The third upper-middle income

Hungary reports a much higher price (ratio 15.2). Excluding outliers Sweden (very low) and

Ireland (very high), the remaining countries reported prices ranging from ratio 4.57 to 16.5. The

prices of Sweden and Ireland are also the lowest and highest price for all national price sources.

Reimbursement prices are reported by 8 countries in the EURO region. Taking the data

limitations for this price type in account it is difficult to compare this price type between sources.

All report their lowest and highest reimbursed prices, leading to a great variation in MSH price

ratios. Sixteen price sources from EURO report retail/patient prices and all of them reported

prices above the MSH reference price of 0.0328 US$. Eleven sources represent high-income

countries; the remaining five are upper-middle income countries. Both the high-income and the

upper-middle income countries display a great variation between prices. Hungary reported the

highest price in the upper-middle income class (ratio 18.6), while Slovakia reported the lowest

price in this income class (ratio 5.18). The variation between prices was even greater for the high-

income countries; France reported the highest price (ratio 22.6) and the Netherlands reported the

lowest price, which was only just above the MSH reference price (ratio 1.01). Denmark and

Sweden also reported a low price (both ratio 2.32), while all other countries within the EURO

region reported prices ranging from 4.27 to 22.6. The lowest and highest retail/patient prices

reported in this region also represent the lowest and highest price for all national price sources.



one provided actual price information on omeprazole 20mg capsules/tablets. Both ex-factory and


respectively 13.7 and 18.6. Looking across other countries, the South African ex-factory price is


relatively high (ratios ranging from 1.86 to 14.3). Only Hungary, also an upper-middle income

country reported a higher price (ratio 14.3). The same can be said of the wholesale price

reported; this is also high compared to all other national sources (ratios ranging from 1.07 to

32.6). And again the South African is the second highest price for all sources, this time after

Ireland (ratio 32.6)


Brazilian, one Canadian and two USA websites reported price information on omeprazole 20mg

capsules/tablets. The procurement price of Brazil was below the MSH reference price with a ratio

of 0.82. The price reported by the USA was the second highest price with a high ratio of 4.27. The

price of the USA (and the highest price of Sudan, ratio 4.88) can be seen as an outlier compared

to the other procurement prices reported by national price sources (ratios ranging from 0.15 to

1.43). For reimbursement two prices were reported; one for Canada (ratio 30.8) and one for the

USA (ratio 8.23). Taking the data limitations for this price type in account it is difficult to compare

this price type between sources. Canada reports a price ceiling, leading to a high MSH price ratio

compared to the USA source and to the MSH reference price.


reported price information on omeprazole 20mg capsules/tablets. All prices reported for the


Sudan is the only country in the EMRO region reporting a price. With a ratio of 4.88 this is the

highest price for all national sources. This high price is remarkable given the fact that all other

procurement prices, which are lower, are reported by countries with a higher income than Sudan

(ratios ranging from 0.152 to 1.43 and 4.27 for USA); this shows that low-income countries like

Sudan can sometimes pay more for medicines than higher income countries. The wholesale price

of Jordan (ratio 16.5) is relatively high compared to all other national price sources (ratios ranging

from 1.07 to 18.6 and 32.6 for Ireland). It is above the mean and median ratio for all national

sources (ratios 12.6 and 12.5, respectively). The reimbursement price for Morocco is a range of

the lowest and highest reimbursed price (ratio 9.45 to 50.6), but not much can be said about this

price type because of its data limitations. Six countries in the EMRO region reported retail/patient

prices. Iran reported the second lowest retail/patient price (ratio 2.10); the prices of all remaining

five countries are about 10 to 20 times as high as the MSH reference price of 0.0328 US$.

Bahrain reports the highest price for omeprazole 20mg in the EMRO region (ratio 21.0), the

difference with the price of Jordan is however small (ratio 20.7). The other three countries report

lower prices, but all are still relatively high (Morocco 9.45, Oman 11.9 and Tunisia 17.7). The

ratios for all national price sources reporting retail/patient prices are ranging from 1.01 to 22.6.

Within this range a high number of 8 sources reports prices more than 15 times as high as the

reference price, including three sources within the EMRO region. In the retail/patient price


category, the median and mean ratio of the sources in the EMRO region (14.8 and 13.8,

respectively) are higher than the median and mean ratio for all national sources (11.0 and 11.7,

respectively). Establishing that the prices reported for this price type in the EMRO region are

relatively high compared to all national price sources. An explanation for the high prices could be

that it's unknown if a dispensing fee and VAT/GST are included in the price; if included this price

may appear high in comparison to retail prices that do not include these costs. However this

factor alone probably does not account for an average price within the EMRO region that is more

than 16 times as high as the MSH reference price.

For the SEARO region two data sources for India are available. Only one of these sources

reported price information on omeprazole 20mg capsules/tablets. The procurement price reported

was the lowest price for all national sources with a MSH ratio of 0.15.

For the WPRO region New Zealand reported ex-factory price information on omeprazole 20mg

capsules/tablets. For ex-factory, this price (MSH ratio 1.86) was the lowest of all national price

sources; remarkable given the fact that a high income country thus reported a lower price than

countries with a lower income. Australia reported reimbursement price information on omeprazole

20mg capsules/tablets. Taking the data limitations for this price type in account it is difficult to

compare this price between sources. Australia reports a price ceiling (ratio 28.4-31.1) leading to a

high MSH price ratio compared to other national sources and to the MSH reference price.


Salbutamol 100mcg/dose inhaler Price information on salbutamol 100mcg/dose inhalers is available from 33 sources, representing

31 countries. Table 27 shows a summary of the results for all these countries. All ratios

mentioned in the text below represent the MSH price ratio, unless otherwise stated. This MSH

price ratio is calculated by dividing the price published by the source by the MSH reference price

for salbutamol 100mcg, which is 0.0090 US$ per dose. For all national sources and for all




(Annex XIX).

Table 27: Ratio of national medicine price to MSH reference price for Salbutamol 100mcg / dose inhaler, all national sources #1



Procurement price

Wholesale price




Salbutamol inhaler 100mcg 0.0090 US$ per dose = MSH ratio 1.00



For salbutamol 100mcg the availability of price data varied across the different price types. The

price type with the largest number of prices found was retail/patient prices (n=21), while few price

points were found for especially procurement (n=4). Remarkable is that in every price category,

except for ex-factory, at least one country reports a price that is lower than the MSH reference

price of 0.0090. Even more remarkable is that the retail/patient price reported in India (ratio 0.46)

is the lowest price reported in all price categories for all national price sources.

Table 27 shows H/L ratios are below 10.0 for the price types ex-factory, procurement and

wholesale; the H/L ratios of ex-factory (1.8) and wholesale prices (2.7) are even below 3.0. The

H/L ratios for reimbursement and retail/patient prices are however much higher (16.2 and 19.5,

respectively). Such large variations in price cannot be justified by comparability issues alone. For

reimbursement the high H/L ratio could be explained by the specific data limitations for this price

type, some sources report ceiling prices, while others report the lowest and highest reimbursed

prices. For retail/patient prices the high H/L ratio could also be explained by data limitations.

Taking into account that it is not always certain whether or not VAT/GST and a dispensing fee are

included. The mean ratio is only 2.50 times as high as the MSH reference price, showing that the

high H/L ratio is due to outliers. Even so, while it is expected that retail prices will be higher than


MSH prices, as the latter do not include local distribution costs, the more than 8-fold difference of

outlier Denmark is considered high.

Table 28: Ratio of national medicine price to MSH reference price for Salbutamol 100mcg / dose inhaler, EURO region#1



Procurement price

Wholesale price




Salbutamol inhaler 100mcg 0.0090 US$ per dose = MSH ratio 1.00



Table 28 shows all available data for countries in the EURO region. A total number of 21 sources,

representing 19 countries reported price information on salbutamol 100mcg/dose inhalers. The

lowest MSH ratios for procurement, reimbursement and retail/patient are below the MSH

reference price (ratios 0.87, 0.82 and 0.82, respectively). The lowest ratios reported by countries

in the EURO region for procurement and reimbursement are also the lowest ratios for all national

sources. However, the highest ratios reported in every price category by countries in the EURO

region are also the highest ratios for all national sources. Ex-factory and wholesale prices have

low H/L ratios below 2.0, meaning that these price types had little variation across sources. The

availability of data was not high in both categories (ex-factory n=7 and wholesale n=8), but high

enough to make a fair comparison to the other price categories. For the ex-factory price category

7 countries reported prices. All countries report prices above the MSH reference price, however

they all are relatively low and there is little variation across sources (ratios ranging from 1.44 to

2.44). Austria, Czech Republic, Slovenia and Spain report the exact same price (ratio 1.44); the

same can be said of Lithuania and Slovakia (ratio 1.56). The procurement price of the UK is

below the MSH reference price of 0.0090 US$, but the price reported by Denmark is much higher

than this reference price (ratios 0.87 and 7.22, respectively). The Danish price is the highest of all

national price sources, while the UK price is the lowest price for all national price sources. Eight

countries report wholesale prices and the variation between the prices reported is very low given

the H/L ratio of 1.2 (ratios ranging from 1.44 to 1.78). The highest price reported by Norway is

also the highest for all national price sources; however this price is still regarded low with a MSH

ratio of only 1.78. Reimbursement prices are reported by 7 countries in the EURO region. Taking



price ratios. Remarkable is that two sources for the UK report different reimbursed amounts. The


Drug Tariff for Scotland reimburses 0.011 US$ (MSH ratio 1.22) per dose, while the Drug Tariff

for England and Wales reimburses 0.026 US$ (MSH ratio 2.89) per dose. Fifteen price sources

from EURO report retail/patient prices, of them only the Netherlands reports a price below the

MSH reference price of 0.0090 US$. This is remarkable given the fact that MSH prices do not

include local distribution costs, while retail/patient prices are at the end of the distribution chain

and thus include mark-up costs. The prices of the four upper-middle income countries Hungary,

Latvia, Lithuania and Slovakia are just above the MSH reference prices with ratios of 1.56, 1.56,

1.67 and 1.67, respectively. Denmark reports the highest price (ratio 8.89), which is also the

highest price for all national price sources. Poland report the second highest price in the EURO

region (ratio 5.22), this is unexpected for an upper-middle income country. Both Denmark and

Poland can be seen as outliers given the fact that the remaining 13 sources, both upper-middle

and high-income countries, report much lower prices (ratios ranging from 0.82 to 3.78). On

average the prices are about 3 times as high as the MSH reference price (mean ratio 2.93 and

median ratio 2.33). These high ratios could be partially explained by the fact that MSH prices do

not include local distribution costs, but this alone probably does not account for differences above

the mean ratio.



one provided actual price information on salbutamol 100mcg/dose inhalers. Both ex-factory and


respectively 1.44 and 1.67. But both are below the median and mean in their own price

categories for all national sources. Thus, while the prices are above the MSH price, they are not

particularly high compared to all other national sources. Looking across other upper-middle

income countries, South African prices are the lowest for ex-factory and average for wholesale.

For the AMRO region 7 sources are available, representing 3 countries. Only the Brazilian and

one Canadian website reported price information on salbutamol 100mcg/dose inhalers. The

procurement price for Brazil is above the MSH reference price with a ratio of 1.44. This is

however below both the median and the mean ratio for all national sources in this price type

(ratios 1.78 and 2.91, respectively). Thus, while the price is above the MSH price, it is not

particularly high compared to all other national sources. For reimbursement Canada reports a

MSH ratio of 3.22. Taking the data limitations for this price type in account it is difficult to compare

this price type between sources. Keeping in mind that Canada reports a price ceiling, its

reimbursement price is very low.

For the EMRO region 8 sources are available, representing 8 countries. Six countries reported

price information on salbutamol 100mcg/dose inhalers. Two countries, Jordan and Oman, stayed

below the MSH reference price and were the lowest ones in their price categories (wholesale and


retail/patient, respectively). For procurement Sudan is the only country in the EMRO region

reporting a price. With a ratio of 2.11 this price was below the average price (ratio 2.91) for all

national sources in this category. It is the second highest price for all national sources and apart

from Denmark (ratio 7.22) the two other countries stay below Sudan's price, although they have a

higher income (Brazil ratio 1.44 and UK ratio 0.87). The wholesale price of Jordan (ratio 0.67) is

the lowest one in its price category compared to all other national price sources. The

reimbursement price for Morocco is a range of the lowest and highest reimbursed price (ratio 2.56

to 3.56), but not much can be said about this price type because of its data limitations. Five

countries in the EMRO region reported retail/patient prices. For Jordan and Oman the prices are

below the MSH reference price of 0.0090 US$ (ratios 0.84 and 0.46, respectively); the price

reported by Jordan is the lowest one found for all the national price sources. The price reported

by Iran represented the median retail/patient price in the EMRO region (ratio 1.44). Morocco and

Bahrain reported comparable, slightly higher prices with ratios of 2.67 and 2.56, respectively. This

is however somewhat remarkable given the fact that Morocco is a lower-middle income country

while Bahrain is a high-income country. Meaning that it would be expected the prices are more

apart (Morocco lower than Bahrain). An explanation could be that it's not always clear if a

dispensing fee and VAT/GST are included in this price; if included this price may appear high in

comparison to retail prices that do not include these costs.



price information on salbutamol 100mcg/dose inhalers. The retail/patient price reported by this

source is not the lowest of all the national price sources, but it is below the MSH reference price

of 0.0090. Further, it must be noted that the retail/patient price reported in India (ratio 0.46) is the

lowest price reported for all price categories with all national price sources. This is remarkable

given the fact that it's a ceiling price, the maximum price allowed to be paid for this medicine.


reported ex-factory price information, while Australia reported reimbursement price information on

salbutamol 100mcg/dose inhalers. For ex-factory, New Zealand reported the lowest price of all

national sources with a MSH price ratio of 1.33. It must be noted that the prices reported by the

other 7 countries were not much higher (ratios ranging from 1.44 to 2.44). Taking the data

limitations for reimbursement prices into account it is difficult to compare this price type between

sources. Australia reports a price ceiling (ratio 8.33 to 10.2) leading to a high MSH price ratio

compared to other national price sources and to the MSH reference price.


Simvastatin 20mg capsules/tablets

Price information on simvastatin 20mg cap/tab is available from 37 sources, representing 34




simvastatin 20mg, which is 0.0629 US$ per capsule or tablet. For all national sources and for all




(Annex XX).

Table 29: Ratio of national medicine price to MSH reference price for Simvastatin 20mg cap/tab, all national sources #1



Procurement price

Wholesale price




Simvastatin 20mg 0.0629 US$ per cap/tab = MSH ratio 1.00



For simvastatin 20mg, the availability of price data varied across the different price types. The

price type with the largest number of prices found was retail/patient prices (n=22), while less than

10 price points were found for ex-factory and procurement prices (n=8 and n=5, respectively).

Table 29 shows that the H/L ratio is above 10.0 for all price types. The H/L ratio of procurement is

just above 10.0 (H/L ratio 12.3), while the ratios of the remaining three price types are much

higher. In particular the H/L ratios for wholesale and reimbursement are high (67.1 and 68.0,

respectively); the H/L ratio for retail/patient is 37.3 and thus high as well. Meaning that large

variation in price exists for these three price types. Such large variations in price cannot be

justified by comparability issues alone. Looking at wholesale it must be noted that few price points

are available. The detailed summary table (Annex XX) shows that four out of the five countries

report prices below the MSH reference price of 0.0629 US$ (ratios ranging from 0.091 to 0.95).

The highest price in this price category is reported by Sudan, but is still low with a MSH ratio of

1.11. For reimbursement the high H/L ratio could be explained by the specific data limitations for

this price type, some sources report ceiling prices, while others report the lowest and highest

reimbursed prices. Taking the data limitations for this price type in account it is not possible to

calculate a median or mean ratio for this price type. For retail/patient prices the high H/L ratio


(37.3) could also be explained by the data limitations. Taking into account that it is not always

certain whether or not VAT/GST and a dispensing fee are included. It is expected that retail

prices are higher than MSH prices, as the latter do not include local distribution costs. However,

the large variation between the prices suggests that this does not account for the differences

alone.

Table 30: Ratio of national medicine price to MSH reference price for Simvastatin 20mg cap/tab, EURO region#1



Procurement price

Wholesale price




Simvastatin 20mg 0.0629 US$ per cap/tab = MSH ratio 1.00




representing 21 countries reported price information on simvastatin 20mg capsules/tablets. In

four price categories one or more prices below the MSH reference price were reported. The

lowest prices of every price type, except for ex-factory, reported in the EURO region are also the

lowest prices for all national price sources. The highest prices reported in this region for ex-

factory and wholesale are also the highest prices for all national price sources. Ex-factory and

procurement prices have the lowest H/L ratio (3.9 and 2.6), meaning that this price type had the

lowest amount of variation across sources. However, for procurement only 2 price points were

available for comparison, so in this case the low H/L ratio does not tell us as much. The H/L ratios

for the remaining three price types are however much higher with values of 67.1 for wholesale,

43.3 for reimbursement and 34.0 for retail/patient. Meaning that large variation in price exists for

these three price types. Such large variations in price cannot be justified by comparability issues

alone. It must be remarked, however that the availability of price points varies for these three

price types varies (n=9, n=8 and n=16). Although this does not influence the difference between

the lowest and highest price, the H/L ratio is a more reliable parameter when it's measured over a

high number of price points.

For the ex-factory price category 6 countries reported prices. The price of France (ratio 5.88) is

the highest price reported in the EURO region. The prices reported by Austria, Hungary and

Lithuania are comparable with ratios of 3.66, 3.66 and 3.82, respectively. The price of France is

also the highest for all national sources, while the prices of Austria, Hungary and Lithuania are

also considered relatively high since they are above the median and mean price for all national


price sources (mean ratio 2.84 and median ratio 2.94). The procurement prices of both Denmark

and the UK are below the MSH reference price of 0.0629 US$. The Danish price is the lowest of

all national price sources with a ratio of 0.091, while the UK price is the second lowest price of all

national price sources (ratio 0.24).

Eight countries report wholesale prices, 6 of them are high-income countries. The two upper-

middle income countries Latvia and Lithuania report very different prices with ratios of 1.91 and

4.13, respectively. The price of Latvia is relatively low in comparison to the other national

sources, the Lithuanian price is however considered high, especially given the income level. The

six high-income also report prices with a great variation (ratios ranging from 0.22 to 14.9); a high

outlier is Ireland with a price almost 15 times as high as the reference price. Finland and Sweden

report prices of about one-fourth the MSH reference price (ratios 0.22 and 0.25, respectively).

Both the lowest and the highest price reported for countries in EURO region are also the lowest

and highest price for all national price sources (ratios 0.22 and 14.9). Reimbursement prices are

reported by 8 countries in the EURO region. Taking the data limitations for this price type in

account it is difficult to compare this price type between sources. All report their lowest and

highest reimbursed prices, leading to a great variation in MSH price ratios. Sixteen price sources

from EURO report retail/patient prices, thirteen of them have prices higher than the MSH

reference price of 0.0629 US$. Eleven sources represent high-income countries; the remaining

five are upper-middle income countries. The upper-middle income countries all report prices

above the MSH reference price (ratios ranging from 2.54 to 4.93). All prices reported by the high-

income countries display a greater variation (ratios ranging from 0.24 to 8.11). All high ratios

could be partially explained by the fact that MSH prices do not include local distribution costs.

However, Denmark, Finland and the Netherlands all report prices below the MSH reference price

(ratios 0.72, 0.43 and 0.24, respectively). This is remarkable given the fact that MSH prices do

not include local distribution costs, while retail/patient prices are at the end of the distribution

chain and thus include mark-up costs.



one provided actual price information on simvastatin 20mg capsules/tablets. Both ex-factory and


respectively 1.59 and 2.23. Looking across other upper-middle income countries, the South

African ex-factory price is low (ratios ranging from 2.23 to 3.82). The same can be said of the

wholesale price reported compared to all other national sources in the same income group (ratios

ranging from 1.91 to 4.29).


Brazilian, one Canadian and three USA websites reported price information on simvastatin 20mg


capsules/tablets. The procurement prices for both Brazil and USA were below the MSH reference

price with ratios of, respectively 0.45 and 0.95. Both prices score just below average in their price

category with all national price sources. For reimbursement 3 prices were reported, one for

Canada (ratio 15.9) and two for the USA (ratio 2.70 and 3.34). Taking the data limitations for this

price type in account it is difficult to compare this price type between sources. Canada reports a

price ceiling, leading to a high MSH price ratio compared to the USA source and to the MSH

reference price.


reported price information on simvastatin 20mg capsules/tablets. All prices reported for the


Sudan is the only country in the EMRO region reporting a price. With a ratio of 1.11 this is the

highest price for all national sources. Although this price is only just above the MSH reference

price it is considered high for a low-income country. Especially given the fact that all other

procurement prices reported are below the MSH price, while they have a higher income than

Sudan (ratios ranging from 0.091 to 0.95); this shows that low-income countries like Sudan can

sometimes pay more for medicines than higher income countries. The wholesale price of Jordan

(ratio 7.15) is the second highest price for all national price sources in this category (Ireland ratio

14.9). This is unexpected because all other countries reporting a lower price for wholesale have a

higher income than Jordan (ratios ranging from 0.22 to 5.72). The reimbursement price for

Morocco is a range of the lowest and highest reimbursed price (ratio 5.25 to 10.9), but not much

can be said about this price type because of its data limitations. Six countries in the EMRO region

reported retail/patient prices. Iran reported the lowest retail/patient price in the EMRO region

(ratio 1.59). The prices of all other five countries are at least 5 times as high as the MSH

reference price of 0.0629 US$. Jordan reports the highest price for simvastatin 20mg in the

EMRO region (ratio 8.90), the difference with the prices of Lebanon and Oman is however small

(ratio 8.74 and 8.59, respectively). Although the difference is small, it is remarkable that lower-

middle income country Jordan has a higher price than upper-middle income countries Lebanon

and Oman. The other two lower-middle income countries Morocco and Tunisia have lower prices,

although the differences are still small (ratios 5.25 and 7.47, respectively). Compared to all

national price sources, the prices in the EMRO region are (relatively) high; all but the Iranian price

are above the median and mean ratio for all sources (ratios 3.90 and 4.00, respectively). The

prices of Jordan, Lebanon and Oman are also the three highest prices for all national price

sources.


found for countries in the SEARO region. None of these sources reported price information on

simvastatin 20mg capsules/tablets.


For the WPRO region only 2 countries provide price information on medicines. For ex-factory,

only New Zealand reported a price below the MSH reference price which was thus also the

lowest ex-factory price of all national sources. The MSH price ratio of 0.38 showed that this price

is only about one-third the international reference price. Australia reported reimbursement price

information on simvastatin 20mg capsules/tablets. Taking the data limitations for this price type in

account it is difficult to compare this price type between sources. Australia reports a price ceiling

(ratio 16.2) leading to a high MSH price ratio compared to the other national price sources and to

the MSH reference price.


Comparison of therapeutic equivalent substances

In addition to comparing the prices of the same medicine across websites, a comparative analysis

between selected therapeutic equivalent pharmaceutical substances was also carried out. The

aim of this comparison was to investigate the extent of the price variance for medicines which

have the same therapeutic effect. Two well-known branded medicines were compared to generic

therapeutically equivalent medicines. Atorvastatin 20mg, which is manufactured by Pfizer under

the names Lipitor, Sortis, Tahor, Torvast and others, was compared to its therapeutic equivalent

simvastatin 20mg. And esomeprazole 20mg, which is manufactured by AstraZeneca under the

names Nexium, Nexium, Inexium and others, was compared to its therapeutic and pharmacologic

equivalent omeprazole 20mg.

Atorvastatin 20mg vs. Simvastatin 20mg

Atorvastatin and simvastatin are considered to be therapeutically equivalent; meaning that both

medicines can be replaced by one-and-other without any change in therapeutic effect. However,

despite this equivalence, many patients are still on a daily prescription of atorvastatin, which is

still under patent and is usually more expensive. Atorvastatin is produced by Pfizer under the

brand names Lipitor, Sortis, Tahor and Torvast. The price comparison was limited to these

products for all price types except retail/patient prices, where the prices of INN generics were also

collected to highlight the importance of generic substitution.

Price information on atorvastatin 20mg cap/tab was available for 25countries. Because most non-

profit suppliers supply the cheaper simvastatin the generic market for atorvastatin is still very

small and therefore a MSH reference price is not (yet) available. To enable the comparison of

prices across different sources, the price of simvastatin was used as a reference. Rather than to

calculate an average price or median price per price type for simvastatin, it was decided to report

the price of simvastatin per individual country to show the actual price difference between

atorvastatin and simvastatin. Prices of simvastatin had previously been collected for the price

comparison across websites and thus were readily available for each of the 25countries.

All ratios mentioned in the text below represent the country price ratio of atorvastatin compared to

simvastatin, unless otherwise stated. This ratio is calculated by dividing the published price for

atorvastatin by the price of simvastatin in the same country. No country price ratios were

calculated for reimbursement prices due to the difficulties in comparing these prices. For

example, reimbursement prices are sometimes presented as a price ceiling (maximum

reimbursed amount), while in other cases countries report their lowest and highest

reimbursement level dependent on the brand chosen.


Summary results for the price comparison between atorvastatin 20mg cap/tab and simvastatin

20mg cap/tab are shown in Table 31. A detailed version of the table, with ratios for individual

national sources, can be found in the Annexes (Annex XXI).

Table 31: Price ratio of branded Atorvastatin 20mg cap/tab compared to generic Simvastatin 20mg cap/tab per country #1 (Pfizer brands: Lipitor, Sortis, Tahor and Torvast)


Ex-factory / Manufacturer price Pfizer vs Generic

Procurement price Pfizer vs Generic

Wholesale price Pfizer vs Generic

Retail / Patient price Pfizer vs Generic

Retail / Patient price Generic vs Generic


No MSH reference price available: reference is country price Simvastatin 20mg Country price ratio = (Country price ATV/Country price SMV)

n = 5 n = 2 n = 10 n = 18 n = 11 Median Ratio 6.48 --- 5.56 5.66 1.98 Mean Ratio 7.64 129.8 20.4 14.8 3.16 Lowest Ratio 4.58 45.5 1.95 2.79 1.26 Highest Ratio 10.8 214.0 103.8 90.0 15.2 High/Low Ratio 2.4 4.7 53.2 32.3 12.1

#1 Please see section IV.4 for all data limitations;; ATV=atorvastatin; SMV=simvastatin;

For atorvastatin 20mg, the availability of price data varied across the different price types. The

price type with the largest number of prices found was retail/patient prices. For the originator

Pfizer brands (Lipitor, Sortis, Tahor and Torvast) 18 retail/patient prices were found, while less

than 10 price points were found for ex-factory and procurement prices (n=5 and n=2,

respectively). The high/low (H/L) ratio is an important parameter, as it shows the variation in

prices across sources. However comparability issues must be taken into account, for example

some prices include VAT while others do not. Table 31 shows that for ex-factory and procurement

prices, the H/L ratio is below 10.0 (2.4 and 4.7, respectively). The H/L ratio of generic

retail/patient prices is just above 10.0 (H/L ratio 12.1), while the H/L ratios of wholesale and Pfizer

brand retail/patient prices are much higher (53.2 and 32.3, respectively). These high H/L ratios

mean a large variation in price exists for these price types. However, given the fact that

comparisons are not with a constant but with a fluctuating simvastatin price it is more difficult to

judge the high or low value of the calculated mean, median and H/L ratios.

For retail/patient prices, price ratios were compared between the originator brand and generic

simvastatin, and between generic atorvastatin and generic simvastatin. A substantial difference in

retail/patient prices between the Pfizer brands and generic products was observed. Namely, the

median and mean value of the generics (ratios 1.98 and 3.16, respectively) are substantially

lower than the median and mean of the Pfizer brands (ratios 5.66 and 14.8, respectively). This

shows that generic substitution is important and can lead to lower prices for patients. Large

high/low ratios observed for both the brand and generic products show that in some countries the

prices of atorvastatin and simvastatin are closer than in others. However low ratios may not be


the result of low atorvastatin prices but rather of high simvastatin prices, and as such may not

always be desirable.

Esomeprazole 20mg vs. Omeprazole 20mg

Esomeprazole and omeprazole are considered therapeutically and pharmacologically equivalent;

meaning that both medicines can be replaced by one-and-other without any change in

therapeutic effect. Esomeprazole is produced by AstraZeneca under the brand names Nexium,

Nexiam and Inexium. The price comparison was limited to these products for all price types.

Price information on esomeprazole 20mg cap/tab was available for 21 countries. Because there

is no generic market for esomeprazole (yet), a MSH reference price is not available. To enable

the comparison of prices across different sources, the price of omeprazole was used as a

reference. Rather than to calculate an average price or median price per price type for

omeprazole, it was decided to report the actual price of omeprazole per individual country to

show the actual price difference between esomeprazole and omeprazole. Prices of omeprazole

had previously been collected for the price comparison across websites and thus were readily

available for each of the 21 countries. All ratios mentioned in the text below represent the country

price ratio of esomeprazole compared to omeprazole, unless otherwise stated. This ratio is

calculated by dividing the published price for esomeprazole by the price of omeprazole in the

same country. No country price ratios were calculated for reimbursement prices due to the

difficulties in comparing these prices. For example, reimbursement prices are sometimes

presented as a price ceiling (maximum reimbursed amount), while in other cases countries report

their lowest and highest reimbursement level dependent on the brand chosen.

Summary results for the price comparison between esomeprazole 20mg cap/tab and omeprazole

20mg cap/tab are shown in Table 32. A detailed version of the table, with ratios for individual

national sources, can be found in the Annexes (Annex XXII).

Table 32: Price ratio of branded Esomeprazole 20mg cap/tab compared to generic Omeprazole 20mg cap/tab per country #1 (Astra Zeneca brands: Nexium, Nexiam and Inexium)


Ex-factory price AstraZeneca vs Generic

Procurement price AstraZeneca vs Generic

Wholesale price AstraZeneca vs Generic

Retail / Patient price AstraZeneca vs Generic


No MSH reference price available: reference is country price Omeprazole 20mg; Country price ratio = (Country price EMP/Country price OMP)

n = 5 n = 3 n = 9 n = 18 Median Ratio 2.92 14.1 2.33 4.36 Mean Ratio 5.96 15.9 6.89 7.19 Lowest Ratio 1.72 4.56 1.32 1.64 Highest Ratio 12.1 28.9 41.1 26.7 High/Low Ratio 7.0 6.3 31.1 16.3


#1 Please see section IV.4 for all data limitations; EMP=esomeprazole; OMP=omeprazole;

For esomeprazole 20mg, the availability of price data varied across the different price types. The

largest number of prices was found for retail/patient prices (n=18), while less than 10 price points

were found for the remaining price types ex-factory, procurement and wholesale prices (n=5, n=3

and n=9, respectively). The high/low (H/L) ratio is an important parameter, as it shows the

variation in prices across sources. However, comparability issues must be taken into account, for

example some prices include VAT while others do not. Table 32 shows that for ex-factory and

procurement prices, the H/L ratio is below 10.0 (7.0 and 6.3, respectively). The H/L ratios of

retail/patient and wholesale prices are much higher with H/L ratios of 31.1 and 16.3, respectively.

These high H/L ratios mean a large variation in price exists for these price types. However, given

the fact that comparisons are not with a constant but with a fluctuating omeprazole price it is more

difficult to judge the high or low value of the calculated mean, median and H/L ratios.

Despite this limitation, the large high/low ratios observed show that in some countries the prices

of esomeprazole and omeprazole are closer than in others. However, low ratios may not be the

result of low esomeprazole prices but rather of high omeprazole prices, and as such may not

always be desirable.


VI - DISCUSSION In recent years many types of medicine price information have become available on websites.

However, both the quality of these websites, and the availability of descriptive information about

the prices to allow appropriate interpretation, can limit their usefulness. We therefore conducted

an evaluation of 71 websites reporting medicine prices. The evaluation of medicine pricing

websites needs specific criteria to assess both the quality of the site in general, and the quality of

the price data reported. This is of importance because the general quality of a website may not be

an indication of the quality of the price information. Most pricing websites are not created for the

purpose of price comparisons, but rather to share information with national organizations,

healthcare professionals such as dispensers and the public. However, these websites are being

used for international price comparisons even though that is not their initial objective. When

assessing websites, comprehensiveness of information should therefore be a key criterion

regardless of the source of the website and its initial objective.

Web based searches were conducted to identify national and international websites for the

comparative analysis. Most of the identified websites were available on a detailed list developed

by Health Action International (HAI) and could easily be accessed through their medicine price

website. Some very useful international websites, like the Price Information Exchange for the

Western Pacific Region (http://piemeds.com/), could unfortunately not be included in the present

analysis because they became available online after the closing date of the qualitative analysis.

After finishing both the qualitative and quantitative analysis of each website, the complete report

was send out for external review. This resulted in the identification of additional websites and/or

price types for Belgium, the Czech Republic, the United Kingdom and Health Action International

(HAI). These additions, identified after analysis by the source, are mentioned in the qualitative

analysis, however they could not be included in the quantitative analysis as it would not be fair to

compare prices of different price dates.

General site quality

The results of the qualitative analysis showed great variation across websites in terms of layout

and design of the price database, however most websites received the highest score (2) for user-

friendliness. Conversely, many websites received a low score for update of site and price

information. Most websites failed to publish the date on which the general website and/or the

price information was last updated, resulting in overall low scores on this criterion. The availability

of a site map, search ability within the price information and the availability of both a download

and print version of the price information were other important elements that could frequently be

improved. Some sites required registration prior to gaining access to price data. In Jordan for


example, price information is only available to patients after registration to make sure they are

always provided with the most up-to-date information (email-updates), while Lebanon only

provides additional price information to healthcare professionals following registration. The great

variation observed across sites with respect to layout and the overall availability of (additional)

price information could partially be explained by cultural difference between countries (e.g.

privacy issues, personal patient accounts (Bahrain)), but the starting point of the analysis could

affect the scoring as well (Jordan, HAI). The homepage of the price reporting website or price

database was chosen as the starting point. However, when using this hyperlink it is not always

possible to access the general homepage of the country or organization.

A limitation of the present study was that no validated tool was available to conduct the qualitative

analysis; a template was therefore developed to assess the pricing websites. The scoring system

was prone to subjectivity to some extent; the three point scoring scale proved to be difficult to

implement for all websites, despite a clear description for each score. To minimize subjectivity, 2

other authors were consulted when scoring was questionable. Overall, the evaluation template

appeared to be a useful tool for investigating websites reporting medicine prices in a consistent

manner.

Another factor that could have influenced the scores is the date and time at which the website

was reviewed. For example, a website with regular updating may have received a higher or lower

score on date of last update depending on the day on which the site was accessed. Because it is

impossible to keep up with the updates of the 50 national and 20 international websites that were

reviewed, the date on which the website was accessed is listed above the table that provides the

individual scores for each website (Annex IV to XIII).

Quality of price information

The national and international websites included in the review reported various types of medicine

prices: ex-factory, procurement, wholesale, reimbursement and retail/patient prices. To improve

the interpretability of the price data it is recommended that websites publish information on the

components of each price, for example whether VAT/GST is included or not and if so, the amount

of the tax. A specific checklist for every price type was designed to assess the

comprehensiveness of the price information. The scoring was based on a simple yes or no

answer based on availability of specific information, as well as not applicable when the criterion

was not valid for the website (e.g. exchange rate if prices were reported in country’s local

currency). In addition, for some criteria specifications were listed (e.g. which INCO term, value of

VAT/GST, etc). Although this scoring system seems straightforward and easy to implement,

difficulties did occur during the assessment. The answer no (i.e. information not available) proved

to be more difficult, as information may in fact be available but may be difficult to find (e.g.


available on different section of website). It was therefore decided to list no if the additional

information was not found in either the price database or by scrolling the medicine prices section

of the website. In this way the quality of the price information could be assessed in a consistent

manner. In addition, website users would probably have similar difficulties in finding information

that was not readily available, justifying a low score.

One additional remark on the qualitative analysis is the relative importance of the awarded

scores. It is difficult to assess what is more important: the site in general or the quality of the price

information reported. Because this depends a great deal on the objective of the user, there is no

easy answer for this question. One could also argue that the user-friendliness of the general site

is important to be able to properly interpret the available price information. Therefore the quality of

both the general site and the price information were considered equally important.

Comparability of prices: issues encountered

A lack of comparability of price data across sites limits the usefulness of price comparisons. In the

quantitative analysis, data was adjusted where possible to improve the comparability of price data

reported from different sources. In some cases websites included sufficient information to allow

such adjustments, for example the value of taxes (VAT/GST) included in retail/patient prices.

However in other cases, such as for reimbursement prices, price comparisons were more difficult.

Overall, the websites generally did not provide all the qualitative (additional) price information

desired to perform international price comparisons, which was a key limitation of the quantitative

analysis.

The exchange rate is an uncertain variable that could also have influenced the variation in price

observed in the quantitative analysis. Prices were rarely reported in American dollars (US$), but

rather in the country’s local currency or in Euros (€). Because none of the websites listed an

exchange rate on their website, these rates were calculated according to the date of price

information. Clear information on the date of the price information was, however, not available on

every website. It is therefore recommended that websites mention the exchange rate on their

website to improve international price comparisons.

For ex-factory and procurement prices, websites did not include information on the INCO term of

reported prices. It was therefore not possible to adjust for this factor, which might have

contributed to the observed price variations between sources. Another issue with ex-factory

prices was that it was not always clear whether actual sale prices or indicative prices were

reported. The comparison of procurement prices was complicated by the way in which prices

were reported. On some websites it was clear that a discount was given for larger pack sizes,

while on others only the price per tablet was reported. The latter could be the lowest (discount)

price, but could also be a mean price over the course of a year.

For wholesale prices it was not always clear if logistic fees and taxes were included, and the


issue of discounts on larger pack sizes or a price per tablet is also applicable for this price type.

For both reimbursement and retail/patient prices, several sources did not specify whether a

dispensing fee and/or VAT/GST were included. Another issue was co-payments, which often

depend on the brand chosen (even differences between INN generics) and for some countries

(e.g. Australia, Portugal, United States), on the patient status and his/her insurance level.

Variations in the way in which reimbursement prices were reported were a further limitation. Most

countries reported a reimbursed amount based on the brand chosen, while others reported the

lowest and highest amounts reimbursed or a price ceiling, which represents the maximum

amount reimbursed for a medicine. This resulted in a large variation in prices, making it difficult to

include reimbursement prices in international price comparisons. Retail/patient prices were also

limited by variations in the way in which they were reported. Some sources published the prices

of several INN generics, while others only reported an average price for the medicine. If multiple

prices were available, the lowest price was selected for comparison, even though this is not

always fair when comparing to other sources with a lower availability of price points. Moreover,

the lowest price sometimes corresponds to a large pack size (up to 500 tablets), when these

would never be sold to a patient. However, the biggest limitation in the comparison of

retail/patient prices relates to the dispensing fee on medicines. Many developed countries charge

a fixed dispensing fee on medicines irrespective of the amount dispensed. Depending on the

price and the quantity of the medicine, this charge might be a significant contributor to the final

patient price, but it is frequently not reported.

International price comparisons

A quantitative analysis of medicine prices found on national websites was conducted to assess

the feasibility of comparing web-based medicine price information from different sources. The

analysis was performed on the prices of 7 medicines selected for their wide range of therapeutic

effects and the expected high availability of price data. These seven were: the tricyclic

antidepressant amitriptyline 25mg cap/tab, the selective beta-blocker (ß1-receptor) atenolol 50mg

cap/tab, the antibiotic ciprofloxacin 500mg cap/tab, the anti-diabetic glibenclamide 5mg cap/tab,

the proton pomp inhibitor omeprazole 20mg cap/tab, the ß2-receptor sympatheticomimetic

salbutamol 100mcg/dose inhaler and the statin simvastatin 20mg cap/tab. Only INN generics

were included in this research in order to keep the comparison of prices as consistent as

possible; prices of INN generics proved to be more comparable across countries. However, large

variations were still found in the prices of individual medicines; this variation was often greatest

for procurement, reimbursement and retail/patient prices. While some price variation would be

expected due to comparability issues, these and other national issues alone would not account

for the large scale price variations that were found. As such it can be concluded that prices for the

same products vary widely across countries, even within one region. It could be argued that


choosing other medicines would have led to different results, but a similar outcome is more likely,

especially given the fact that most countries occupied the same position (low/average/high price)

for every medicine, compared to all other national price sources. For example, the Austrian prices

for ex-factory, wholesale and retail were high for all selected medicines, while the Netherlands

was the only country reporting a retail price below the MSH reference price for both simvastatin

and salbutamol, and a retail price equal to the MSH reference price for omeprazole. The prices of

the Scandinavian countries - Finland, Norway and Sweden - varied but were generally low. The

prices of countries within the EMRO region were generally high, even though their income level

was lower than most countries in, for example, the EURO region. The ex-factory prices of New

Zealand were considered low for six out of the seven selected medicines (no price reported for

glibenclamide 5mg).The procurement and retail/patient prices of India were also low for all

selected medicines, whereas all reported South African prices were close to the mean.

Although results were not grouped according to their World Bank Country Income Category, it

was taken into account by comparing countries not only regionally (that is by WHO Region), but

by also comparing them to other countries in their respective income class. Surprisingly, lower

income countries reported higher prices than higher income countries on more than one

occasion. For Hungary this was the case for all medicines except atenolol 50mg cap/tab. For

Jordan and Sudan, this was even the case for each of the prices they reported. Because the

incomes of countries are different, there is a different meaning to low and high prices. While it

may not influence the availability of medicine in a higher income country, a high price in a lower

income country has a greater influence on the availability of the selected medicines because their

Purchasing Power Parity (PPP) is lower. Moreover, in high income countries more funding

options (e.g. health insurance) are available to pay for a higher-priced medicine; the negative

impact of a high price is thus greater for lower income countries.

It was clearly visible that a strong local manufacturing sector for the selected medicines strongly

influenced their prices. For example both India (procurement and retail) and Iran (retail) reported

low prices for all medicines analysed.

While only a few countries reported more than two price types per medicine, differences in mark-

up costs within the distribution chain (ex-factory to retail price) were noticeable. For ciprofloxacin,

for example, Austria (reporting ex-factory, wholesale, retail) and France (reporting ex-factory,

reimbursement, retail) published high prices in each of the categories and the price differences

between the price types were very high, suggesting high add-on costs. The effect of add-on costs

in the distribution chain on medicine prices was unfortunately not clear in all countries, as many

countries did not report multiple price types (some countries reported no more than one price

point per medicine).

A final general remark regarding the quantitative price analysis relates to the use of MSH

reference prices for the comparison of the 7 selected medicines. Namely, that MSH reference


prices are largely Ex-Works and are based on the median price of mainly non-profit suppliers and

therefore might not be suitable for comparison with every country and every price type. However,

MSH is a constant factor for comparison and little fluctuation is observed in prices over time (e.g.

low difference between MSH 2008 and MSH 2009). Therefore it is not expected that the use of

MSH prices from 2008 will influence the comparability with newer or older prices (except for

medicines that are recently off-patent, which have not been selected for the price comparisons).

When considering the use of web-based price information for external reference price setting, the

key findings from this quantitative analysis of seven medicines should be taken into account. With

the exception of the New Zealand ex-factory prices (reporting 6 out of the 7 medicines) and Tamil

Nadu procurement prices (reporting 5 out of the 7 medicines), there was no consistency as to

which website reported the lowest prices. In addition, there was little correlation between national

GDP (Gross Domestic Product) per capita and prices. Therefore a wide range of countries should

be included in the reference basket and the average (or median) of the three lowest prices should

be used as the reference. Where countries use the average of a large number of countries (as

Austria does) the final price will inevitably be high.

Generic therapeutic substitution

In this analysis, two brand medicines were compared to their generic therapeutic equivalent

substance to investigate the potential cost savings of generic therapeutic substitution. The prices

of the brand of atorvastatin, Lipitor (Pfizer) 20mg cap/tab were compared to the INN generic

simvastatin 20mg cap/tab; while the brand of esomeprazole, Nexium (Astra Zeneca) 20mg was

compared to the INN generic omeprazole 20mg cap/tab. All branded atorvastatin products

manufactured by Pfizer were included (e.g. Lipitor, Sortis, Tahor and Torvast), as were all

esomeprazole products manufactured by Astra Zeneca (e.g. Nexium, Nexiam and Inexium).

It should be noted that both Lipitor and Nexium were matched on dosage strength (both 20mg

brand compared to 20mg generic) and not on their supposedly therapeutic equivalent dosage

strength. This comparison should merely be looked at as a comparison of equivalent

pharmaceutical substances. While there are slight differences in the therapeutic effect of these

products in practice they are often used interchangeable. Statins may be titrated against

cholesterol levels but are frequently used empirically. Several studies suggest that atorvastatin is

slightly more potent in lowering low-density lipoprotein cholesterol (LDL-C) than simvastatin.

(14,15, 16) The results of the CURVES study (15) showed reductions in LDL-C of 28% to 41% for

simvastatin 10 to 40mg, as opposed to 38% to 51% for atorvastatin 10 to 40mg. Atorvastatin

20mg reduced LDL-C 46%, while simvastatin reduced LDL-C 35%; only the reductions at the

40mg dose (41% vs. 51%) were considered statistically significant. (15) The results of the IDEAL

study (14) also showed greater reductions in LDL-C for atorvastatin compared to simvastatin.

However, although this reduced the risk of secondary end points and nonfatal acute Myocardial

Infarct (MI), it did not result in a significant reduction in the primary outcome of major coronary


events (e.g. fatal MI). (14) As discussed, the CURVES study showed atorvastatin 20mg (-46%)

reduced LDL-C levels more than simvastatin 20mg (-35%) and even simvastatin 40mg (-41%);

thus atorvastatin could be seen as more potent. It must however be noted that the difference in

prices was much greater than the found differences in potency. As Ara et al. stated (16),

atorvastatin will be the more cost-effective treatment if the cost decreases (patent ends in 2011)

to that observed for simvastatin.

A similar discussion point is applicable for the comparison of omeprazole and esomeprazole. It is

suggested that esomeprazole provides more effective acid control than omeprazole. (17,18)

Esomeprazole 40mg proved to be about 6% to 10% more potent than omeprazole 20mg in acute

treatment in a UK study. (18) The increased effect of esomeprazole when administering the same

dosage appeared (both 40mg) to be 13% to 20%. (17) Once again it must however be noted, as

concluded by Wahlqvist et al. (18), that the cost of esomeprazole needs to be reduced in order for

esomeprazole to become the more cost-effective treatment.

Because a MSH reference price was not available for either medicine, the price of simvastatin

and omeprazole respectively, were used as a reference. To compare prices between sources, a

country price ratio was calculated: price of Lipitor or Nexium in country A divided by the price of

simvastatin or omeprazole in country A. The comparison of prices was therefore more difficult as

the prices of both simvastatin and omeprazole are different in each country. Also, the availability

of price data was substantially less than in the other 7 comparisons, but still high enough to

analyze the benefits of generic therapeutic substitution.

When comparing the prices of Lipitor and Nexium with their therapeutic equivalents, it was seen

that all of the prices of Lipitor and Nexium were far higher. In fact, differences up to 214-fold

(procurement price of Denmark) for Lipitor compared to simvastatin and differences up to 41.1

(wholesale price of Sweden) for Nexium compared to omeprazole were reported. In the Lipitor

comparison, the retail/patient prices of INN generic atorvastatin were also included in the

comparison. Although these prices were also higher than those of simvastatin, they were

remarkably lower (median ratio of 1.98-fold and a mean ratio of 3.16-fold) than the simvastatin

price. These substantial price variations clearly show the potential cost savings of generic

therapeutic substitution of simvastatin for Lipitor and omeprazole for Nexium.

In conclusion, many websites are fast and user-friendly, but they often report different price

information and have key limitations which users should take into consideration. The quantitative

analysis of 7 selected medicines in this study has proven that it is possible to conduct

international price comparisons using the price information on the identified websites, but it is

demanding work. Comparisons are possible for a selection of medicines, but when comparing

multiple medicines the use of multi-national price sources should be considered. Looking at the

price comparisons in general it is surprising that although medicine price information appears to

be widely available on the internet, great variations in prices still exist. The substantial price


variations observed in the Lipitor and Nexium price comparisons showed that generic therapeutic

substitution is a policy measure that should be more widely practiced.


VII - RECOMMENDATIONS

Recommendations for webmasters on general site quality

The comprehensiveness of the general information on a website reporting medicine prices is

considered a major criterion in its evaluation, regardless of the publisher and the website's

primary objective.


Websites should display the date on which the general site was last updated to show users how

recent the information on the website is. Displaying the date of last update of the price data is

considered equally important. Only then will users be able to interpret all information available on

the website in an appropriate manner.

Example

Three USA websites - PBM (http://www.pbm.va.gov/DrugPharmaceuticalPrices.aspx), CHFS

(http://chfs.ky.gov/dms/maximum.htm) and CDC (http://www.cdc.gov/vaccines/programs/vfc/cdc-

vac-price-list.htm) - are considered good examples. General and price-specific information are

updated at least once a month.

Search option within price information

The ability to search medicine prices can be very useful. It saves time (no need to scroll down a

long list), especially when medicines are listed by brand name (varies throughout countries) or

manufacturer name rather than alphabetized by INN name.

Example

The price information database on the Swedish website (http://www.tlv.se/beslut/sok/lakemedel/)

can be searched by INN name, drug name, manufacturer or ATC code. Moreover, in the excel

document that can be downloaded from the database, the display can be modified by individual

characteristic (e.g. only display amoxicillin, only display generics, only display wholesale price).

Parent/child relationship

Some of the national websites that were reviewed did not link to the homepage of the

source/author. The inclusion of a link to the main website (parent) of the organization/author of

the pricing website (child) is recommended. This ensures that users are properly informed about

the objectives of both the author and the pricing website.

Example

The Danish price database website has a good parent/child relationship. It is a theme website of

the Danish Medicines Agency and although both have a different web address, the medicine

prices theme website (http://www.medicinpriser.dk/) is situated in the general website frame of

the Danish Medicines Agency (http://www.dkma.dk). This allows the information and features of

both websites, such as site map, search engine and contact information, to be easily accessed

(less than 5 mouse clicks) using either of the two website links.


Site map

The inclusion of a site map improves the user friendliness of a website, as it facilitates navigation

for the user. Moreover, it provides an overview of the various types of price information available

on the website.

Example

A clear site map can be found on the PHARMAC website from New Zealand

(http://www.pharmac.govt.nz/sitemap/). The website is divided into 4 separate sections; the site

map is therefore divided into these 4 sections as well. Moreover, all subjects listed in the site map

are active links to that subject on the website.

Print/download version

A downloadable version of the published price information is recommended. Price information

can be updated or removed and in this way one can secure data (e.g. for price comparisons) at

different times. A downloadable version could include either individual search results or the entire

database (both is ideal). A print version is useful for the same reason and is also recommended.

Example

Two websites providing both a print and download format of the price information are those of

Lebanon (http://www.moph.gov.lb/Drugs/Pages/Drugs.aspx) and Morocco

(http://www.assurancemaladie.ma/anam.php?id_espace=6). For Lebanon a downloadable format

of the prices is accessible above the prices search engine, while for Morocco the downloadable

format is available below the prices search engine. Both websites also include a 'print screen'

feature in their searches box.

Links to other price reporting websites

Not all websites link to other price reporting sites, something that would be useful when

conducting international price comparisons. In particular, when sites have used other websites as

data sources, it is recommended that they publish links to these sources as a minimum.

In all cases it is recommended that websites link to the WHO listing of pricing websites

(http://www.who.int/medicines/areas/access/ecofin/en/index.html).

ExampleThe CEDD website was one of the few sites reporting links to other price reporting

websites. The useful links page (http://cedd.oep.hu/) featured links to drug price lists, drug prices

and other links (e.g. governmental and health organizations).


Recommendations for webmasters & database authors on medicine price

reporting

The comprehensiveness of the descriptive information accompanying price data is a major

criterion in the evaluation of websites, regardless of the website's primary objective and publisher.

Medicines listed by INN name

An International Nonproprietary Name (INN) is unique for each medicine and globally recognized.

The INN name of a medicine is the same in every country, while brand names differ per country.

As such, the use of INN names facilitates the identification of pharmaceutical substances and

thus facilitates international comparisons across different sources. Therefore it is strongly

recommended that pricing websites list medicines by their INN name (and not on the brand

name) in order to improve general user friendliness as well as the comparability of price

information.

Example

Three UK websites - eMIT (http://www.cmu.nhs.uk/Medicines/Generic/Pages/eMIT.aspx), Drug

Tariff for England&Wales (http://www.ppa.org.uk/ppa/edt_intro.htm) and Drug Tariff for Scotland

(http://www.isdscotland.org/isd/2246.html) list all medicines on INN name and not on brand name

to improve search ability and comparability.

Additional charges included in published price

Access to information on the add-on costs included in a price is important for achieving a fair

international price comparison.

Ex-factory and procurement prices should include INCO terms, and when insurance and freight

are included in the price their value should be specified (preferably in real amounts or a

percentage).

For wholesale prices it should be clear if logistic fees and taxes are included, and if so their value

should be specified (preferably in real amounts or a percentage).

For reimbursement and retail/patient prices it is important to know whether or not dispensing fees,

taxes (e.g. VAT/GST) and/or co-payments are included in the published price. If any of these are

included their value should be specified (preferably in real amounts or a percentage).

Example

The website of the Netherlands (www.medicijnkosten.nl) clearly lists that the price reported

includes VAT, but that a dispensing fee is not included. Although specifications are given on the

dispensing fee, the value of the included VAT is not specified on the website.

Exchange rate used

Clear information on the date of origin of the prices reported is not always available. This should

be published, as well as the US$ exchange rate at that time (weekly/monthly fluctuations).

Even if the price is reported in the countries' local currency, the US$ exchange rate at the time

the price information should be reported.


Example

The CEDD website reports prices in Euros (€); the exchange rate of € to the national currencies

of the Czech Republic, Hungary, Latvia, Lithuania, Norway, Poland and Slovakia at the date of

the price information are published on top of the price information. The exchange rate can be

adjusted manually and results in Euros will immediately be changed to this new exchange rate.


Recommendations for users of websites for price comparisons

For users of websites reporting medicine prices, some general recommendations are listed

below. As users can seek information on medicine prices for various reasons, and can come from

different backgrounds (e.g. country differences such as strong generic or originator market), it is

difficult to give specific recommendations on topics such as policy implications.

Price data collection

Medicines should be searched by their INN name to achieve a large sample size because, in

contrast to a brand name, this is a universal name and reported on many national and

international sites.

Website selection

National websites should be used for country price comparisons of a small selection of medicines

only, as comparing medicine prices across many different sources is very demanding (differences

in explanatory price information).

International multi-country source websites, such as the Hungarian CEDD website (European

comparisons (ex-factory, wholesale and retail prices)) and the MSH website (comparisons of

developing countries (non-profit procurement prices only)), should be used for price comparisons

consisting of more than 10 medicines.

The websites of international health organizations, such as MSF and WHO, should be used for

price comparisons of disease-specific medicines (e.g. antiretrovirals).

International price comparisons

In general, United States dollars (US $) are used for price comparisons between countries. This

study has shown that medicine prices are generally reported in the country's national currency

and an exchange rate to US $ is not reported.

One-on-one country comparisons

When conducting international comparisons of medicine prices, a currency should be chosen that

is used by many of the countries included in the analysis. For example, as most prices in Europe

are reported in Euros (€), this currency should be used in price comparisons across European

countries.

Price comparison using MSH reference prices

As MSH reference prices are reported in US $, this currency should be used for price

comparisons that include MSH prices. For optimal accuracy, a currency exchanger should be

used that provides exchange rates on a daily basis (in this study OANDA was used:

http://www.oanda.com/).


VIII - CONCLUSION Many publicly available websites reporting medicine prices are available on the internet from both

national and international sources. Most of these websites are fast and user-friendly, but they

often report different price information and lack key information to perform valid international price

comparisons. Actual price information can be compared across various price sources but the

seven medicine comparisons conducted in this study showed that this is very demanding work.

More extensive comparisons using all national websites would be even more demanding;

therefore, the use of international websites such as the Hungarian CEDD website should be

considered for price comparisons. Although a comparison of prices is also possible using a small

selection of national websites, a reasonable outcome can only be expected when using multiple

sites.

The usefulness of price comparisons is limited by the lack of comparability of price data across

sites. If a high number of price data points is available and a wide range in prices is observed, as

in this study, a conclusion based on this wide range would still be considered useful. While some

variation would be expected due to comparability issues, these alone would not account for large

scale price variation. However, when only a small range of price data points is available it is more

difficult to determine the potential influence of comparability issues on the results. Looking at the

price comparisons in general as well as their results it is surprising that although medicine price

information appears to be widely available on the internet, great variations in prices still exist.

Even within similar countries (e.g. similar WHO region and country income class) large price

variations were observed. The results of the Lipitor and Nexium price comparisons were equally

surprising, showing that generic therapeutic substitution is still not widely practiced.


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ANNEX I

Descriptive characteristics for websites reporting medicine prices

To classify the websites and the type of price information they contain, the following descriptive

characteristics will be used.

Source of website

o National: non-profit (e.g. government, non-governmental organizations)

o National: for-profit (e.g. wholesaler, health insurance)

o International: non-profit (e.g. multi-country databases, non-governmental organizations)

o International: for-profit (e.g. manufacturer)

General information

o Internet address (link)

o Country or organization behind the website (author)

o Basis for access (free to access?)

o Database or other format

o Languages available: national, English, French, Spanish

Type of price information

o Ex-factory / manufacturer

� INCO term

o Procurement

� INCO term

� taxes, duties and other charges included?

o Wholesale


o Reimbursement


� co-payment or without co-payment?

� dispensing fee included?

o Retail / Patient


� co-payment or without co-payment?

� dispensing fee included?


ANNEX II

NATIONAL MEDICINE PRICE SOURCES

COUNTRY TITLE WEBSITE Australia Schedule Pharmaceutical

Benefits http://www.pbs.gov.au/html/home

Austria The Common European Drug Database (CEDD)

http://cedd.oep.hu/

Bahrain Ministry of Health http://www.moh.gov.bh/EN/E-services/DrugPrices.aspx

Belgium Institut national d'assurance maladie-invalidité / Rijksinstituut voor ziekte- en invaliditeitsverzekering

http://www.inami.fgov.be/drug/fr/drugs/index.htm (2 databases accessible: reimbursement reference pricing and pharmaceutical specialties)

Brazil Banco de Precos Em Saude

http://bpreco.saude.gov.br/bprefd/owa/consulta.inicio

Canada Patented Medicine Prices Review Board (PMPRB)

http://www.pmprb-cepmb.gc.ca/english/view.asp?x=572

Canada Ontario Drug Benefit

Formulary / Comparative Drug Index

http://www.health.gov.on.ca/english/providers/program/drugs/odbf_mn.html

Czech Republic

State Institute for Drug Control

http://www.sifdc.eu/index.php?lang=2

Czech Republic

The Common European Drug Database (CEDD)

http://cedd.oep.hu/

Denmark Medicin priser http://www.medicinpriser.dk/

Finland The Common European Drug Database (CEDD)

http://cedd.oep.hu/

France L'assurance maladie - Base des Médicaments et Informations Tarifaires

http://www.codage.ext.cnamts.fr/codif/bdm_it/index_presentation.php?p_site=

France

Ministry of Health http://medicprix.sante.gouv.fr/welcome.do

France

Ameli l'Assurance Maladie (Reimbursement percentages)

http://www.ameli.fr/assures/soins-et-remboursements/combien-serez-vous-rembourse/medicaments-et-vaccins/remboursement-des-medicaments-et-tiers-payant/quels-remboursements-pour-vos-medicaments.php

Germany German DIMDI reimbursement prices

http://www.dimdi.de/static/en/amg/fbag/index.htm

Hungary The Common European Drug Database

http://cedd.oep.hu/

India National Pharmaceutical Pricing Authority

http://www.nppaindia.nic.in/prnotif2001/pr-not-ind-01.html

India Tamil Nadu Medical Services Corporation

http://www.tnmsc.com/

Iran Ministry of Health and Medical Education: Food and Drug Department

http://www.fdo.ir/Drug/Fa/Downloads/ShowSection.aspx?fid=11

Ireland The Common European Drug Database (CEDD)

http://cedd.oep.hu/

Italy L'Agenzia Italiana del farmaco (AIFA)

http://farmaco.agenziafarmaco.it/index.php

Jordan Jordan Food and Drug Administration (JFDA)

http://www.jfda.jo/barcode_java/index.jsp


COUNTRY TITLE WEBSITE Latvia The Common European

Drug Database (CEDD) http://cedd.oep.hu/

Lebanon Ministry of Public Health: Drugs Public Price List G

http://www.moph.gov.lb/Drugs/Pages/Drugs.aspx

Lithuania The Common European Drug Database (CEDD)

http://cedd.oep.hu/

Morocco Agence Nationale de L'assurance Maladie

http://www.assurancemaladie.ma/anam.php?id_espace=6&id_srub=19

Netherlands College voor Zorgverzekeringen (CVZ)

http://www.medicijnkosten.nl/

New Zealand The Pharmaceutical Management Agency (PHARMAC)

http://www.pharmac.govt.nz/healthpros

Norway The Common European Drug Database (CEDD)

http://cedd.oep.hu/

Norway

Statens legemiddelverket http://www.legemiddelverket.no/templates/InterPage____38824.aspx?filterBy=CopyToMedecs

Oman Ministry of Health http://www.moh.gov.om/nv_menu.php?fNm=pharma/internetprices.htm&SP=1

Poland The Common European Drug Database (CEDD)

http://cedd.oep.hu/

Portugal National Authority of Medicines and Health products) INFARMED

http://www.infarmed.pt/infomed/inicio.php

Portugal Guia dos Medicamentos Genéricos e Precos de Referència

http://www.infarmed.pt/genericos/menu.html

Slovakia The Common European Drug Database (CEDD)

http://cedd.oep.hu/

Slovenia The Common European Drug Database (CEDD)

http://cedd.oep.hu/

South Africa Department of Health http://www.doh.gov.za/docs/misc/asepi-f.html

South Africa Department of Health - Database of Medicine Prices

http://www.doh.gov.za/department/medic_prices-f.html

South Africa Treatment Action Campaign: Public sector ARV tender prices

http://www.tac.org.za/community/node/2027

Spain Agencia Espana de Medicamentos y Productos Sanitarios (AEMPS)

https://sinaem4.agemed.es/consaem/fichasTecnicas.do

Spain

Informacion de Medicamentos y Principios Activos

http://www.vademecum.es/

Sudan Federal Pharmacy and Poisons Board - Sudan Index

http://www.nmpb.gov.sd/drugsearch.php

Sweden The Dental and Pharmaceutical Benefits Agency (TLV)

http://www.tlv.se/in-english/

Tunisia La Pharmacie Centrale de Tunisie

http://www.phct.com.tn/fr/produits.php#

United Kingdom

Drug Tariff for Scotland http://www.isdscotland.org/isd/2245.html


COUNTRY TITLE WEBSITE United Kingdom

NHS Generic Pharmaceuticals electronic Market Information Tool (eMIT)

http://www.pasa.nhs.uk/PASAWeb/Productsandservices/Pharmaceuticals/

United Kingdom

NHS Dictionary of Medicines and Devices (DMD)

http://www.dmd.nhs.uk/dictionary

United Kingdom

British National Formulary (BNF)

http://bnf.org/bnf/index.htm

United Kingdom

National Health Service Drug Tariff for England and Wales

http://www.ppa.org.uk/ppa/edt_intro.htm

United States Department of Veterans Affairs

http://www.pbm.va.gov/ContractsAndAgreements.aspx

United States MEDICAID http://www.cms.hhs.gov/Reimbursement/

United States Kentucky MEDICAID Services

http://chfs.ky.gov/dms/maximum.htm

United States Centers for Disease Control (CDC) - Vaccine Price List

http://www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm

Detailed information on type of price information for some of the websites above can be found on the HAI medicine prices website! NATIONAL PRICE SOURCES http://www.haiweb.org/medicineprices/national-medicine-prices-sources.php


ANNEX IIIa

INTERNATIONAL MEDICINE PRICE GUIDES

ORGANISATION(S) TITLE WEBSITE Clinton Foundation Antiretroviral (ARV) price list http://www.clintonfoundation.org/what-we-

do/clinton-hiv-aids-initiative/information-center-resources

Global Fund to fight AIDS, TB & Malaria

Price & Quality Reporting (PQR)

http://www.theglobalfund.org/en/procurement/pqr/

Health Action International

Medicine Prices, Availability, Affordability & Price Components

http://www.haiweb.org/medicineprices/


WHO/HAI database of medicine prices, availability, affordability and price components

http://www.haiweb.org/GlobalDatabase/

International Trade Centre / World Health Organization

The market news service for pharmaceutical starting materials

http://www.intracen.org/mas/mns.htm

Management Sciences for Health

International drug price indicator guide

http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=DMP&language=English

Médecins Sans Frontières

Untangling the web of antiretroviral price reductions

http://utw.msfaccess.org/

Insurance Fund Administration of Hungary

European Drug Database (CEDD)

http://cedd.oep.hu/

WHO Western Pacific Region

Price Information Exchange (PIE) for selected medicines

http://piemeds.com/

Österreichisches Bundesinstitut für Gesundheitswesen (OBIG) (Austria)

Pharma price information (PPI) http://www.goeg.at/en/PPI

AIDS Medicines and Diagnostics Service (AMDS) (WHO)

Global Price Reporting Mechanism (GPRM)

http://www.who.int/hiv/amds/gprm/en/index.html

WHO / UNICEF / Roll Back Malaria Partnership / Management Sciences for Health / Population Services International

Sources and prices of selected products for the prevention, diagnosis and treatment of malaria

http://www.who.int/medicines/areas/access/AntiMalariaSourcesPricesEnglish.pdf

WHO AFRO Essential medicines price indicator

http://www.afro.who.int/en/divisions-a-programmes/dsd/essential-medicines.html

WHO, PAHO PAHO Strategic Fund reference prices

http://new.paho.org/hq/index.php?option=com_content&task=view&id=1042&Itemid=988

WHO, UNICEF Sources and prices of selected medicines for children

http://www.unicef.org/supply/files/Sources_and_prices_of_selected_medicines.pdf

Detailed information on type of price information for some of the websites above can be found on the HAI medicine prices website! MULTI-COUNTRY PRICE SOURCES http://www.haiweb.org/medicineprices/international-medicine-prices-sources.php


ANNEX IIIb

INTERNATIONAL MEDICINE PRICELIST SOURCES

ORGANISATION(S) TITLE WEBSITE Action Medeor Deutsches Medikamenten-

Hilfswerk http://gb.medeor.org/Professionals/Products/New-Price-Indicator.html

Action Medeor International Healthcare

Not-for profit procurement agency in Tanzania

http://www.medeor.org/Professionals/medeor-Tansania/Medikamenten-Hilfe

Durbin PLC International sales - Medical supplies

http://www.durbin.co.uk/exports_catalogue.htm

Global Drug Facility (tuberculosis)

Product catalogue http://www.stoptb.org/gdf/drugsupply/drugs_available.asp

IDA Foundation Web catalogue http://www.idafoundation.org/we-offer/web-catalogue.html (login!!)

IDA HIV/AIDS Group Web catalogue http://www.idafoundation.org/we-offer/web-catalogue/category/hivaids-related-products.html (login!!)

Joint Medical Stores Private-not-for profit NGO http://www.jms.co.ug/downloads.html Detailed information on type of price information for some of the websites above can be found on the HAI medicine prices website! MULTI-COUNTRY PRICE SOURCES http://www.haiweb.org/medicineprices/international-medicine-prices-sources.php


ANNEX IV Qualitative Country Annex

African Regional Office (AFRO) SOUTH AFRICA

- www.doh.gov.za/docs/misc/asepi-f.html

Website accessed on 29-04-2010

Source of website

o National: non-profit

� Department of Health

General information

o Country or organization behind the website

� South Africa, Ministry of Health

o Basis for access

� free to access, no registration


� downloadable excel pricelist, individual list for every manufacturer (ZIP files)

o Languages available

� English

Country: South Africa Website: www.doh.gov.za/docs/misc/asepi-f.html Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x

No undesired advertisements x � Combined score user-friendliness 2


Last update website, site maintenance x Last update price information x � Combined score update 0

Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 2 Accessibility of information

Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1


Download time at 56 K 2

Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: start screen on homepage does not have a clear layout with all the different formats and colors, but this page changes into a screen with a clear layout after one click; * Update: no information available on date of creation of website or on last update of website, price lists manufacturers last updated on 06-10-2009; * Site map/search: useful search engine, a search on INN name links to documents with prices listed and to documents with background information, but no site map available on site; * Search within prices: prices are listed in A-Z listing on manufacturer name and not on INN name, no quick scanning of documents possible, difficult to compare prices of the same product between different manufacturers;


* Download/print version: no print version available, downloadable ZIP files with prices; * Author information: disclosure of source and contacts of employees of Ministry of Health on website, furthermore a document containing the 'Reference Price List 2009 Statement' is posted above downloadable documents and contains direct contact information to responsible author; * Links: useful national links (incl provincial health websites), international links, specific links on HIV/AIDS topics, but no links to other price reporting websites; * Additional price information: following prices (or components) are shown: - new increased ex-manufacturers price (excl VAT) - new logistics fee (excl VAT) - value added tax (VAT) � specified amount, not percentage - new single exit price (SEP), after the increase (incl VAT) - unit price � price per tablet, per ml, … INDICATIVE! South Africa - Manufacturer lists


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size / Unit INCO term X Logistics fee listed (specified

amount per medicine) but not which INCO term is used

Exchange rate (if not national currency) NA NA South African Rand (ZAR) = National currency

Date of price information X 05-02-09 t/m 30/09/09 Price type X Reference price list, individual list

for each manufacturer Quality X Pharmacopoeial specifications X


SOUTH AFRICA

- www.doh.gov.za/department/medic_prices-f.html


Source of website


� Department of Health

General information


� South Africa, Ministry of Health

o Basis for access



� downloadable excel pricelist


� English

Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation x








Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: start screen on homepage does not have a clear layout with all the different formats and colors, but this page changes into a screen with a clear layout after one click; * Update: no information available on date of creation of website or on last update of website, price lists manufacturers last updated on 22-04-2010; * Site map/search: useful search engine, a search on INN name links to documents with prices listed and to documents with background information, but no site map available on site; * Search within prices: prices are listed in individual documents for every manufacturer, not clear which manufacturer produces which medicines and no option to find out besides downloading all documents and manually checking for medicines; * Download/print version: no print version available, downloadable ZIP document with prices; * Author information: disclosure of source and contacts of employees of Ministry of Health on website, furthermore a document containing the 'Call for submissions on the schedule of medicine prices' is posted in same window as price document and contains direct contact information to responsible author; * Links: useful national links (incl provincial health websites), international links, specific links on


HIV/AIDS topics, but no links to other price reporting websites; * Additional price information: following prices (or components) are shown: - new increased ex-manufacturers price (excl VAT) - new logistics fee (excl VAT) - value added tax (VAT) � specified amount, not percentage - new single exit price (SEP), after the increase (incl VAT) - unit price � price per tablet, per ml, … South Africa - Medicine price list


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size / Unit INCO term X Logistics fee listed (specified

amount per medicine) but not which INCO term is used

Exchange rate (if not national currency) NA NA South African Rand (ZAR) = National currency

Date of price information X 05-02-09 t/m 30/09/09 Price type X Actual prices, exclusive of logistics

fee and VAT Quality X Pharmacopoeial specifications X South Africa - Medicine price list

Wholesaler price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size / Unit Volume X Exchange rate (if not national currency) NA NA South African Rand (ZAR) =

National currency Date of price information X Price type X Actual prices, including logistics

fee and VAT(amounts specified) Taxes & duties & other charges X Logistics fee and VAT included

(amount specified)


SOUTH AFRICA

- www.tac.org.za/community/node/2027


Source of website


� Treatment Action Campaign (TAC)

General information


� South Africa, Treatment Action Campaign (TAC)

o Basis for access



� downloadable excel pricelists; public sector antiretroviral tender prices, private sector

antiretroviral (and other) single exit prices


� English






Number of clicks to access price information x Search ability within price information x Download / print version price information x x � Combined score accessibility of information 1/1.3



Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: no information available on date of creation of website or on last update of website, public sector antiretroviral tender price list is valid until 31-05-2010 (24 month contract), private sector antiretroviral (and other) single exit prices updated weekly; * Site map/search: site map available on site, but no useful search engine (no search on INN name possible); * Search within prices: prices are listed in A-Z index according to INN name, but no search option within ZIP document or online prices list; * Download/print version: private sector single exit medicine prices are available online, as a print version and in a download version; public sector price list is only available in print version; * Author information: disclosure of source and contacts of employees of TAC on website contains direct contact information to responsible author; * Links: useful national links (most link to a topic on TAC site), but no links to other price reporting websites;


* Important note: People in South Africa obtain medicines either through the public health system or from private dispensing doctors and pharmacies. - Public health system: patients receive medicines for free but have to put up with extraordinarily long queues and inconsistent service. The state buys medicines for the public sector, usually but not always via a tender process. - Private sector: patients are usually insured by a medical scheme to which they pay a monthly premium. Pharmaceutical companies sell medicines at a single exit price to the private sector. South Africa - Antiretrovirals - Public sector tender prices


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X INCO term X Supplier X Volume purchased X Minimum purchase order Purchase terms X Payment terms / timelines X Date of price information X Tender prices: contract valid 01-

06-08 until 31-05-10 Date of procurement award X Exchange rate at time of award X South African Rand (ZAR) =

National currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Prices including VAT (14%) South Africa - Antiretrovirals - Private sector single exit prices


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Volume X Price per volume Exchange rate (if not national currency) NA NA South African Rand (ZAR) =

National currency Date of price information X 26-04-10 (weekly updated) Price type X Single exit price (actual prices),

excluding or including VAT Taxes & duties & other charges X Price with and without VAT listed


ANNEX V Qualitative Country Annex

The Americas Regional Office (AMRO)

BRAZIL

- http://bpreco.saude.gov.br/bprefd/owa/consulta.inicio

Website accessed on: 19-04-2010

Source of website

o National: for-profit

� Banco de Preços em Saude

General information


� Brazil, Ministry of Health

o Basis for access



� searchable internet database


� Portuguese, Spanish, English






Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1.3



Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website in general, prices last updated in 2008; * Site map/search: no site map available on website, search engine provides search on item type (medicines, hospital medical equipment, medicinal gases, nutrition - food, health services) but no search by INN name possible; * Search within prices: database listed as an A-Z index by INN name, classification, institution, or as a report with minimum and maximum prices; * Download/print version: no download or direct print version available; * Author information: no background information (not even general information on Ministry of Health), no contact information listed (not even general contact information); * Links: no useful links, not even a link to the main page of Ministry of Health, nor links to other price reporting sites;


Brazil


INN name & dosage form & strength X Brand name & manufacturer X X Brand name listed,

manufacturer name not listed Packaging specifications & size X INCO term X Supplier X Volume purchased X Total quantity purchased Purchase terms X Payment terms / timelines X Date of price information X Variable dates: 2006 to 2008 Date of procurement award X Exchange rate at time of award X Prices can be shown in

Brazilian Real, Dollar Quality X Pharmacopoeial specifications X Taxes & duties & other charges X


CANADA

- http://www.pmprb-cepmb.gc.ca/english/view.asp?x=572


Source of website


� Patented Medicine Prices Review Board (PMPRB)

� Conseil d' Examen du Prix des Médicaments Brevetés (CEPMB)

General information


� Canada, PMPRB is part of the Health Portfolio but operates independently from the

Ministry of Health

o Basis for access



� A-Z index with new patented drugs, individual documents (per drug)


� English, French









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: price information is collected during introductory period just after receiving patent, therefore different price data, but most data from several years ago; * Site map / Search: no site map available, search options by INN name and by brand name; * Search within prices: easy to access A-Z index of all patented medicines in Canada; * Download/print version: download version available per medicine, not one database list; * Links: none available on the website; * Consumer Price Index (CPI)-Adjustment factors for 2010: To allow patentees to set prices in advance, the Board´s CPI-Adjustment Methodology provides for the calculation of the CPI-Adjustment factors based on forecast changes in the CPI. The Board informs patentees on an annual basis of the CPI-adjustment factors for future pricing period. * Exchange rates for International Price Comparisons: The methodology for calculating exchange


rates for purposes of the PMPRB´s International Price Comparisons is described in Schedule 3 of the Compendium of Guidelines, Policies and Procedures.(http://www.pmprb-cepmb.gc.ca/english/view.asp?x=137&mid=1066) Existing Drug Products "The simple average of the monthly average noon spot exchange rates for each country for the 36-month period ending December 2009 will be used in the review of prices for existing medicines in the second half of 2009. The international prices of an existing drug product for the period January to December 2009 can be converted to Canadian currency for comparison purposes by multiplying the local currency price in each country by the corresponding simple average exchange rate." New Drug Products "The simple average of the monthly average noon spot exchange rates for each country for the 36-months period ending four months before the date of the first sale of the drug product. e.g.: A new drug product first sold in Apr 2007, the exchange rates used are Apr 2007 including four months before the date of the first sale of the drug product as per Guidelines."

Canada - Patented Medicine Prices Review Board Reimbursement price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Originator brand listed Packaging specifications & size X Exchange rate (if not national currency) NA NA Canadian dollar (CA$) =

national currency Date of price information X Variable price dates: price

dependent on patent of medicine (start and end date)

Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X


CANADA

- www.health.gov.on.ca/english/providers/program/drugs/drugs_program_mn.html


Source of website


� Ontario Public Drug Programs

General information


� Canada, Ontario Ministry of Health and Long-Term Care

o Basis for access





� English, French




Last update website, site maintenance x Last update price information x � Combined score update 1.5


Number of clicks to access price information

x

Search ability within price information x Download / print version price information x � Combined score accessibility of information

1.7



Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting

sites 1

* Update: prices in Ontario Drug Benefit Formulary/Comparative Drug Index effective from 02-03-2010, prices last updated on 13-04-2010; * Site map/search: site map button links to another site, but there's no sitemap on this homepage (www.health.gov.on.ca) and no additional information on Ontario Drug Benefit (ODB) program; search by INN name, by brand name or by DIN/PIN code is possible; * Search within prices: search by INN name, by brand name or by DIN/PIN code possible; * Download/print version: full text of formulary edition 41 (January 2008), all 20 updates (last update effective 23-04-2010) available for download in pdf and excel files; no print version; * Author information: direct link to email address for authors Ontario Public Drug Programs; * Links: useful links to provincial government sites, federal government sites, both national and international health-related sites, but none to other price reporting sites;


* Conditions for payment of a Dispensing Fee under the ODB Program: In order to receive payment of a dispensing fee under the ODB Program, the dispenser must supply at one time the lesser of : a. the entire quantity of the listed drug product that is specified on the prescription to be dispensed at one time; or b. the maximum quantity permitted under section 18 of the ODBA Regulation 1 (“Maximum Quantity”). 1 For most ODB recipients, the maximum quantity would be a supply sufficient for a 100-day course of treatment; for ODB recipients who are eligible for benefits under the Ontario Works program, the maximum quantity is a 35-day supply; and in the case of medications to which the Trial Prescription Program applies, the maximum quantity for which the EO is required to pay is a quantity sufficient for 30 days. http://www.health.gov.on.ca/english/providers/program/drugs/odbf/odbf_conditions_for_payment.html "In other words, the dispenser is required to dispense at one time the Maximum Quantity unless the prescriber has directed that a smaller quantity be dispensed. In cases where the prescriber has directed the dispensing of a reduced quantity (i.e. less than the Maximum Quantity), the ministry will provide payment for a maximum of two (2) dispensing fees per medication per recipient per calendar month." Canada - Ontario Public Drug Programs


INN name & dosage form & strength X Incl. formulary listing date Brand name & manufacturer X Packaging specifications & size X Exchange rate (if not national currency) NA NA Canadian dollar (CA$) =

national currency Date of price information X Prices effective from 02-03-

2010; price section updated on 13-04-2010 but unclear what has been updated

Taxes & duties & other charges X Price incl. co-payments X Drug benefit price listed

(patient price) and amount that Ministry reimburses (difference is co-payment)

Price incl. dispensing fee X


UNITED STATES

- http://www.pbm.va.gov/ContractsAndAgreements.aspx


Source of website


� Pharmacy Benefits Management Services (PBM)

General information


� United States, Department of Veterans Affairs

o Basis for access



� downloadable excel document containing prices for all schemes


� English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: last update website 28-04-2010, price list valid until 30-06-2010; * Site map/search: site map available on website, search engine provides advanced search option, search by INN name possible, however this only shows background materials and no links to price information; * Search within prices: database only available in downloadable excel document, no search option within document (random alphabetical order); * Download/print version: download version of database, but no direct print version available; * Author information: detailed background information on PBM Services and on differences between pricelists, direct contact information to prices author listed; * Links: no useful links nor links to other price reporting sites;


United States - Pharmacy Benefits Management Services Procurement price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Package size INCO term X Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Contract until 30-06-2010 Date of procurement award X Exchange rate at time of award NA NA American dollar (US$) =

national currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X


UNITED STATES

- http://www.cms.gov/Reimbursement/01_Overview.asp#TopOfPage


Source of website


� Centers for Medicare & Medicaid Services (CMS)

General information


� United States, Department of Health & Human Services

o Basis for access



� downloadable document with federal upper limits (FUL)


� English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: website in general last updated on 02-04-2010 (cms.hhs.gov changed to cms.gov on this date), last update price information 25-09-2009; * Site map/search: no site map available on website, search engine provides search by INN name possible, however this only shows background materials and no links to price information; * Search within prices: database only available in downloadable pdf document, no search option within document (A-Z listing on INN name); * Download/print version: download version of database, but no direct print version available; * Author information: detailed background information on CMS Services and about Medicaid, direct contact information to prices author listed; * Links: no useful links nor links to other price reporting sites; * Additional Information: Medicaid Prescription Reimbursement Information by State – Quarter Ending March 2010 http://www.cms.gov/Reimbursement/Downloads/reimbursementchart1q2010.pdf


United States - Centers for Medicare & Medicaid Services Reimbursement price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size Exchange rate (if not national currency) NA NA American dollar (US$) =

national currency Date of price information X 25-09-2009 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X


UNITED STATES

- http://chfs.ky.gov/dms/maximum.htm


Source of website


� Kentucky Department for Medicaid Services

General information


� United States, Kentucky Cabinet for Health and Family Services

o Basis for access



� downloadable pricelist in pdf document


� English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites * Update: website in general last updated on 20-04-2010 (cms.hhs.gov changed to cms.gov on this date), last update price information April 2010; * Site map/search: site map available on website, search engine provides advanced search, but no search by INN name possible; * Search within prices: database only available in downloadable pdf document, no search option within document (A-Z listing on INN name); * Download/print version: download version of database, but no direct print version available; * Author information: detailed background information on CMS Services and about Medicaid, direct contact information to prices author listed; * Links: useful national and international links, but no links to other price reporting sites;


United States - Kentucky Department for Medicaid Services Reimbursement price YES NO SPECIFICATIONS

INN name & dosage form & strength X Generic names only Brand name & manufacturer X Packaging specifications & size X Price per dosage unit Exchange rate (if not national currency) NA NA American dollar (US$) =

national currency Date of price information X 04-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X


UNITED STATES

- http://www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm


Source of website


� Centers for Disease Control and Prevention (CDC) Vaccine Price List

General information


� United States, Department of Health and Human Services

o Basis for access





� English, Spanish (only CDC homepage, not price list)

� website front can also change to the following languages (menu options and a

selection of information in this language, but not all menu options available): Chinese,

French, Russian, Portuguese, German, Italian, Vietnamese, Haitian Creole, Korean,

Tagalog (Filipino)









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: website last updated on 07-04-2010, last update price information 23-04-2010; * Site map/search: site map available on website and A-Z index with all contents, search on INN name in this case not applicable because only vaccine names are listed, a search on vaccine name is possible and search results include background articles and a link to the price database; * Search within prices: database only available online, no search option within prices, vaccines grouped into 4 categories: pediatric/vfc vaccines, adult vaccines, pediatric influenza vaccines, adult influenza vaccines, A-Z listing within categories on vaccine name; * Download/print version: no download version nor print version available;


* Author information: disclosure of source, but no direct contact information to prices author; * Links: useful national and international links on specific health topics, but no links to other price reporting sites; United States – Vaccine Price List


INN name & dosage form & strength X X Vaccine name listed Brand name & manufacturer X Packaging specifications & size X Package size INCO term X Supplier X CDC = supplier Volume purchased X Packaging volume Purchase terms X Payment terms / timelines X Date of price information X 23-04-2010 Date of procurement award X Exchange rate at time of award NA NA American dollar (US$) =

national currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X X Federal excise tax specified

per vaccine


ANNEX VI Qualitative Country Annex

Eastern Mediterranean Regional Office (EMRO)

BAHRAIN

- http://www.moh.gov.bh/EN/E-Services/DrugPrices.aspx


Source of website


� Ministry of Health

General information


� Bahrain, Ministry of Health

o Basis for access





� Arabic, English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: last update website not clear, bottom of page: 16-08-2009, web analytic report shows last update 01-04-2010; no specific information available on date or update of price information; * Search: search engine available on website, but search by INN name not possible; * Search ability within prices: A-Z search index, but on brand/product name and not on INN name; * Author information: disclosure of source and specific contact information for different services; * Links: useful links to both Bahrain and international websites, but no price reporting links;


BAHRAIN Retail / Patient price YES NO SPECIFICATIONS

INN name & dosage form & strength

X X No INN name listed

Brand name & manufacturer X Manufacturer, country of origin and supplier in Bahrain listed

Exchange rate (if not national currency)

NA NA Bahraini Dinar = national currency

Date of price information X Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X


IRAN

- http://www.fdo.ir/Drug/Fa/Downloads/ShowSection.aspx?fid=11


Source of website


� Ministry of Health and Medical Education - Food and Drug Department

General information


� Iran, Ministry of Health and Medical Education

o Basis for access





� Arabic, partly in English









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website in general (date of copyright 2005), but last update price information February 2010; * Site map/search: no site map, no search on INN name possible in general search engine; * Search within prices: search options within database by INN name, by code, by price or by date; * Download/print version: no download version available, but print option for individual search results by clicking them; * Author information: disclosure of source, information on Ministry of Health and their contact information, but no direct contact information to prices author; * Links: some links available to university or governmental websites, but no links to other price reporting websites;


Iran

Retail / Patient price YES NO SPECIFICATIONS

INN name & dosage form & strength X X Brand name or INN name (generic products) listed

Brand name & manufacturer X X Brand name or INN name (generic products), no manufacturer listed

Exchange rate (if not national currency) NA NA Iranian Rial = national currency Date of price information X Persian calendar: prices 2008

or 2009 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X


JORDAN

- www.jfda.jo/barcode_java


Source of website


� Jordan Food and Drug Administration (JFDA) - Barcode Project

General information


� Jordan, Royal Scientific Society & Jordan Pharmaceutical Association

o Basis for access

� free to access, registration required (guest account provided)




� Arabic, English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website in general, prices last updated in 2008; * Site map/search: no site map available on website, search engine provides search on item type (medicines, hospital medical equipment, medicinal gases, nutrition - food, health services) but no search by INN name possible; * Search within prices: search medicines by INN name, trade name, medicine code, store name, manufacturer, bar code, ATC code; * Download/print version: no download or direct print version available; * Author information: no background information (not even general information on JFDA), no contact information listed (not even general contact information); * Links: links to Royal Scientific Society and Jordan Pharmaceutical Association, but no direct link to the main page of Jordan Food and Drug Administration, nor links to other price reporting sites;


Jordan – Pharmacy price Wholesaler price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Box size listed Volume X Price per box Exchange rate (if not national currency) NA NA Jordanian Dinar = national

currency Date of price information X Price type X Taxes & duties & other charges X Jordan – Public price Retail / Patient price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Jordanian Dinar = national

currency Date of price information X Taxes & duties & other charges X Public taxed price listed, but no

specification of amount Price incl. co-payments X Price incl. dispensing fee X


LEBANON

- http://www.moph.gov.lb/Drugs/Pages/Drugs.aspx


Source of website


� Ministry of Public Health

General information


� Lebanon, Ministry of Public Health

o Basis for access

� free to access, registration required to access additional information on price

conversions of imported medicines (anyone can register, but you need additional

permission to access the documents)




� English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: menu options in panel on the left, subcategories per menu option open next to menu panel, logical presentation; * Update: site daily updated, last update price information 27-03-2010; * Site map/search: both are available on the website and searches are possible by brand name (originator) and INN name, however search results are not combined: e.g. search term amoxicillin only provides generics, while search term amoxil only shows the originator brand; * Basis for access: no access fee or registration required to access price information, but registration is required to access additional information such as exchange rates used on imported pharmaceuticals, furthermore special permission is necessary; * Download/print version: a download version of the database is available in the search screen and the search engine is also provided with a button to make a 'print screen' of the displayed


table with search results, however this print does not show some of the additional information that's only available when scrolling over search results (registration number, strength, packsize, dosage form, pharmacist margin); * Author information: full disclosure of source per department and direct contact information to 'service of pharmacy' the department responsible for the database on medicine prices; * Links: some useful links, national and international, but no links to other pricing websites; Lebanon Retail / Patient price YES NO SPECIFICATIONS

INN name & dosage form & strength X X Brand name or INN name (generic products) listed

Brand name & manufacturer X Both and country of origin Exchange rate (if not national currency)

NA Lebanese Pound = national currency

Date of price information X 27/03/2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X Pharmacist margin included,

amount specified for each product


MOROCCO

- http://www.assurancemaladie.ma/anam.php?id_espace=6&id_srub=19


Source of website


� Agence Nationale de l'Assurance Maladie (ANAM)

General information


� Morocco, National Agency of Health Insurance

o Basis for access





� French









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information available on last update of site in general (date of creation 2006), price information is dated on 16-04-2010; * Site map/search: both a site map and an useful search engine are available on the website, searches can be performed by medicine name (only originator), by therapeutic class or by DCI (Dénominations Communes Internationales; generic name). Very good feature: below search box examples that match your search term are shown (useful tool in site of e.g. type errors, name differences between countries); * Search within prices: clicking on search results within the table links to another table with all possible hits on INN name (all brands, generic and originator); * Download/print version: a download version of the database is available from the search engine and the search engine is also provided with a button to make a 'print screen' of the displayed table with search results (all details shown); * Author information: disclosure of source and additional information on projects, but no direct contact information for database author (only contact information ANAM in general);


* Links: useful links, national and international, to governmental sites and those of health authorities, but no links to other pricing websites; Morocco Reimbursement price YES NO SPECIFICATIONS


X

Brand name & manufacturer X Packaging specifications & size X Presentation: box, bottle, etc. Exchange rate (if not national currency)

NA NA Moroccan Dirham = national currency

Date of price information X 24/02/2010 Taxes & duties & other charges X Price incl. co-payments X Reimbursement price listed next

to retail/patient price � difference is co-payment

Price incl. dispensing fee X Morocco Retail / Patient price YES NO SPECIFICATIONS


X

Brand name & manufacturer X Exchange rate (if not national currency)

NA NA Moroccan Dirham = national currency

Date of price information X 24/02/2010 Taxes & duties & other charges X Price incl. co-payments X Reimbursement price listed next

to retail/patient price � difference is co-payment



OMAN

- http://www.moh.gov.om/nv_menu.php?fNm=pharma/internetprices.htm&SP=1


Source of website


� Ministry of Health

General information


� Sultanate of Oman, Ministry of Health

o Basis for access





� Arabic, English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information available on last update of website in general, database with prices is dated on 17-04-2010; * Site map/search: site map available on website as well as a search box, but no searches possible (search not operating); * Download/print version: no download version available, search results with prices and additional information can be printed per individual product (no print version of complete search/database); * Author information: disclosure of source, detailed information on Ministry of Health and their projects and mission statement, and detailed contact information for hospitals, pharmacies and sub-divisions of the Ministry of Health; * Links: links are available on home page to other departments of government and important international organizations (e.g. WHO, UNICEF, EMRO), also list of Ministries of Health at Gulf Countries Council included, but all broken links, no links to other price reporting websites;


Oman Retail / Patient price YES NO SPECIFICATIONS


X


NA NA Omani Rial = national currency

Date of price information X 17/04/2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X Amount not specified


SUDAN

- www.nmpb.gov.sd/drugsearch.php


Source of website



� National Medicines & Poisons Board - Sudan Index 2009

General information


� Republic of Sudan, National Medicines & Poisons Board (NMPB)

o Basis for access





� Arabic, English









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 * Clear layout: start screen webpage is search box with some additional information on content of the database above this search box (only in Arabic); * Update: no information available on last update of website in general, database shows a directory with prices of patented drugs in Sudan until the end of 2009 (12-2009); * Site map/search: no site map available, website only consists of search engine and database; * Search within prices: search engine provides search by: INN name, brand name, country of origin, manufacturer, sales agent in Sudan; * Download/print version: no download or print version available of database or search results; * Author information: disclosure of source, but no specific contact information for prices author; * Links: no links available on website, not even a link to main webpage of NMPB; * Additional information: The Sudan Index 2009 lists entry prices into the country for medicines imported from abroad and for national pharmaceutical manufacturers it lists the retail price to the


public (both prices are procurement). * Important note: all prices are listed in different currencies, this makes it hard to compare between companies and countries of origin (even different currencies within countries) � currencies used: SDG (Sudanese Pound), AED (United Arab Emirates Dirham), $ (US? Canadian? Australian?), € (Euro), SR Sudan Procurement price YES NO SPECIFICATIONS


X

Brand name & manufacturer X Both and country of origin Packaging specifications & size X Packsize listed INCO term X Supplier X Agent in Sudan Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 2009, but not further specified Date of procurement award X Exchange rate at time of award X Different currencies used

(depending on country of origin) Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Additional information: The Sudan Index 2009 lists entry prices into the country for medicines imported from abroad and for national pharmaceutical manufacturers it lists the retail price to the public (both prices are procurement). Important note: all prices are listed in different currencies, this makes it hard to compare between companies and countries of origin (even different currencies within countries) � currencies used: SDG (Sudanese Pound), AED (United Arab Emirates Dirham), US$, €


TUNISIA

- http://www.phct.com.tn/fr/produits.php


Source of website



� La Pharmacie Centrale de Tunisie - la santé d'abord

General information


� Tunisia, Ministry of Public Health

o Basis for access





� Arabic, French









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: last update website in general 20-04-2010, but no information available on last update price information; * Site map/search: no site map, nor general search engine available on website; * Search within prices: search options within database by INN name, by manufacturer, by therapeutic class of the drug; * Download/print version: no download version available, but print option for individual search results by clicking them; * Author information: disclosure of source, information on Ministry of Health and PHCT specific information, contact information for all different departments available; * Links: some links available to national health or governmental websites, but no links to other price reporting websites;


Tunisia Retail / Patient price YES NO SPECIFICATIONS


X


NA NA Tunisian Dinar = national currency

Date of price information X Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X


ANNEX VII Qualitative Country Annex

European Regional Office (EURO)

AUSTRIA

- http://cedd.oep.hu/


Source of website


� Main Association of Austrian Social Security Institutions

General information


� Hungary, National Health Insurance Fund Administration of Hungary

o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 01-03-2010; * Site map / Search: both give the option to search by country or by ATC code * Author information: only mentioned that the Main Association of Austrian Social Security Institutions contributed and a link to their website, but no additional information or direct contact information for Austrian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in German, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date


(meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP. Austria



manufacturer not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-03-2010 Price type X Quality X Pharmacopoeial specifications X Austria



manufacturer not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit of package Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-03-2010 Price type X Taxes & duties & other charges X Austria



manufacturer not listed Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-03-2010 Taxes & duties & other charges X VAT = 10% Price incl. co-payments X Price incl. dispensing fee X


BELGIUM

- www.riziv.fgov.be / www.inami.fgov.be


Source of website


� Rijksinstituut voor ziekte- en invaliditeitsverzekering (RIZIV)

� Institut national d'assurance maladie-invalidité (INAMI)

General information


� Belgium, Ministry of Social Affairs

o Basis for access



� two searchable internet databases: reimbursement reference pricing and

pharmaceutical specialties


� French, Dutch









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Unclear layout: pull-down tabs for different categories, not easy to see what to find where; * Update: website updated every day, update price information at beginning of each new month; * Download/print: option to print table that lists search results on price information; * Author information: disclosure of source and specific contact information for different services; * Links: useful links to both Belgian and international websites, but no price reporting links;


Belgium Ex-factory price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X X Packaging specifications & size X Pack size listed for every price INCO term Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 01-04-2010 Price type Quality Pharmacopoeial specifications Belgium


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size listed for every price Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT = 6%, included in price Price incl. co-payments X Price ceiling is maximum price

reimbursed ('remgeld'), difference with pack price is co-payment

Price incl. dispensing fee X Belgium


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT = 6%,included in price Price incl. co-payments X Seperate column Price incl. dispensing fee X


CZECH REPUBLIC

- http://www.sukl.cz


Source of website


� State Institute of Drug Control of the Czech Republic

General information


� Czech Republic, State Institute of Drug Control

o Basis for access





� Czech and partly in English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, price information updated every month; * Site map / Search: site map available in Czech and English, useful general search engine but search results do not include price database, however very useful search engine for medicinal products database (search in Czech and English); * Download/print:no direct print option, database is available in a downloadable excel format; * Author information: full disclosure of source, general and price database specific contact information available on website; * Links: useful links to SUKL partners, including links to other price reporting websites; * Price database: Price information online available in English, download format is only available in Czech, however an explanatory document to translate Czech words used in the excel sheet is available in a download file as well;


Czech Republic – State Institute of Drug Control Ex-factory price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Both listed unless generic Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X Czech Koruna (CZK) =

national currency Date of price information X 31-09-2010 Price type X Price ceiling, maximum ex-

factory price Quality X Pharmacopoeial specifications X Czech Republic – State Institute of Drug Control


INN name & dosage form & strength X Brand name & manufacturer X Both listed unless generic Packaging specifications & size X Pack size listed for every price Exchange rate (if not national currency) NA NA Czech Koruna (CZK) =

national currency Date of price information X 31-09-2010 Taxes & duties & other charges X Price incl. co-payments X Difference between

reimbursed amount and rough patient price is co-payment

Price incl. dispensing fee X Czech Republic – State Institute of Drug Control


INN name & dosage form & strength X Brand name & manufacturer X Both listed unless generic Exchange rate (if not national currency) X Czech Koruna (CZK) =

national currency Date of price information X 31-09-2010 Taxes & duties & other charges X Rough payment listed, taxes

not included Price incl. co-payments X Difference between

reimbursed amount and rough patient price is co-payment

Price incl. dispensing fee X Orientation payment and regulatory fee listed


CZECH REPUBLIC



Source of website


� State Institute of Drug Control of the Czech Republic

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-04-2009; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the State Institute of Drug Control of the Czech Republic contributed and a link to their website, but no additional information or direct contact information for Czech price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Czech, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Czech Republic



manufacturer name not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X € 1.00 = CZK 26.523

(adjustable on website to date of access)

Date of price information X 02-04-2009 Price type X Quality X Pharmacopoeial specifications X Czech Republic



manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = CZK 26.523


Date of price information X 02-04-2009 Taxes & duties & other charges X VAT = 9% Price incl. co-payments X Price incl. dispensing fee X


DENMARK

- www.medicinpriser.dk


Source of website


� Lægemiddelstyrelsen

General information


� Denmark, Danish Medicines Agency

o Basis for access





� Danish, English







Speed search page


Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: prices are updated every fortnight and reimbursements are updated daily; * Site map: only on Danish Medicines Agency site, but includes detailed site map of pricing site; * Author information: not specific for medicine pricing site; * Links: useful links on Danish Medicines Agency website, but no links to pricing sites; * Important note: Medicinpriser.dk is a theme site of the Danish Medicines Agency, although both have a different web link the site medicinpriser.dk is situated in the general website frame of the Danish Medicines Agency (www.dkma.dk). This way site map, contact information and more is still easy to access from medicinpriser.dk (within 5 mouse clicks).


* Conversion from pharmacy purchase price (AIP) to consumer price (ESP): http://www.dkma.dk/1024/visUKLSArtikel.asp?artikelID=9016 (all in Danish Krones (DKK)) � Dispensing fee: excluding VAT=DKK 8.00 and including VAT=DKK 10.00. � Conversion formula AIP to ESP: ESP = 10.00 + 1.25 x (AIP + 0.083 x AIP + 8.71) � the constant 10.00 is the dispensing fee including VAT; ESP is always rounded to the nearest amount divisible by DKK 0.05; � Conversion formula ESP to AIP: AIP = (0.8 x ESP - (8.00 + 8.71)) / (1 + 0.083) � A back calculation should always be performed to make sure that the figure has been rounded to the nearest amount divisible by DKK 0.05; � Note: All calculations do not take into consideration any finishing fees; Denmark – Pharmacy Purchase Price


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size INCO term X Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Timeframe 05-04-2010 to 13-

04-2010 (daily updates) Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Excl VAT (Pharmacy Purchase

Price ('AIP' in Danish)) Denmark


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size Exchange rate (if not national currency) X Website in Danish = prices in

Danish Krones (DKK) = national currency Website in English = prices in Euro (€) (exchange rate unknown)

Date of price information X Timeframe 05-04-2010 to 13-04-2010 (daily updates)

Taxes & duties & other charges X VAT = 25% Price incl. co-payments X Reimbursement and

retail/patient price listed (difference is co-payment)

Price incl. dispensing fee X Fee is DKK 10.0 incl. VAT Fee is DKK 8.0 excl. VAT


Denmark


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) X Website in Danish = prices in

Danish Krones (DKK) = national currency Website in English = prices in Euro (€) (exchange rate unknown)

Date of price information X Timeframe 05-04-2010 to 13-04-2010 (daily updates)

Taxes & duties & other charges X VAT = 25% Price incl. co-payments X Reimbursement and

retail/patient price listed (difference is co-payment)

Price incl. dispensing fee X Fee is DKK 10.0 incl. VAT Fee is DKK 8.0 excl. VAT


FINLAND



Source of website


� Finnish Ministry of Social Affairs and Health

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-02-2010; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Finnish Ministry of Social Affairs and Health contributed and a link to their website, but no additional information or direct contact information for Finnish price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Finnish, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Finland Wholesaler price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X X Brand name is listed,

manufacturer name is not Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-02-2010 Price type X Taxes & duties & other charges X Finland



manufacturer name is not Exchange rate (if not national currency) X Euro (€) = national currency Date of price information X 02-02-2010 Taxes & duties & other charges X VAT = 8% Price incl. co-payments X Price incl. dispensing fee X


FRANCE

- http://www.codage.ext.cnamts.fr/codif/bdm_it/index_presentation.php?p_site


Source of website


� l'Assurance Maladie - Securité Sociale

General information


� France, National Health Insurance

o Basis for access



� searchable internet database, downloadable documents


� French






Number of clicks to access price information x Search ability within price information x Download / print version price information X � Combined score accessibility of information 1.7



Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 0 * Update: site consists of 4 separate databases, each of them has an individual date of update and version count; * Site map/search: no site map available, but very useful search engine!! Searches possible by: CIP code, specialty (medicine name), other criteria (e.g. indication, active substance, route of administration, ATC, pharmaceutical form), therapeutic alternatives, prescription analysis, codification, downloading files and changes of the week/month; * Download/print version: no print version available, but download files available listing all reimbursable medicines, reimbursable medicines updated this week and a file with delisted medicines; * Author information: No disclosure of source and no contact information available, website only contains databases, no additional information; * Links: no useful links, nor links to other pricing websites; * Important note: 4 different databases available on website 1. Table Nationale de codage de Biologie (TNB) 2. Base de Données des Médicaments (BDM) 3. Base des Médicaments et Informations Tarifaires (BDM_IT) � database containing medicine prices


4. Liste des Produits et des Prestations (LPP) * Price types: manufacturer price, retail/patient price, reimbursement price (shown as % of retail price) France - Codage


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X INCO term X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 14-04-2010 Price type X Actual price per box Quality X Pharmacopoeial specifications X

France- Codage Reimbursement price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Box size (20-100 tablets) Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 14-04-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X

France - Codage Retail / Patient price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 14-04-2010 Taxes & duties & other charges X VAT = 5.5%, 19.6% Price incl. co-payments X Price incl. dispensing fee X


FRANCE

- http://medicprix.sante.gouv.fr/medicprix/welcome.do


Source of website


� Comité Economique des Produits de Santé (CEPS)

General information


� France, Ministry of Health and Sports

o Basis for access





� French









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 * Clear layout: theme website specific for medicine prices, welcome screen is search box, results of search displayed in clear table; * Update: no information available on date of creation website, nor on last update of both website in general and database with price information; * Site map/search: useful search engine with advanced search option (search by INN name, brand name, manufacturer, generic medicine only); * Download/print version: both options are not available in the database; * Author information: disclosure of source and additional information on projects, but no direct contact information for database author (only contact information Ministry of Health in general); * Links: no useful links available on website, nor links to other pricing websites;


* Additional information: http://medicprix.sante.gouv.fr/medicprix/glossaire.do Detailed glossary given on contents of database: Medicine: each identified by its name (brand name or INN name) and name of manufacturer; Pharmaceutical specialty: under one drug name there may be several dosage strengths and dosage forms listed of the active ingredient; Presentation: each of these pharmaceutical specialties may exist in one or more presentations depending on the quantity sold (e.g. number of tablets or volume of bottle); Manufacturer price: price excluding taxes, sale price to wholesalers; Retail price: price including all taxes; CIP: Code Inter Pharmaceutique, each medicine is associated with this identifier code (each brand, generic has a different code); Presentation type: generic, originator or 'princeps' (originator no longer patented) and generic substitutions shown; Prices and costs liability: for some generic groups CEPS sets a "Tariff of responsibility" (TFR), this is in addition to the price of the originator and generic products. The TFR is generally equal to the retail price, including all taxes, of generics. France - Comité Economique des Produits de Santé


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Box size INCO term X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Price type X Actual price per box Quality X Pharmacopoeial specifications X

France - Comité Economique des Produits de Santé Retail / Patient price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X Price includes all taxes

VAT 5.5% Price incl. co-payments X Price incl. dispensing fee X


GERMANY

- http://www.dimdi.de/static/en/amg/fbag/index.htm


Source of website


� Deutsche Institut für Medizinische Dokumentation und Information (DIMDI)

General information


� Germany, Ministry of Health

o Basis for access



� downloadable Excel file


� German, English

Site quality Criterion description 0 1 2 User-friendliness Clear layout, logical presentation X

No undesired advertisements X � Combined score user-friendliness 2


Last update website, site maintenance X Last update price information X � Combined score update 2


Number of clicks to access price information X Search ability within price information X Download / print version price information X � Combined score accessibility of information 1



Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: website update every week, but last price update 01-04-2010; * Search: search engine available on website, but search by INN name not possible; * Search ability within prices: downloadable document, no search option within database; * Author information: disclosure of source and specific contact information for different services; * Links: useful links to both German and international websites, but no price reporting links;


Germany Reimbursement price YES NO SPECIFICATIONS


manufacturer name not listed Packaging specifications & size X Price per box Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT included, amount not

specified Price incl. co-payments X Reimbursed amount is ceiling

price (not always retail price) Price incl. dispensing fee X


HUNGARY



Source of website


� National Health Insurance Fund Administration of Hungary

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-03-2010; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the National Health Insurance Fund Administration of Hungary contributed and a link to their website, but no additional information or direct contact information for Hungarian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Hungarian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Hungary Ex-factory price YES NO SPECIFICATIONS


manufacturer name not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X € 1.00 = HUF 271.99

(adjustable on website dependent on date of access)

Date of price information X 02-03-2010 Price type X Quality X Pharmacopoeial specifications X Hungary


INN name & dosage form & strength X Brand name & manufacturer X Brand name listed,

manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) X € 1.00 = HUF 271.99


Date of price information X 02-03-2010 Price type X Taxes & duties & other charges X Hungary



manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = HUF 271.99




IRELAND



Source of website


� Irish Health Service Executive

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-01-2010; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Irish Health Service Executive contributed and a link to their website, but no additional information or direct contact information for Hungarian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: all characteristics in English (national language); * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Ireland Wholesaler price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Pack size & unit size Volume X Pack size & unit size Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 02-01-2010 Price type X Taxes & duties & other charges X (VAT oral 0%, other 21%)


ITALY

- http://farmaco.agenziafarmaco.it/index.php


Source of website


� Agenzia Italiana del Farmaco (AIFA)

General information


� Italy, Ministry of Health

o Basis for access





� Italian, small selection in English (English corner)









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different headings to access the AIFA website for patients & consumers, for health professionals, for pharmaceutical companies and a pressroom; * Update: no information on site updates or maintenance, mentioned above database search engine that prices are regularly updated but no date given; * Site map/search: both are available on website, search by INN name (Italian) possible but search results do not link to price database; additional feature: pull down tab specific for medicine news (INN name) gives some background information on INN name (ATC code, anatomical group, pharmaco-therapeutic subgroup, chemical subgroup, active ingredient, note from AIFA, links to other medicines in same (sub)groups); * Search within prices: possibility to search on INN name, product name and manufacturer, search results list brand name, active substance, ATC, reimbursement class/system, speed of delivery, retail price; * Download/print version: no print version nor download version available; * Author information: disclosure of source, but no specific contact information for author responsible for medicine pricing;


* Links: useful links to Medicine Authorities in Europe per country and some international websites, but no price reporting links; Italy


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X VAT = 10-20% Price incl. co-payments X Price incl. dispensing fee X


LATVIA



Source of website


� Latvian State Medicines Pricing and Reimbursement Agency

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-01-2010; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Latvian State Medicines Pricing and Reimbursement Agency contributed and a link to their website, but no additional information or direct contact information for Latvian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Latvian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Latvia Wholesaler price YES NO SPECIFICATIONS


manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) X € 1.00 = LVL 0.6990


Date of price information X 02-01-2010 Price type X Taxes & duties & other charges X Latvia



manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = LVL 0.6990




LITHUANIA



Source of website


� Department of Pharmacy under the Ministry of Health of the Republic of Lithuania

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 20-02-2008; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Department of Pharmacy under the Ministry of Health of the Republic of Lithuania contributed and a link to their website, but no additional information or direct contact information for Lithuanian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Lithuanian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Lithuania Ex-factory price YES NO SPECIFICATIONS


manufacturer name not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X € 1.00 = LTL 3.4528


Date of price information X 20-02-2008 Price type X Quality X Pharmacopoeial specifications X Lithuania



manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) X € 1.00 = LTL 3.4528


Date of price information X 20-02-2008 Price type X Taxes & duties & other charges X Lithuania



manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = LTL 3.4528




NETHERLANDS

- www.medicijnkosten.nl


Source of website


� College voor Zorgverzekeringen (CVZ)

General information


� the Netherlands, College for Health Insurances (NGO)

o Basis for access





� Dutch









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 Update: no information on last update available for both site in general and price information nor date of creation (no dates mentioned on website); * Site map: only available on general website College for Health Insurances (CVZ) and does not include a site map of the medicine costs theme website; * Author information: disclosure of source, but contacts not specific for price information; * Links: no links to other websites, only links to theme websites of CVZ; * Important note: Medicijnkosten.nl is a theme site of the College for Health Insurances. Both have a different web link (www.cvz.nl) and a link to this general website is not easy to find. * Price information: Average prices based on average use during 15 days (filled in by patient) including VAT, excluding dispensing fee. * Dispensing fee: � standard dispense (1 to 3 month supply): fee is € 6.35 (up to a maximum of € 7.99) � weekly dispense: € 3.49 (up to a maximum of € 4.40) * Additional fees:


� first dispense: € 6.35 (up to a maximum of € 7.99) � dispense in the evening or on a Sunday (incl. holidays): € 12.69 (up to a maximum of € 15.98) � simple pharmacy preparation: € 12.69 (up to a maximum of € 15.98) � complex pharmacy preparation: € 95.17 (up to a maximum of € 119.91)

Netherlands


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X Price incl. co-payments X Difference between retail price

and reimbursed amount is co-payment

Price incl. dispensing fee X Not included Netherlands


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X Price incl. co-payments X Difference between retail price

and reimbursed amount is co-payment

Price incl. dispensing fee X Not included


NORWAY



Source of website


� Norwegian Medicines Agency

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 02-07-2009; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Norwegian Medicines Agency contributed and a link to their website, but no additional information or direct contact information for Norwegian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Norwegian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Norway – Common European Drug Database Wholesaler price YES NO SPECIFICATIONS


manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Pack size & unit size Exchange rate (if not national currency) X € 1.00 = NOK 9.4275


Date of price information X 02-03-2010 Price type X Taxes & duties & other charges X (VAT 25%) Norway – Common European Drug Database



manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = NOK 9.4275




NORWAY

www.legemiddelverket.no/templates/InterPage____28315.aspx?filterBy=CopyToGeneral


Source of website


� Statens legemiddelverk

General information


� Norway, Norwegian Medicines Agency

o Basis for access



� downloadable document with package prices (A-Z index on product name (originator

or generic brand))


� Norwegian, important documents in English (such as price information) but some

menu options only available in Norwegian









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites * Clear layout: website is divided into 5 sections: general information, consumer part, health professional part, pharmacies and wholesalers parts, and industries part (sections only available in Norwegian); * Update: no information available on last update of website in general, some topics on the website show a date of creation and last update but very irregular, price list with package prices is dated on 01-04-2010; * Site map/search: site map and search engine are both available on the website, search engine provides the option to search by INN name but the results don't link to the prices because they are only listed in a download document; * Search within prices: no search option within price document, A-Z listing on product name (not INN name); * Download/print version: download version (excel document) containing prices and additional


information per product, but no print version available on website; * Author information: disclosure of source, detailed information on Norwegian Medicines Agency and their projects and mission statement, and detailed contact information for each separate topic on the website (all contacts listed in a table); * Links: no useful links available on website, nor links to other pricing websites; * Additional pricing information: www.legemiddelverket.no/templates/InterPage____25641.aspx?filterBy=CopyToGeneral Pharmacy purchasing price (PPP): All prescription medicines must be given a maximum price, set by the Drug Administration, before they can be brought into commerce. The main rule when pricing a medicinal product in Norway is that it be set at the mean of the three lowest market prices of that product in a selection of countries. The basis of price comparisons is the actual market price in each of the individual countries in the price comparison group. This market price is defined as the price which the major part of the market pays for the product. If there is no price in three or more of the countries which are included in the price comparison group the price will usually be set at the mean price in the countries where a market price exists. The countries which are normally included in the price comparison group are: Sweden, Finland, Denmark, Germany, Great Britain, The Netherlands, Austria, Belgium and Ireland. The price which is set by the Norwegian Medicines Agency is the permitted maximum market price to the pharmacist (PPP). The product can be freely sold at a lower price than the maximum price. Pharmacy retail price (PRP): The maximum pharmacy purchasing price (PPP) plus the maximum pharmacy gross profit defines the value of the pharmacy retail price (PRP). Price and reimbursement overview: Please note that both the maximum pharmacy purchasing price (PPP) and the maximum pharmacy retail price (PRP) are maximum prices and that the real cost may therefore be lower than listed in the database. Exchange rates: Price comparison is based on the price in the local currency, converted to NOK. The mean exchange rate of the last six whole months, as presented by the Central Bank of Norway, is used as the basis for the comparison of prices. * The stepped price model: This model was introduced on 01-01-2005 to reduce the costs of the National Insurance and the patients, related to the use of generic drugs. The price of a medicine is reduced step by step by predefined rates. This occurs after the medicine has lost patent protection and has been exposed to generic competition. The model has been modified twice after its introduction to reduce prices. The last change was implemented 01-01-2008. * The stepped price: The stepped price is the maximum price reimbursed by the National Insurance. The maximum reimbursement price for a generic product is set as a percentage of the maximum retail price of the original pharmaceutical product (PRP) at the time it was exposed to generic competition. The reimbursement price is cut by two or three steps. The first price-cut takes place when generic competition arises. The second cut is implemented 6 months after generic competition has occurred. The third step is applicable 12 months or more after the time of the second step. The rates of reduction depend on the annual sale of the product and are described in the table below. The generic substance simvastatin is an exception and the price of this substance has been reduced by 85% after 6 months. * Obligations of the pharmacies and wholesalers: The pharmacies are obliged to secure the capacity to deliver at least one pharmaceutical product at a retail price equal to the stepped price. If a pharmaceutical product is delivered in both small and large packages, the pharmacy is obliged to deliver both small and large packages to a retail price equal to the stepped price. The wholesalers are obliged to offer the pharmacies pharmaceutical products that enable them to fulfill these obligations.


Norway - Statens legemiddelverk Wholesaler price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Volume X Multiple pack size Exchange rate (if not national currency) NA NA Norwegian Krone (NOK) =

national currency Date of price information X 01-04-2010 Price type X Actual price list Taxes & duties & other charges X Norway - Statens legemiddelverk


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Exchange rate (if not national currency) NA NA Norwegian Krone (NOK) =

national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT = 25% Price incl. co-payments X Difference between patient

price and reimbursed amount is co-payment

Price incl. dispensing fee X Norway - Statens legemiddelverk


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) X Norwegian Krone (NOK) =

national currency Date of price information X 01-04-2010 Taxes & duties & other charges X VAT = 25% Price incl. co-payments X Difference between patient

price and reimbursed amount is co-payment



POLAND



Source of website


� Polish Ministry of Health

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 17-07-2008; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Polish Ministry of Health contributed and a link to their website, but no additional information or direct contact information for Polish price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Polish, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Poland Retail / Patient price YES NO SPECIFICATIONS


manufacturer not listed Exchange rate (if not national currency) X € 1.00 = PLN 4.0777




PORTUGAL

- www.infarmed.pt/infomed/inicio.php


Source of website


� Infarmed, Autoridade Nacional do Medicamento e Produtos de Saude

General information


� Portugal, National Authority supervised by Ministry of Health

o Basis for access

� free to access, no registration (registration required for download of database)




� Portuguese, English partly available









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different headings on main webpage for patients & consumers, for health professionals, for pharmacies & suppliers and for the industry; * Update: no information on date of price information or last update of price information; * Site map/search: search on INN name links to last update document with price information; * Download/print version: download version of search results available; * Author information: full disclosure of source, and direct contact information to all the different departments and teams within INFARMED; * Links: useful national, European, international links, but no to other price reporting websites;


Portugal - Inicio Reimbursement price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X VAT = 6% Price incl. co-payments X Difference between

reimbursement and patient price is co-payment

Price incl. dispensing fee X Portugal – Inicio


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X VAT = 6%, included Price incl. co-payments X Difference between




PORTUGAL

- www.infarmed.pt/genericos/menu.html


Source of website


� Infarmed, Autoridade Nacional do Medicamento e Produtos de Saude

General information


� Portugal, National Authority supervised by Ministry of Health

o Basis for access

� free to access, no registration (registration required for download of database)




� Portuguese, English partly available









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different headings on main webpage for patients & consumers, for health professionals, for pharmacies & suppliers and for the industry; * Update: last update of price information 29-03-2010, website in general weekly updated; * Site map/search: search on INN name links to last update document with price information; * Search within prices: search options by INN name, by therapeutic group, by pharmaco-therapeutic subgroup or complete list of all generic drugs available (A-Z index); * Download/print version: no download version nor print version of price information available; * Author information: full disclosure of source, and direct contact information to all the different departments and teams within INFARMED; * Links: useful national, European, international links, but no to other price reporting websites;


Portugal - Genericos Reimbursement price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Price per pack size Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 29-03-2010 Taxes & duties & other charges X VAT = 6% Price incl. co-payments X Difference between


Price incl. dispensing fee X Portugal - Genericos


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 29-03-2010 Taxes & duties & other charges X VAT = 6% Price incl. co-payments X Difference between




SLOVAKIA



Source of website


� Slovakian Ministry of Health

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 30-09-2008; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Slovakian Ministry of Health contributed and a link to their website, but no additional information or direct contact information for Slovakian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Slovakian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Slovakia Ex-factory price YES NO SPECIFICATIONS


manufacturer name not listed Packaging specifications & size X Pack size & unit size INCO term X Exchange rate (if not national currency) X € 1.00 = SKK 30.30


Date of price information X 30-09-2008 Price type X Quality X Pharmacopoeial specifications X Slovakia



manufacturer name not listed Exchange rate (if not national currency) X € 1.00 = SKK 30.30




SLOVENIA



Source of website


� Slovenian Health Insurance Institute

General information



o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price update 10-12-2008; * Site map / Search: both give the option to search by country or by ATC code; * Author information: only mentioned that the Slovenian Health Insurance Institute contributed and a link to their website, but no additional information or direct contact information for Slovenian price source available; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in Slovenian, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website http://cedd.oep.hu/; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP.


Slovenia Wholesaler price YES NO SPECIFICATIONS


manufacturer name not listed Packaging specifications & size X Pack size & unit size Volume X Price per unit pack Exchange rate (if not national currency) X Euro (€) = national currency Date of price information X 10-12-2008 Price type X Taxes & duties & other charges X (VAT = 8.5%)


SPAIN

- https://sinaem4.agemed.es/consaem/fichasTecnicas.do


Source of website


� Agencia Española de Medicamentos y Productos Sanitarios (AEMPS)

General information


� Spain, Ministry of Health and Social Policies

o Basis for access





� Spanish, partly in English (only headings translated, results and additional info in

Spanish)









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update of general website AEMPS, last update website containing database with price information is 20-07-2009; * Site map/search: site map is available on website, search engine provides option to search by INN name (only in Spanish) but does not link to documents with price information; * Search within prices: search options by INN name, brand name, national code, authorization number, manufacturer, therapeutic group, but searches only possible in Spanish terms; * Download/print version: no print version available, but search results can be exported to 4 different formats (csv, excel, xml, pdf); * Author information: full disclosure of source (AEMPS in general) and contact information to contact author price information directly available; * Links: useful national and international links available (Medicine Evaluation Agencies (national, European and international), Institutions on health (national and international), groups of interest (national and international sites on health topics), but no links to other price reporting sites;


Spain - Agencia Española de Medicamentos y Productos Sanitarios


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X 20-07-2009 Taxes & duties & other charges X VAT = 16% Price incl. co-payments X Price incl. dispensing fee X


SPAIN

- http://www.vademecum.es/


Source of website


� Vademecum.es

General information


� Spain, United Business Media Medica Spain (UBM Medica Spain)

o Basis for access





� Spanish









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Undesired advertisements: newsfeeds from governmental sites, vademecum itself but also from pharmaceutical companies and some health-related organizations, these banners could distract users from the most important content on the website; * Update: last update of website in general 26-04-2010 but no information on last update of database containing price information; * Site map/search: site map is available on website, search engine provides option to search by INN name (only in Spanish) but does not link to documents with price information; * Search within prices: search options by INN name (search term or A-Z index), brand name (search term or A-Z index), manufacturer, therapeutic group (disease & symptoms), but searches only possible in Spanish terms; * Download/print version: print version available of search results and search results can be shared with others by emailing them; * Author information: full disclosure of source (legal notice) UBM Medica Spain and contact information to contact author price information directly available (select department); * Links: links to national health related websites, but no links to other price reporting sites;


Spain - Vademecum


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Volume listed (1 pack) INCO term X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Price type X Manufacturer selling price Quality X Pharmacopoeial specifications X Spain- Vademecum


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Euro (€) = national currency Date of price information X Taxes & duties & other charges X VAT = 16% Price incl. co-payments X Price incl. dispensing fee X


SWEDEN

- www.tlv.se/in-english/price-database/


Source of website


� Tanvårds- och Läkemedelsförmånsverket (TLV)

General information


� Sweden, Ministry of Health

o Basis for access





� Swedish, English (database with medicine prices not in English)









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update of website in general, price information last updated on 26-04-2010 (monthly price lists with cheapest products); * Site map/search: both are present on website, searches on general website by INN name provide results with additional information in background documents, but also a specific link saying how many hits are found in the pricing database (direct access link); * Search within prices: search option by INN name, drug name, manufacturer, ATC code; additional feature: in Excel document all characteristics displayed can be changed individually (e.g. only display amoxicillin, only display reimbursed medicines, only display generics, …); * Download/print version: search results alone or complete database can be exported into excel file and search results can be printed; * Author information: disclosure of background information on DLV, but no specific contact information for author of database (only general TLV contact); * Links: useful links to national and some international websites, but no links to other price reporting websites; * Additional information: because the database is only available in Swedish a glossary in English


is displayed on the website: • Produkt = Product • Form = Dosage form • Styrka = Strength • Storlek = Size • AIP (Apotekets inköpspris) = AIP (Pharmacy Wholesale Price) • Pris = Price (Skr) • Sub = Reimbursed • Företag = Company • ATC-kod = ATC code • Varunr = Product number • Begränsning av subvention = Restriction of reimbursement

* Important note: In Sweden the government subsidizes medicines so that everyone has access to good and effective medicines. However, not all medicines are subsidized; one of the tasks of TLV is to determine which medicines should be subsidized. To get the patients a discount another 4 criteria need to be fulfilled. The medicine should:

1. be written on a prescription; 2. aim to prevent, diagnose, treat or cure a disease, or symptoms of a disease in a human; 3. be prescribed by a person authorized to do so (licensed); 4. be on a recipe with a "working-place-code"

Sweden - Pharmacy Wholesale Price


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Volume X Price per packsize Exchange rate (if not national currency) NA NA Swedish Krone (SEK) =

national currency Date of price information X 26-04-2010 Price type X Actual price list Taxes & duties & other charges X Sweden – Patient Price


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Swedish Krone (SEK) =

national currency Date of price information X 26-04-2010 Taxes & duties & other charges X Excl. VAT Price incl. co-payments X Price incl. dispensing fee X


UNITED KINGDOM

http://www.cmu.nhs.uk/Medicines/Generic/Pages/eMIT.aspx


Source of website


� National Health Service Commercial Medicines Unit (NHS CMU): Generic

Pharmaceuticals electronic Market Information Tool (eMIT)

General information


� United Kingdom, Ministry of Health

o Basis for access



� downloadable excel database


� English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website but date of creation website is January 2010, excel file with price information is version April 2010; * Site map/search: no site map available on website, search engine provides advanced search option, search by INN name possible, however this only shows background materials and no links to price information; * Search within prices: pull down within excel tab to select medicine and its price (A-Z index on INN name (generic medicines only)); * Download/print version: download version available, but no print version; * Speed to search page: download time at 56K is 131.6 seconds; * Author information: disclosure of source, additional background information on eMIT and specific contact information for prices author available; * Links: no useful links available on website (only internal quick links) nor links to other price reporting websites; * Background information: The data provided in eMIT includes an estimate of NHS hospital-sector


annual usage from English trusts for the product selected, the average (weighted arithmetic mean) price paid for that product over the last four months of the period and a measure of the variance of that average. The estimates provided are derived from data collected via NHS CMU's PharmEx system (covering ca. 95% of the constituent NHS trusts) representing the 12 month period to end September 2009. United Kingdom - Generic Pharmaceuticals electronic Market Information Tool


INN name & dosage form & strength X Brand name & manufacturer X Generic products only Packaging specifications & size X Pack size listed INCO term X Supplier X Volume purchased X Price per pack Purchase terms X Payment terms / timelines X Date of price information X 04-2010 Date of procurement award X Exchange rate at time of award NA NA English Pound (£) = national

currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Excl. VAT


UNITED KINGDOM

http://www.dmd.nhs.uk/dictionary


Source of website


National Health Service Dictionary of Medicines and Devices (NHS DM+D)

General information



o Data supplier

� NHS Prescription Services of the NHS Business Services Authority (NHSBSA)

o Basis for access



� online database


� English




Last update website, site maintenance x Last update price information X � Combined score update 1





Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website, price information updated monthly; * Site map/search: no site map available on website, search engine provides search by INN name; * Search within prices: search on INN name, possibility to select different dosage forms and manufacturers and variable pack sizes; * Download/print version: download version available after registration, but no print version; * Speed to search page: download time at 56K is 131.6 seconds; * Author information: disclosure of source, additional background information on DMD and specific contact information for prices author available; * Links: no useful links available on website (only internal quick links) nor links to other price reporting websites; Additional information: The dm+d dictionary contains unique identifiers and associated textual


descriptions for medicines and medical devices. It is to become the NHS standard for medicines and device identification, ensuring safe and reliable exchange of information on medicines and devices. United Kingdom – NHS Dictionary of Medicines and Devices


INN name & dosage form & strength X Brand name & manufacturer X Yes, if not generic product Packaging specifications & size X Quantity specified Exchange rate (if not national currency) NA NA British Pound (£) = national

currency Date of price information X 11-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X


UNITED KINGDOM

- http://www.isdscotland.org/isd/2246.html


Source of website


� Scottish Drug Tariff

General information


� Scottish Government, Information Services Division (ISD Scotland)

o Basis for access



� downloadable Excel document


� English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 2 * Update: Last update website on National Drug Tariff 31-03-2010, last version price information is 01-04-2010; * Site map/search: both are available on the website, search on site mastered by Google; * Search within prices: database only available in downloadable excel document, A-Z listing on INN name, no search option within document; * Download/print version: download version of database, but no direct print version available; * Author information: detailed background information on ISD Scotland and on National Drug Tariff, direct contact information to prices author listed underneath download link database; * Links: useful national and international links, including links to other price reporting sites;


United Kingdom - Scottish Drug Tariff


INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X Quantity specified Exchange rate (if not national currency) NA NA British Pound (£) = national

currency Date of price information X 01-04-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X


UNITED KINGDOM

- http://www.ppa.org.uk/ppa/edt_intro.htm


Source of website


� National Health Service Drug Tariff for England and Wales (NHS)

General information



o Data supplier

� NHS Prescription Services of the NHS Business Services Authority (NHSBSA)

o Basis for access





� English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website, price database is dated 01-05-2010 (monthly updated database); * Site map/search: no site map available on website, search engine provides advanced search option, search by INN name possible, however this mainly shows background materials and no links to current price information; * Search within prices: database containing price information can be arranged by contents (different chapters per topic), index (A-Z listing of pharmaceutical products) or a search box can be used to find specific information immediately; * Download/print version: download version not available (online database), but print versions available (complete database, specific chapter or search results); * Author information: disclosure of source, additional background information on Electronic Drug Tariff and specific contact information for prices author available;


* Links: no useful links available on website (only internal quick links) nor links to other price reporting websites; * Professional fees (Pharmacy contractors): - all prescriptions attract a professional fee with a value of £ 0,90 United Kingdom - Drug Tariff for England and Wales


INN name & dosage form & strength X Brand name & manufacturer X Yes, if not generic product Packaging specifications & size X Quantity specified Exchange rate (if not national currency) NA NA British Pound (£) = national

currency Date of price information X 01-05-2010 Taxes & duties & other charges X Price incl. co-payments X Price incl. dispensing fee X Not included


UNITED KINGDOM

- http://bnf.org/bnf/index.htm


Source of website


� British National Formulary (BNF)

General information


� United Kingdom,

o Basis for access

� registration required, free to access for residents of the UK and some developing

countries (list on website)


� access after payment


� English





Site map / Search Site map, useful search engine 1 Basis for access No access fee, no registration 0 1 Accessibility of information

Number of clicks to access price information Search ability within price information Download / print version price information � Combined score accessibility of information 0 1



Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website; latest version BNF is March 2010; * Site map/search: no site map available on website, search by INN name possible, however this only shows background materials and no links to price information; * Basis for access: registration required, free to access for residents of the UK and some developing countries (list on website), other countries need a subscription to access; * Search within prices: * Download/print version: download version available, but no print version; * Author information: disclosure of source, additional background information on BNF and specific contact information for prices author available; * Links: no useful links and no links to price reporting sites;


ANNEX VIII Qualitative Country Annex

South East Asia Regional Office (SEARO)

INDIA

- www.nppaindia.nic.in/index1.html


Source of website


� National Pharmaceutical Pricing Authority (NPPA)

General information


� India, Ministry of Chemicals and Fertilizers: Department of Pharmaceuticals

o Basis for access



� downloadable document (prices of bulk drugs) & online database (ceiling prices of

scheduled formulations)


� English, Hindi









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update of website in general, last update price information in database link on 15-05-2008, some prices reviewed on 16-04-2010 but no changes made in pricing document (yet); * Site map/search: site map available on website, search engine provides search on INN name and search results link to pricing documents; * Search within prices: database and document listed as an A-Z index by INN name, no search option within price list; * Download/print version: download version of both price lists available but no direct print version; * Author information: background information on NPPA and Drugs Prices Control Order (DPCO),


no specific contact information for prices author; * Links: useful links to related Departments within the Ministry and to Ministries of Health of other countries, but no links to other price reporting sites; * Additional information: The retail price of a formulation shall be calculated by the Government in accordance with the following formula namely: R.P. = (M.C. + C.C. + P.M. + P.C.) x (1 + MAPE/100) + ED. where

• "R.P." means retail price; • "M.C." means material cost and includes the cost of drugs and other pharmaceutical aids

used including overages, if any, plus process loss thereon specified as a norm from time to time by notification in the Official Gazette in this behalf;

• "C.C." means conversion cost worked out in accordance with established procedures of costing and shall be fixed as a norm every year by notification in the Official Gazette in this behalf;

• "P.M." means cost of the packing material used in the packing of concerned formulation, including process loss, and shall be fixed as a norm every year by, notification in the Official Gazette in this behalf;

• "P.C." means packing charges worked out in accordance with established procedures of costing and shall be fixed as a norm every year by notification in the Official Gazette in this behalf;

• "MAPE" (Maximum Allowable Post-manufacturing Expenses) means all costs incurred by a manufacturer from the stage of ex-factory cost to retailing and includes trade margin and margin for the manufacturer and it shall not exceed one hundred per cent for indigenously manufactured Scheduled formulations;

• "E.D." means excise duty: Provided that in the case of an imported formulation, the landed cost shall form the basis for fixing its price along with such margin to cover selling and distribution expenses including interest and importer's profit which shall not exceed fifty percent of the landed cost.

India - National Pharmaceutical Pricing Authority


INN name & dosage form & strength X Brand name & manufacturer X Exchange rate (if not national currency) NA NA Indian Rupee (INR/Rs) =

national currency Date of price information X 15 / 05 / 2008 Taxes & duties & other charges X Maximum ceiling prices exclusive of

excise duty and local taxes Price incl. co-payments X Price incl. dispensing fee X Maximum ceiling prices exclusive of

excise duty and local taxes


INDIA

- http://www.tnmsc.com/tnmsc/new/html/services.php#


Source of website


� Tamil Nadu Medical Services Corporation Ltd. (TNMSC)

General information


� India, Government - Health & Family Welfare Department

o Basis for access



� downloadable document with finalized rates and suppliers


� English









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website in general, last update price information 30-04-2010, new list for tender valid from this date (2010-2011); * Site map/search: no site map, nor search engine available on website; * Search within prices: prices only available in downloadable document, no search option within document, listing on product number (random alphabetical order); * Download/print version: download version of price list but no direct print version available; * Author information: background information on TNMSC in general and on their procurement services, but no specific contact information for prices author; * Links: no useful links nor links to other price reporting sites on website;


India - Tamil Nadu Medical Services Corporation Ltd.


INN name & dosage form & strength X Brand name & manufacturer X Only generics, all listed on INN name Packaging specifications & size X Unit (box, bottle, ampul) INCO term X Supplier X Supplier listed for each medicine

(Name of the tenderer) Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Tender contract 2010-2011 Date of procurement award X Exchange rate at time of award NA NA Indian Rupee (INR/Rs) =

national currency Quality X Pharmacopoeial specifications X Taxes & duties & other charges X All prices are exclusive of taxes


ANNEX IX Qualitative Country Annex

Western Pacific Regional Office (WPRO)

AUSTRALIA

- www.pbs.gov.au


Source of website


� Pharmaceutical Benefits Scheme

General information


� Australia, government: Department of Health and Ageing

o Basis for access





� English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different versions of the PBS for consumers, for health professionals, for industry; * Update: Site & price update reported on website (01-04-2010), latest news feed shows PBS Website Update and documents with detailed information on changes made; * Links: useful links to Australian health related websites, but none to price reporting websites; * Current patient fees & charges: http://www.pbs.gov.au/html/consumer/pbs/about � Patient co-payments: from 01-01-2010 patients pay up to $33.30 (Australian Dollars) for most PBS medicines or $5.40 if they have a concession card. The Australian Government pays the remaining cost. The amount of co-payment is adjusted on 1 January each year in line with the Consumer Price Index (CPI).


� Safety Net: from 01-01-2010, the Safety Net threshold is $324.00 for concession card holders and $1,281.30 for all other patients. After reaching this threshold, general patients pay for further PBS prescriptions at the concessional co-payment rate and concession card holders are dispensed PBS prescriptions at no further charge for the remainder of that calendar year. The Safety Net threshold may be reached using scripts filled at both community pharmacies and out-patient pharmacies at public hospitals – this is called the joint Safety Net. From 1-01-2010, the contribution rate for general patients as outpatients at public hospitals in most states and territories in Australia is $26.60. � Price below general patient co-payment: For general patients, an allowable additional patient charge can apply. The allowable additional patient charge is a discretionary charge to general patients if a pharmaceutical item has a dispensed price for maximum quantity less than the general patient co-payment. The pharmacist may then charge the allowable additional fee but the fee cannot take the cost of the prescription above the general patient co-payment for the medicine. The maximum fee is currently $3.83 and is adjusted on 1 January each year. This fee does not count towards a patient's Safety Net threshold. � Additional fee for ready prepared items: In addition, if a medicine has a ‘dispensed price for maximum quantity’ less than the general co-payment a safety net recording fee may be charged by the pharmacist. This fee may not take the cost of the script above the co-payment. This fee is currently $1.05 and is adjusted on 1 August each year. The amount of this fee does count towards a patient's Safety Net threshold. � Price premium: A price premium or brand premium, may apply to some medicines. Where there are two or more brands of the same drug on the Schedule, the Government subsidizes each brand to the same amount - up to the cost of the lowest priced brand. If a patient takes a more expensive brand the price difference is paid by the patient as a brand premium. This cost is in addition to co-payment. Pharmacists are legally required to charge brand premiums. The brand premium does not count towards the Safety Net threshold. Australia


INN name & dosage form & strength X Brand name & manufacturer X X Brand name is listed, manufacturer

is not listed Packaging specifications & size X Exchange rate (if not national currency) NA NA Australian dollar (AU$) =

National currency Date of price information X 01/04/2010 Taxes & duties & other charges X GST = 10%, unknown if it is

included or not Price incl. co-payments X Amount paid by government,

maximum paid by patient and reimbursed amount listed

Price incl. dispensing fee X Pharmacist fee, amount not specified


NEW ZEALAND

- www.pharmac.govt.nz


Source of website


� Pharmaceutical Management Agency

General information


� New Zealand, Pharmaceutical Management Agency

o Basis for access



� searchable internet database and downloadable database file


� English, Maori (partly)






Number of clicks to access price information x Search ability within price information x Download / print version price information x � Combined score accessibility of information 1,7



Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Clear layout: Different headings to access the Pharmaceutical Schedule for patients & consumers, for health professionals, for district health boards, for pharmaceutical suppliers; * Update: both site in general and price information updated once every month; * Site map: last update 13-11-2008, site last updated in 04-2010; * Download/print: only a download version of the database is available; * Author information: disclosure of source and contact information specific for pricing author; * Links: some useful links (not clearly labeled), no price reporting links;


New Zealand Ex-factory price YES NO SPECIFICATIONS

INN name & dosage form & strength X Brand name & manufacturer X Brand name or generic name listed Packaging specifications & size X Price per amount (tablets,

capsules, milliliter) INCO term X Exchange rate (if not national currency) NA NA New Zealand dollar (NZ$) =

National currency Date of price information X 05-2010 Price type X Quality X Pharmacopoeial specifications X


ANNEX X Qualitative Price Guides Annex

Global Fund to fight AIDS, Tuberculosis and Malaria

& AIDS Medicines and Diagnostic Services

Global Fund to fight AIDS, Tuberculosis and Malaria

http://www.theglobalfund.org/en/procurement/pqr/


Source of website

o International: non-profit

� The Global Fund: Price & Quality Reporting (PQR)

General information


� The Global Fund

o Basis for access



� searchable internet database (product catalogue)


� English, Spanish, French, Chinese, Russian









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update website Global Fund but date of copyright 2010, prices dated 01-2002 to 05-2010; * Site map/search: site map on website available in different version depending on user, search by INN name possible (only ARV), search results are background information, news events but no links to most recent prices; * Search within prices: price list online available, search by purchase order date, invoice date, last modified date, INCO term or therapeutic category; search results are A-Z listed on INN name; * Download/print version: prices online available, option to print or export search results or


complete database; * Author information: detailed background information on The Global Fund and on Price & Quality Reporting including direct contact information to PCR author; * Links: some useful links and a link to Global Price Reporting Mechanism of WHO; The Global Fund: Price & Quality Reporting

Wholesaler price YES NO IF YES (SPECIFICATIONS)

INN name & dosage form & strength X Brand name & manufacturer X X Manufacturer listed Packaging specifications & size X Volume X Exchange rate (if not national currency) NA NA Prices in US$ Date of price information X Tender contract 01-01-2002 to

03-05-2010 Price type X High/low/mean price Taxes & duties & other charges X


AIDS Medicines and Diagnostic Services

- http://www.who.int/hiv/amds/gprm/en/index.html


Source of website


� Global Price Reporting Mechanism (GPRM)

General information


� World Health Organization

o Basis for access





� English









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website but date of copyright 2010, last version GPRM report dated on November 2009, order data vary from years ago (2006) until February 2010; * Site map/search: site map not available on website, search by INN name possible, search results are background information, news events and links to most recent prices in reports; * Search within prices: price information online available, search by therapeutic category, INN name, strength, search by country or region or revenue category, dosage form, name and country of manufacturer, grant number, purchase order date (since / until option); search results are A-Z listed on country that purchased order; * Download/print version: prices online available, option to export database or search results into pdf or excel file, no direct print option; * Author information: detailed background information on Global Price Reporting Mechanism and contact information of AMDS (AIDS Medicines and Diagnostics Service) listed, but no contact information of database author; * Links: some useful links to other departments working on HIV/AIDS but no links to other price reporting websites;


AMDS - Global Price Reporting Mechanism

Procurement price YES NO IF YES (SPECIFICATIONS)

INN name & dosage form & strength X Brand name & manufacturer X Generic & country of origin &

manufacturer Packaging specifications & size X INCO term X + shipment method Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Date of purchase order Date of procurement award X Exchange rate at time of award NA NA Prices in US $ Quality X Pharmacopoeial specifications X Taxes & duties & other charges X


ANNEX XI Qualitative Price Guides Annex

Clinton Foundation & Médecins Sans Frontières

Clinton Foundation

http://www.clintonfoundation.org/what-we-do/clinton-health-access-initiative/information-

center-resources


Source of website


� Clinton Health Access Initiative (CHAI): Antiretroviral (ARV) price list

General information


� Clinton Foundation

o Basis for access



� download version pricelist


� English









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update website, last update price list April 2010; * Site map/search: site map on website, search by INN name possible (only ARV), search results are background information, news events and links to most recent and previous price list; * Search within prices: price list only available in downloadable pdf document, no search option within document, 2 categories (adult products, pediatric products), A-Z listing on INN name; * Download/print version: download version of price list, but no direct print version available; * Author information: detailed background information on Clinton Foundation and its projects and initiatives including CHAI, but no direct contact information to CHAI listed; * Links: no useful links nor links to other price reporting sites;


http://www.clintonfoundation.org/files/chai_arv_priceList_april2010_english.pdf * CHAI: The Clinton Health Access Initiative (CHAI) supports national governments to expand high-quality care and treatment to people living with HIV/AIDS. CHAI offers reduced prices for antiretrovirals (ARVs) to members of its Procurement Consortium. * Price agreements: CHAI has agreements with seven manufacturers: Aurobindo Pharma, Cipla Ltd., Hetero Drugs, Macleods Pharmaceuticals, Matrix Laboratories, Ranbaxy Laboratories and Strides Arcolabs. The ARVs included in CHAI’s pricing agreements are: abacavir (ABC), atazanavir (ATV), efavirenz (EFV), emtricitabine (FTC), lamivudine (3TC), lopinavir/ritonavir (LPV/r), nevirapine (NVP), stavudine (d4T), tenofovir (TDF) and zidovudine (AZT). Prices listed below are available to countries participating in the CHAI Procurement Consortium, which currently includes over 70 nations. These prices apply to procurements by national governments that are members of the CHAI Procurement Consortium, or organizations procuring on behalf of member governments, to support public care and treatment programs. * CHAI prices: CHAI prices represent price ceilings at or below which the indicated suppliers must price their products when selling or communicating price quotes for the specified products to members of the CHAI Procurement Consortium. In establishing price ceilings, CHAI aims to offer the lowest available prices to Consortium members while ensuring that products are available from more than one partner supplier wherever possible. * Per person per year prices: for pediatric formulations these prices are determined based on the recommended daily dosing for a 10 kg child (unless a formulation is not recommended for a 10kg child, then the annual price is calculated based on dosing for an applicable weight band). * Inco term: Prices listed are FCA Airport from the point of export FCA (Free Carrier) - The seller is responsible for arranging transportation, but acting at the risk and the expense of the buyer. The seller chooses and works with the freight forwarder or the carrier. Delivery is accomplished at a predetermined port or destination point and the buyer is responsible for insurance. * Quality: CHAI is committed to the sustainable supply of high-quality ARVs, consistent with the specifications of dossiers approved by the World Health Organization (WHO) Prequalification Programme, U.S. Food and Drug Administration (U.S. FDA), a stringent regulatory authority (SRA) as defined by the International Conference on Harmonization (ICH) or recommended for procurement by Expert Review Panel (ERP) of The Global Fund. Clinton Foundation


INN name & dosage form & strength X Antiretroviral abbreviations Brand name & manufacturer X X Manufacturer listed Packaging specifications & size X INCO term X FCA = free carrier Supplier X 7 supplier contracts Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 04-2010 contract Date of procurement award X Exchange rate at time of award X Quality X WHO / FDA / SRA Pharmacopoeial specifications X Taxes & duties & other charges X


Médecins Sans Frontières (Doctors Without Borders)

http://utw.msfaccess.org/


Source of website


� MSF Campaogn for Access to Essential Medicines

General information


� Médecins Sans Frontières (MSF)

o Basis for access





� English









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website, database with prices last updated 22-02-2010; * Site map/search: no site map, nor search engine available on website; * Search within prices: view summary table of all medicine prices or search prices by therapeutic class, INN name (A-Z list to choose from) or manufacturer name (A-Z list to choose from); * Download/print version: prices online available, a tab exists on each drug page to print individul pages and every year there is a paper version which can be downloaded; * Author information: detailed background information on HIV/AIDS treatment and work done by MSF so far and new projects and goals, contact information specific for MSF Campaign for Access to Essential Medicines listed on main page; * Links: some useful links to other organizations working on HIV/AIDS, links on price resources are available on Annex 11 and each reference has an individual link, but no links to other price reporting websites; General information: General information on the history of the product and relevant WHO guidance is provided for each of the antiretrovirals (ARVs) included in this publication.15, 16 Separate profiles are


included for both single ARVs and fixed-dose combinations (FDCs) containing two or three ARVs. Table 1: Prices quoted by companies for eligible developing countries All prices are quoted in United States Dollars (US$). Currency conversions were made on the day the price information was received using the currency converter site www.oanda.com. Prices are rounded up to the third decimal for unit price and to the nearest whole number for yearly price per patient. The annual cost of treatment per patient year (ppy) has been calculated according to the WHO dosing schedules, multiplying the unit price (one tablet, capsule or millilitre) by the number of units required for the daily dose, and by 365. The price of the smallest unit is included in brackets. Where no WHO guidelines exist for a product, the dosage used is the U.S. FDA approved dosage. For paediatric treatments, prices are calculated for a 10kg child using recommended dosing based on weight bands, as it appears in the WHO treatment guidelines.16 This is an estimate, as the weight of a child increases during any given year. When it was not possible to calculate the dose for a 10kg child, only the unit price is indicated. For paediatric FDCs, the dosages used for the calculation are those recommended by the Paediatric Antiretroviral Working Group at WHO. The Clinton Foundation’s HIV/AIDS Initiative negotiates with several manufacturers for reduced prices for over 40 different ARV formulations for countries in their pooled procurement consortium. Manufacturers who have a product included in the most recent price announcement are indicated by a (CF) in the header of the table. Médecins Sans Frontières


INN name & dosage form & strength X Antiretroviral abbreviations Brand name & manufacturer X X Manufacturer listed Packaging specifications & size X INCO term X FCA = free carrier Exchange rate (if not national currency) NA NA Prices in US$ Date of price information X Last update 22-02-2010 Price type X Average selling price Quality X Products included in the List of

Prequalified Medicinal Products (as of April 2010), including the ones approved by Health Canada, the European Medicines Agency (EMA) or (tentatively) approved by U.S. FDA, appear in bold in the tables of drug prices.

Pharmacopoeial specifications X


ANNEX XII Qualitative Price Guides Annex

Common European Drug Database, Management Sciences for Health &

Österreichisches Bundesinstitut für Gesundheitswesen

Common European Drug Database

http://cedd.oep.hu/


Source of website


� Main Association of Austrian Social Security Institutions, State Institute of Drug

Control of the Czech Republic, Finnish Ministry of Social Affairs and Health, National

Health Insurance Fund Administration of Hungary, Irish Health Service Executive,

Latvian State Medicines Pricing and Reimbursement Agency, Department of Pharmacy

under the Ministry of Health of the Republic of Lithuania, Norwegian Medicines Agency,

Polish Ministry of Health, Slovakian Ministry of Health, Slovenian Health Insurance

Institute

General information


� Hungary, National health Insurance Fund Administration of Hungary

o Basis for access





� English




Last update website, site maintenance x Last update price information x x � Combined score update 0 / 0.5





Author information Disclosure of source, contact information 2


Links Clearly labeled, links to price reporting sites 2 * Update: no information available on last update of website, last price updates vary between countries (01-03-2010 to 20-02-2008) (see country specific tables); * Site map / Search: both give the option to search by country or by ATC code; * Author information: Disclosure of source is an introduction on the CEDD project and participating countries, direct contact information to CEDD author in National Health Insurance Fund Administration of Hungary; * Links: useful links to drug price lists, drug prices and other links; * Price table: product name and dosage form in national language, other characteristics in English; * Important note: The National Health Insurance Fund Administration of Hungary (OEP) maintains the website cedd.oep.hu; the general website characteristics are not influenced by the participating countries. Unfortunately, the country specific database is not always up-to-date (meanwhile changes in prices will not be instantly executed in the database). However, these data are based on the information of the authorities of the participating countries. Meaning that the criteria price information (e.g. updates) and author information are the responsibility of the individual countries and not that of OEP. SEE COUNTRY ANNEXES FOR PRICE QUALITY CHARACTERISTICS


Management Sciences for Health

http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=DMP&language=English


Source of website


� International Drug Price Indicator Guide

General information


� Management Sciences for Health

o Basis for access



� searchable internet database (product catalogue)


� English, French, Spanish









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update website, all price data is from 2008; * Site map/search: no site map available on website, search by INN name possible and search results link to most recent prices; * Search within prices: online database with prices, searches possible on INN name, by letter (A-Z) or by WHO EML Therapeutic Class; price data is from at least 5 suppliers and 5 buyers; * Download/print version: prices online available, option to download complete database in pdf format but no direct print option; * Author information: detailed background information on The Price Guide and contact information for MSH, but no direct contact information for prices author; * Links: some useful links and links to other price reporting websites;


Management Sciences for Health Procurement price YES NO IF YES (SPECIFICATIONS)

INN name & dosage form & strength X Brand name & manufacturer X Packaging specifications & size X INCO term X Details per supplier Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 2008 Date of procurement award X Exchange rate at time of award X Quality X Data notes for 2008 Pharmacopoeial specifications X Taxes & duties & other charges X


Österreichisches Bundesinstitut für Gesundheitswesen

http://www.goeg.at/en/PPI


Source of website


� Pharma Price Information

General information


� Österreichisches BundesInstitut für Gesündheidswesen (ÖBIG)

o Basis for access

� fee to be paid to access price information


� access to query results upon request and payment (no internet database)


� German, English




Last update website, site maintenance x Last update price information ? ? ? � Combined score update 0 1 2





Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update website, but price queries on request (always most recent data available, so update gets a high score); * Site map/search: no site map, search engine on website but no search on INN name possible; * Search within prices: PPI queries carried out on INN name, ATC code, strength, dosage form per price type (manufacturer, wholesale, retail), therefore probably easy to search within prices; * Download/print version: no option to print or download price information (only after payment); * Author information: detailed background information on ÖBIG and PPI and specific contact information for PPI authors listed on website; * Links: no useful links, nor links to other price reporting websites; Pharma Price Information GÖG/ÖBIG’s Pharma Price Information service (PPI), upon request, provides quick, reliable and independent information on pharmaceutical prices in all member states of the EU, in Switzerland and in Norway.


Within Europe, pharmaceutical prices vary to a great extent. Despite a common currency – the euro – a comparison of prices is difficult and requires considerable resources and knowledge. We offer up-to-date price information that permits comparison at European level and we carry out comprehensive price comparisons to make cost-containment options visible. Standard query: you are interested in the market availability or the prices of a pharmaceutical product of a certain manufacturer/distributor. For carrying out the required research, we need a written enquiry that names the speciality in question (trade name, market authorisation holder), the desired strength (e.g., 20 mg) or pharmaceutical form as well as the desired price type (manufacturer’s price, pharmacy purchasing price, pharmacy retail price incl./excl. VAT) and the respective countries. Special query: you are interested in the prices of all pharmaceuticals with a certain active ingredient (brands, generics, parallel imports, etc.). For carrying out the required research, we need a written enquiry that names the active ingredient, the ATC code (if available) as well as the desired strength (e.g., 20 mg) or pharmaceutical form as well as the desired price type (manufacturer’s price, pharmacy purchasing price, pharmacy retail price incl./excl. VAT) and the respective countries. Example price of a PPI standard query: EUR 70 (excl. VAT) for one product, two strengths, one pharmaceutical form, all pack sizes, per country. Do not hesitate to contact us for customised price information according to individual needs that are not covered by our standard and special query services. MEDICINE PRICE INFORMATION NOT FREE TO ACCESS

NO DETAILS ON PRICE TYPES PROVIDED AND PRICE QUALITY CHARACTERISTICS


ANNEX XIII Qualitative Price Guides Annex

International Trade Centre, WHO databases, Health Action International &

UNICEF

International Trade Centre

http://www.intracen.org/market-news Website accessed on 30-04-2010

Source of website


� The Market News Service for Pharmaceutical Starting Materials (MNS report)

General information


� International Trade Centre

o Basis for access

�

� Developing countries(including sub-Saharan Africa): free access to all MNS reports

� Developed countries: subscription fee required to access one or all MNS reports


� downloadable version of MNS report, hardcopy available upon request


� English









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website ITC but date of creation 2010 (new website), prices dated April 2010 (bimonthly report on Pharmaceutical Starting Materials); * Site map/search: no site map on website, search by INN name possible, search results are background information, news events and link to (sample) MNS report; * Basis for access: free access to bimonthly report on pharmaceutical starting materials (ingredients) for users from developing countries (list on website), users from developed countries


need a subscription to access reports (US$ 400 per sector); * Search within prices: price information only available in downloadable document and no search option within this document, medicines A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information on MNS and ITC, general contact information for ITC listed, form needs to be filled in to contact MNS team, no specific form for author price report on pharmaceuticals, however list of price information providers listed at the end of the MNS report; * Links: list of quick links within website, some useful links, but no links to other price reporting websites; MEDICINE PRICE INFORMATION NOT FREE TO ACCESS

NO DETAILS ON PRICE TYPES PROVIDED AND PRICE QUALITY CHARACTERISTICS


WHO databases

World Health Organization AFRO

http://www.afro.who.int/en/divisions-a-programmes/dsd/essential-medicines.html


Source of website


� Essential Medicines Price Indicator

General information



o Basis for access



� downloadable pdf document


� English, French (not price document), Portuguese (not price document)









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update website and date of copyright 2009, information on prices dated on September 2007; * Site map/search: site map available on website, search by INN name possible, search results are background information, news events but no links to most recent prices in reports; * Search within prices: price information only available in downloadable pdf document and no search option within this document, essential medicines A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information on Essential Medicines and contact information of WHO AFRO and agencies that provide price information, but not all contact information is still correct (2007 version); * Links: some useful links to other organizations working on essential medicines and to other WHO websites and links to other price reporting websites;


All prices have been converted to the US dollar and the average inter-bank exchange rates for the data collection period were used. The changes in the inter-bank rates can cause prices to vary widely. The most current rate at the time of the analysis should always be used when calculating medicine prices. It should be noted that direct comparison of prices between suppliers for a given product may be unrealistic because of the varying units of presentation and terms and services offered by different suppliers. Similarly units of presentation for some of the products in countries are not specified and vary; therefore direct comparison of prices may not be possible and realistic. Taking this into consideration, all attempts will be made to address this gap in the future edition. When calculating and projecting prices, it is important to consider factors such as delivery times, insurance costs, modes of transport (air/sea/land), handling charges. An analysis of these factors is beyond the scope and intent of the present price indicator. However, it is reasonable for estimation purposes to add 20-30% for shipping costs to FOB prices. Tender prices in CIF or DDP prices do not require adjustment for shipping charges. When using the price indicator for comparison with other prices, or for estimating the total value of a proposed procurement list, it is useful to use an average price. The average price is used primarily for budget estimates. The mean price and the median price are the two types of average prices that can be used. The mean price, the most commonly used average, is the simple average of all prices for a medicine: values are added up and divided by the number of values. The mean price is useful when medicine prices are relatively close and the same type prices are used (FOB, EXW etc.) The median price splits a set of values in half when a series is put in ascending order if there is an odd number of a value in the series. When there is an even number of values in the series, the median is calculated by averaging the two middle values. The median value is likely to be more useful in estimating prices (or comparing with local prices) when there is skewed distribution because, unlike the mean value, the median is not affected by outliers i.e. very high or very low values. WHO AFRO – Essential Medicines Price Indicator


INN name & dosage form & strength X Brand name & manufacturer X Generic products only Packaging specifications & size X INCO term X EXW/FOB Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 09-2007 Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Not included


World Health Organization - Malaria Price Information Services

http://www.who.int/medicines/areas/access/med_prices_malaria/en/index.html


Source of website


� Roll Back Malaria Partnership Secretariat (RBM), WHO, UNICEF, Population

Services International (PSI), and Management Sciences for Health (MSH)

General information



o Basis for access





� English, French









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website but date of copyright 2010, however information on prices dated on September 2004; * Site map/search: site map not available on website, search by INN name possible, search results are background information, news events but no links to most recent prices in reports; * Search within prices: price information only available in downloadable pdf document and no search option within this document, antimalarial medicines A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information on Roll Back Malaria Partnership (RBM) and contact information of all organizations working on this project listed in report (RBM Partnership Secretariat, Malaria Medicines and Supplies Service (MMSS), UNICEF Supply Division, WHO Department Essential Drugs and Medicines Policy (EDM)), but not all contact information is still correct (2004 version); * Links: some useful links to other organizations working on essential medicines but no links to


other price reporting websites; The report provides market information on products reviewed for the prevention, diagnosis and treatment of malaria from 80 manufacturers in 20 countries. It gives purchasers of malaria-related products a range of choices related to suppliers and affordability. This report is the first in a series of annual publications of sources and prices surveys commenced in 2004 by Roll Back Malaria Partnership Secretariat (RBM), WHO, UNICEF, Population Services International (PSI), and Management Sciences for Health (MSH). The report includes sections on antimalarial medicines, mosquito nets, diagnostic tests, insecticides, insecticide spraying equipment, and resistance test kits. The medicines included were selected on the basis of WHO treatment recommendations. The list is not exhaustive but covers the most commonly used antimalarials, with paediatric forms included wherever possible. There is a section on registration status of products. This information will be useful for countries that are in the process of granting market authorization to malaria-related products. Detailed information is provided on the artemisinin-based combination therapy, and on how to place an order for Coartem® through WHO and UNICEF. WHO – Malaria Price Information Services


INN name & dosage form & strength X Brand name & manufacturer X Generic medicines only Packaging specifications & size X INCO term X Amount not specified � EXW,

FOB, FCA Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 09-2004 Date of procurement award X Exchange rate at time of award NA NA Prices in US $ Quality X Pharmacopoeial specifications X Taxes & duties & other charges X Not added fright, insurance,

import duties and taxes


World Health Organization PAHO

http://new.paho.org/hq/index.php?option=com_content&task=view&id=1042&Itemid=988


Source of website


� Procurement and Supply Management

General information



o Basis for access



� 4 downloadable pdf documents with product prices: anti Tuberculosis medicines, anti

Malaria medicines, anti Chagas medicines, antiretrovirals (HIV/AIDS)


� English, Spanish (not price documents)









Author information Disclosure of source, contact information 1 Links Clearly labeled, links to price reporting sites 1 * Update: no information on last update website, price documents last updated April 2009; * Site map/search: site map available on website, search by INN name possible, search results are background information, news events but no links to most recent prices in reports; * Search within prices: price information only available in downloadable pdf document and no search option within this document, essential medicines A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information on Strategic Fund and direct contact information available for price documents author; * Links: useful links to related organizations and governmental authorities and news events, but no links to other price reporting websites; One of the objectives of PAHO Strategic Fund is to promote access to affordable medicines in the Americas region. To this end, as far as possible the Strategic Fund will purchase generic drugs if it is clear that its price is lower. In such cases, participating countries must ensure that products


purchased is consistent with national laws and regulations on patents.

It is recognized that generic drugs represent one of the most efficient cost in the field of public health. In countries like the United States and Canada, although the share of generic drugs in the dollar value of U.S. market as a whole is very small (11% and 15% respectively), almost 50% of prescriptions in both countries are generics. In addition, the WHO report on global drug situation provides important data on the increasing participation of generic drugs on the market in Argentina, Brazil and Mexico. Generic drugs are pharmaceutical products containing the same quantity of the same active ingredients as the original one in which they are based. They begin to be sold after the expiry of the patent or of other exclusive rights, legally obtained from various sources and:

• interchangeable with the original product; • its sale has been approved by national authorities after determining that have the same

quality, safety and efficacy as the original; • are marketed under a non-proprietary name (international nonproprietary name or

another name approved) or a trade name and • can be "branded generics."

According to national legislation, these elements may be different in some countries. For this reason we have introduced the term "proceeds from various sources", which covers both branded generic and unbranded. The basic idea is that, regardless of local variations in the definition, generic drugs are well-known products of proven safety and efficacy WHO PAHO – Procurement and Supply Management


INN name & dosage form & strength X Brand name & manufacturer X Generic products only Packaging specifications & size X Blisters/box INCO term X Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X Updated 04-2009 Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X



http://www.haiweb.org/GlobalDatabase/


Source of website


� WHO/HAI database of medicine prices, availability, affordability and price

components

General information


� Health Action International in collaboration with the World Health Organization

o Basis for access





� English









Author information Disclosure of source, contact information 0 Links Clearly labeled, links to price reporting sites 0 * Update: no information on last update of website in general, price data from time period 2001-2006 depending on survey(last survey December 2006)); * Site map/search: no site map available, search engine provides search on INN name; * Search within prices: search medicines on INN name, query type, strength, dosage form, public sector, private sector, reference data source and survey (author name and publication date listed), but not possible to view entire database (entry in all search fields required); * Download/print version: no download or direct print version available; * Author information: no background information (not even general information on HAI), no contact information listed (not even general contact information); * Links: no useful links, not even a direct link to the main page of HAI, nor links to other price reporting sites; * Important note: very little information given on search results, prices listed in a median price ratio (mpr), 25th percentile price ratio (p25) and 75th percentile price ratio (p75), but not mentioned


in which currency the prices are calculated; MPR isn’t in a currency as it’s a ratio. It is outlined in the manual how a median price ratio is calculated – see * Query type: - Price and availability per medicine or per survey - One survey - Summary data - Affordability per survey or per condition * Sector: - public sector procurement or patient prices - private pharmacies patient prices - other sector patient prices * Reference datasources used in the surveys: - MSH 2001, 2002, 2003, 2004, 2005 - AustralianPBSNov03 - Spain manufacturer's selling prices 2004 Health Action International - Medicine price surveys (multi country price sources)


INN name & dosage form & strength X Brand name & manufacturer X Brand products surveyed’ page Packaging specifications & size X INCO term X Price components page Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 2001 to 2006 (depending on

survey) Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X



http://www.haiweb.org/medicineprices/surveys.php


Source of website


� HAI medicine prices website

General information


� Health Action International

o Basis for access



� downloadable pfd documents with links to country and multi-country price websites

� hyperlink to HAI Global Database (http://www.haiweb.org/GlobalDatabase/)

o Languages available: English




Last update website, site maintenance x Last update price information na � Combined score update 2


Number of clicks to access price information x Search ability within price information na Download / print version price information x � Combined score accessibility of information 1.5



Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 2 * Update: no information on last update of website in general, but news, publications updated monthly; date of price information is not applicable; * Site map/search: no site map available, no search engine available; * Search within prices: search medicines on INN name, query type, strength, dosage form, public sector, private sector, reference data source and survey (author name and publication date listed), but not possible to view entire database (entry in all search fields required); * Download/print version: download version of document with national and multi-country price sources available, but no direct print version; * Author information: background information on surveys listed and easy to access link to the general HAI website with additional author information; * Links: useful links to other national and international price reporting sites and useful links to publications, presentations and survey manuals for price comparison; * Important note: no price information is available on this website, however on this website several useful links to price databases by HAI and price reporting websites of both national and international sources are available


UNICEF

http://www.unicef.org/supply/index_47129.html


Source of website


� Sources and Prices of Selected Medicines for Children

General information


� UNICEF, World Health Organization

o Basis for access





� English, Spanish (not price document), French (not price document), Arabic (not price

document), Chinese (not price document)









Author information Disclosure of source, contact information 2 Links Clearly labeled, links to price reporting sites 1 * Update: last update website 27-04-2010, price document last updated 28 April 2010; * Site map/search: no site map available on website, search by INN name possible, search results are background information, news events but no links to most recent prices in reports; * Search within prices: price information only available in downloadable pdf document and no search option within this document, essential medicines divided into disease categories and within these categories A-Z listed on INN name; * Download/print version: price information only available after downloading report, no direct print version available on website; * Author information: detailed background information (including methods, results, discussion of survey used to collect medicine prices) on report and contact information of responsible department of WHO and UNICEF listed; * Links: useful links to other websites of the United Nations System of Organizations, but no links to other price reporting websites;


UNICEF – Sources and prices of selected medicines for children


INN name & dosage form & strength X Brand name & manufacturer X Generic products only Packaging specifications & size X INCO term X Supplier X Volume purchased X Purchase terms X Payment terms / timelines X Date of price information X 04-2010 Date of procurement award X Exchange rate at time of award X Quality X Pharmacopoeial specifications X Taxes & duties & other charges X


ANNEX XIV: Amitriptyline 25mg cap/tab Table 33: Prices Amitriptyline 25mg cap/tab per country (prices in US$ per cap/tab, excl taxes) Country WHO

Region World Bank Income Category

Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date

Ex-factory / Manufacturer

Procurement Wholesale Reimburse-ment

Retail / Patient

MSH reference price (2008)

NA NA 0.0059 NA

Australia WPRO High-income 0.29-0.41#2 AU$ 1.09 05-2010

Austria EURO High-income 0.054#1

0.054 0.081 € 0.74

03-2010 Brazil AMRO Upper-middle-

income 0.0091#1

BRL 1.68

04-2008 Canada AMRO High-income 0.076 CA$ 1.01

04-2010 Czech Republic EURO High-income 0.026#1 0.036 € 0.76

04-2009 Denmark EURO High-income 0.059#1

0.088-0.14 0.088 € 0.76

05-2010 Finland EURO High-income 0.055 0.096 € 0.73

02-2010 France EURO High-income 0.061#1

0.059 #3 0.091 € 0.76

05-2010 Germany EURO High-income 0.27-0.30 € 0.74

04-2010 Hungary EURO Upper-middle-

income 0.041#1 0.041 0.054 € 0.74

03-2010 India Tamil Nadu

SEARO Low-income 0.0024#1

INR 45.4

03-2010 Iran EMRO Lower-middle-

income 0.0087 IRR 9741

2008-2009 Ireland EURO High-income 0.014 € 0.70

01-2010 Italy EURO High-income 0.063 € 0.74

04-2010


Country WHO Region

World Bank Income Category




Retail / Patient


NA NA 0.0059 NA

Jordan EMRO Lower-middle-income

0.027 0.034 JOD 0.70 #7 Unknown

Latvia EURO Upper-middle-income

0.014 0.029 € 0.70 01-2010

Lithuania EURO Upper-middle-income

0.015#1

0.015 0.029 € 0.68

02-2008 Morocco EMRO Lower-middle-

income 0.076 0.076 MAD 7.69 #7

Unknown Netherlands EURO High-income 0.049-0.058 0.049 € 0.76

05-2010 New Zealand WPRO High-income 0.025#1 NZ$ 1.38

05-2010 Norway EURO High-income 0.061 0.095 0.095 NOK 6.05

05-2010 Oman EMRO Upper-middle-

income 0.096#6

OMR 0.38 04-2010

Poland EURO Upper-middle-income

0.044 € 0.63 07-2008

Portugal EURO High-income 0.016 #4 0.042 € 0.74 04-2010

Slovakia EURO Upper-middle-income

0.029#1 0.039 € 0.69 09-2008

Slovenia EURO High-income 0.054 € 0.74 12-2008

South Africa AFRO Upper-middle-income

0.049#1

0.061 ZAR 7.32

04-2010 Spain EURO High-income 0.059#1

0.072 € 0.76

05-2010


#1 : INCO-term unknown

#2 : Goods and Services Tax (GST) 10%, unknown if included #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 39% of Retail/Patient Price

#5 : VAT/GST varies throughout states in USA, unknown if it is included in price #6 : VAT/GST unknown, unknown if it is included in price

#7 : Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)

Country WHO Region





Retail / Patient


NA NA 0.0059 NA

Sudan EMRO Low-income 0.018#1

NA

2009 Sweden EURO High-income 0.063 0.090 SEK 7.19

05-2010 Tunisia EMRO Lower-middle-

income 0.025 TND 1.22 #7

Unknown United Kingdom NHS eMIT

EURO High-income 0.0087#1

£ 0.66

04/05-2010 United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales

EURO High-income 0.059 £ 0.66 04/05-2010

United States Veterans Affairs

AMRO High-income 0.017#1

NA

2009-2010 United States MEDICAID

AMRO High-income 0.094#5 NA 2009-2010

United States Kentucky MEDICAID


All WHO Regions n = 36

n = 9 n = 6 n = 11 n = 12 n = 21 Median Price 0.041 0.013 0.054 NA 0.054 Mean Price 0.040 0.019 0.042 NA 0.059 Lowest Price 0.015 0.0024 0.014 0.016 0.0087 Highest Price 0.061 0.059 0.063 0.41 0.096 High/Low Ratio 4.1 24.6 4.5 25.6 11.0


Table 34: MSH price ratio Amitriptyline 25mg cap/tab per country Country WHO


Amitriptyline 25mg - MSH price ratio Ex-factory / Manufacturer

Procurement Wholesale Reimburse- ment

Retail / Patient


NA NA 0.0059 = 1.00

Australia WPRO High-income 49.2-69.5#2 Austria EURO High-income 9.15#1

9.15 13.7

Brazil AMRO Upper-middle-income

1.54#1

Canada AMRO High-income 12.9 Czech Republic EURO High-income 4.41#1 6.10 Denmark EURO High-income 10.0#1 14.9-23.7 14.9 Finland EURO High-income 9.32 16.3 France EURO High-income 10.3#1 10.0#3 15.4 Germany EURO High-income 45.8-50.8 Hungary EURO Upper-middle-

income 6.95#1

6.95 9.15

India SEARO Low-income 0.41#1 Iran EMRO Lower-middle-

income 1.47

Ireland EURO High-income 2.37 Italy EURO High-income 10.7 Jordan EMRO Lower-middle-

income 4.58 5.76


2.37 4.92


2.54#1

2.54 4.92

Morocco EMRO Lower-middle-income

12.9 12.9

Netherlands EURO High-income 8.31-9.83 8.31 New Zealand WPRO High-income 4.24#1 Norway EURO High-income 10.3 16.1 16.1


Country WHO Region


Amitriptyline 25mg - MSH price ratio (0.0059 US$ = 1.00) Ex-factory / Manufacturer


Retail / Patient

Oman EMRO Upper-middle-income

16.3#6


7.46

Portugal EURO High-income 2.78#4 7.12 Slovakia EURO Upper-middle-

income 4.92#1

6.61

Slovenia EURO High-income 9.15 South Africa AFRO Upper-middle-

income 8.31#1

10.3

Spain EURO High-income 10.0#1 12.2 Sudan EMRO Low-income 3.05#1 Sweden EURO High-income 10.7 15.3 Tunisia EMRO Lower-middle-

income 4.24

United Kingdom NHS eMIT


United Kingdom Drug Tariff Scotland/ Tariff England&Wales

EURO High-income 10.0



United States MEDICAID





n = 9 n = 6 n = 11 n = 12 n = 21 Median Ratio 6.95 2.21 9.15 NA 9.15 Mean Ratio 6.76 3.23 7.07 NA 10.0 Lowest Ratio 2.54 0.41 2.37 2.78 1.47 Highest Ratio 10.3 10.0 10.7 69.5 16.3 High/Low Ratio 4.1 24.6 4.5 25.6 11.0



#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price

#4 : Reimbursement is 69% of Retail/Patient Price


Table 35: AFRO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1

Amitriptyline 25mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0059) Ex-factory / Manufacturer

Procurement Wholesale Reimbursement Retail / Patient

Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio South Africa 0.049#1 8.31#1 0.061 10.3 n = 1 n = 0 n = 1 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown


Table 36: AMRO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 5



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.0091

#1 1.54#1

Canada 0.076 12.9 United States Veterans Affairs

0.017#1 2.88#1


0.094#2 15.9#2


0.044#2 7.46#2

n = 0 n = 2 n = 0 n = 3 n = 0 Median Price/Ratio NA NA 0.013 2.21 NA NA NA NA NA NA Mean Price/Ratio NA NA 0.013 2.21 NA NA NA NA NA NA Lowest Price/Ratio NA NA 0.0091 1.54 NA NA 0.044 7.461 NA NA Highest Price/Ratio NA NA 0.017 2.88 NA NA 0.094 15.9 NA NA High/Low Ratio NA NA 1.9 1.9 NA NA 2.1 2.1 NA NA #1 : INCO-term unknown #2 : VAT/GST varies throughout states in USA, unknown if it is included in price


Table 37: EMRO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 6



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Iran 0.0087 1.47 Jordan 0.027 4.58 0.034 5.76 Morocco 0.076 12.9 0.076 12.9 Oman 0.096#2 16.3#2 Sudan 0.018#1 3.05#1 Tunisia 0.025 4.24 n = 0 n = 1 n = 1 n = 1 n = 5 Median Price/Ratio NA NA NA NA NA NA NA NA 0.034 5.76 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.048 8.13 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.0087 1.47 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.096 16.3 High/Low Ratio NA NA NA NA NA NA NA NA 11.0 11.0 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price


Table 38: EURO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 21



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.054#1 9.15#1 0.054 9.15 0.081 13.7 Czech Republic 0.026#1 4.41#1 0.036 6.10 Denmark 0.059#1 10.0#1 0.088-

0.14 14.9-23.7

0.088 14.9

Finland 0.055 9.32 0.096 16.3 France 0.061#1 10.3#1 0.059#2 10.0#2 0.091 15.4 Germany 0.27-

0.30 45.8-50.8

Hungary 0.041#1 6.95#1 0.041 6.95 0.054 9.15 Ireland 0.014 2.37 Italy 0.063 10.7 Latvia 0.014 2.37 0.029 4.92 Lithuania 0.015#1 2.54#1 0.015 2.54 0.029 4.92 Netherlands 0.049-

0.058 8.31-9.83

0.049 8.31

Norway 0.061 10.3 0.095 16.1 0.095 16.1 Poland 0.044 7.46 Portugal 0.016#3 2.78#3 0.042 7.12 Slovakia 0.029#1 4.92#1 0.039 6.61 Slovenia 0.054 9.15 Spain 0.059#1 10.0#1 0.072 12.2 Sweden 0.063 10.7 0.090 15.3 United Kingdom NHS eMIT

0.0087#1

1.47#1

United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales

0.059 10.0


WHO Region EURO n = 21



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio n = 7 n = 2 n = 9 n = 7 n = 16 Median Price/Ratio 0.041 6.95 NA NA 0.054 9.15 NA NA 0.059 9.92 Mean Price/Ratio 0.041 6.90 0.034 5.74 0.041 6.99 NA NA 0.063 10.6 Lowest Price/Ratio 0.015 2.54 0.0087 1.47 0.014 2.37 0.016 2.78 0.029 4.92 Highest Price/Ratio 0.061 10.3 0.059 10.0 0.063 10.7 0.30 50.8 0.096 16.3 High/Low Ratio 4.1 4.1 6.8 6.8 4.5 4.5 18.8 18.8 3.3 3.3

#1 : INCO-term unknown #2 : Reimbursement is 65% of Retail/Patient Price #3 : Reimbursement is 69% of Retail/Patient Price


Table 39: SEARO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 1



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio India 0.0024

#1 0.41#1

n = 0 n = 1 n = 0 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown


Table 40: WPRO Region: Price and MSH price ratio Amitriptyline 25mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 0.29 -

0.41#2 49.2-69.5#2

New Zealand 0.025#1 4.24#1 n = 1 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA

#1 : INCO-term unknown #2 : Goods and Services Tax (GST) 10%, unknown if it is included in price


ANNEX XV: Atenolol 50mg cap/tab Table 41: Prices Atenolol 50mg cap/tab per country (prices in US$ per cap/tab, excl taxes) Country WHO


Atenolol 50mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date



Retail / Patient


NA NA 0.016 NA

Australia WPRO High-income 0.31 - 0.41 #2 AU$ 1.09 05-2010

Austria EURO High-income 0.14 #1

0.16

0.22

€ 0.74 03-2010

Bahrain EMRO High-income 0.27 #7

BHD 0.37 #10 Unknown

Belgium EURO High-income 0.041-0.062 #3 € 0.74 03-2010

Brazil AMRO Upper-middle-income

0.0074 #1

BRL 1.68

04-2008 Canada AMRO High-income 0.26

CA$ 1.01

04-2010 Czech Republic EURO High-income 0.072

€ 0.76 04-2009

Denmark EURO High-income 0.014 #1

0.042-0.13

0.042

€ 0.76 05-2010

Finland EURO High-income 0.082

0.14

€ 0.73 02-2010

France EURO High-income 0.092 #1

0.086-0.093 #4

0.14

€ 0.76 05-2010

Germany EURO High-income 0.24-0.38

€ 0.74 04-2010

Hungary EURO Upper-middle-income

0.027 #1 0.033 0.041

€ 0.74 03-2010

India Tamil Nadu

SEARO Low-income 0.0019 #1

INR 45.4


income

0.011 IRR 9741

2008-2009


Country WHO Region





Retail / Patient


NA NA 0.016

Ireland EURO High-income 0.20

€ 0.70 01-2010

Italy EURO High-income 0.15

€ 0.74 04-2010


0.089

0.12

JOD 0.70 #10 Unknown


0.043

0.067

€ 0.70 01-2010

Lebanon EMRO Upper-middle-income

0.10 #8

LBP 1489 03-2010


0.044 #1

0.049

0.056

€ 0.68 02-2008

Netherlands EURO High-income 0.087-0.090

0.087

€ 0.76 05-2010

New Zealand WPRO High-income 0.0090#1 NZ$ 1.38 05-2010

Norway EURO High-income 0.055

0.069-0.090

0.069

NOK 6.05 05-2010


0.084 #9

OMR 0.38 04-2010


0.030

€ 0.63 07-2008

Portugal EURO High-income 0.049-0.072 #5

0.071

€ 0.74 04-2010


0.043 #1 0.058

€ 0.69 09-2008

Slovenia EURO High-income 0.11

€ 0.74 12-2008


0.038 #1

0.061

ZAR 7.32

04-2010



#2 : Goods and Services Tax (GST) 10%, unknown if included #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price #5 : Reimbursement is 69% of Retail/Patient Price

#6 : VAT/GST varies throughout states in USA, unknown if included

#7 : VAT/GST unknown, unknown if it is included in price #8: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #9 : VAT/GST unknown, unknown if it is included in price

#10: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)

Country WHO Region





Retail / Patient


NA NA 0.016

Spain EURO High-income 0.051 #1

0.062

€ 0.76 05-2010

Sudan EMRO Low-income 0.066 #1

NA

2009 Sweden EURO High-income 0.017

0.058

SEK 7.19 05-2010


EURO High-income 0.0065 #1

£ 0.66


EURO High-income

0.054 £ 0.66

04/05-2010


AMRO High-income 0.0083 #1

NA




AMRO High-income 0.035 #6 NA 2009-2010


n = 8 n = 6 n = 11 n = 12 n = 21 Median Price 0.044 0.0079 0.058 NA 0.072 Mean Price 0.056 0.017 0.078 NA 0.093 Lowest Price 0.0090 0.0019 0.017 0.035 0.011 Highest Price 0.14 0.066 0.20 0.41 0.27 High/Low Ratio 15.6 34.7 11.8 11.7 24.5


Table 42: MSH price ratio Atenolol 50mg cap/tab per country Country WHO

Region World Bank Category

Atenolol 50mg - MSH price ratio Ex-factory / Manufacturer


Retail / Patient


NA NA 0.0161 = 1.00

Australia WPRO High-income 19.3-25.5 #2 Austria EURO High-income 8.70 #1 9.94 13.7 Bahrain EMRO High-income 16.8 #7 Belgium EURO High-income 2.55-3.85 #3 Brazil AMRO Upper-middle-

income 0.46 #1

Canada AMRO High-income 16.1 Czech Republic EURO High-income 4.47 Denmark EURO High-income 0.87 #1 2.61-8.07 2.61 Finland EURO High-income 5.09 9.32 France EURO High-income 5.71 #1 5.34-5.78 #4 8.70 Germany EURO High-income 14.9-23.6 Hungary EURO Upper-middle-

income 1.68 #1

2.05 2.55

India Tamil Nadu

SEARO Low-income 0.12 #1

Iran EMRO Lower-middle-income

0.68


income 5.53 7.45


2.67 4.16


6.21


2.73 #1

3.04 3.48

Netherlands EURO High-income 5.40-5.59 5.40


Country WHO Region

World Bank Category

Atenolol 50mg - MSH price ratio (0.0161 US$ = 1.00) Ex-factory / Manufacturer


Retail / Patient

New Zealand WPRO High-income 0.56#1 Norway EURO High-income 3.42 4.29-5.59 4.29 Oman EMRO Upper-middle-

income 5.22 #8


1.86

Portugal EURO High-income 3.04-4.47#5 4.41 Slovakia EURO Upper-middle-

income 2.67 #1 3.60


income 2.36 #1 3.79

Spain EURO High-income 3.17 #1 3.85 Sudan EMRO Low-income 4.10 #1 Sweden EURO High-income 1.06 3.60 United Kingdom NHS eMIT

EURO High-income 0.40 #1













#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price



#8 : VAT/GST unknown, unknown if it is included in price

Table 43: AFRO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1

Atenolol 50mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0161) Ex-factory / Manufacturer


Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio South Africa 0.038 2.36 0.061 3.79 n = 1 n = 0 n = 1 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA


Table 44: AMRO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 5




#1 0.46#1


0.0083#1

0.52#1


0.050#2 3.11#2


0.035#2 2.17#2

n = 0 n = 2 n = 0 n = 3 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA 0.0079 0.49 NA NA NA NA NA NA Lowest Price/Ratio NA NA 0.0074 0.46 NA NA 0.035 2.17 NA NA Highest Price/Ratio NA NA 0.0083 0.52 NA NA 0.26 16.1 NA NA High/Low Ratio NA NA 1.1 1.1 NA NA 7.4 7.4 NA NA #1 : INCO-term unknown #2 : VAT/GST varies throughout states in USA, unknown if it is included in price


Table 45: EMRO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 6



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Bahrain 0.27#2 16.8#2 Iran 0.011 0.68 Jordan 0.089 5.53 0.12 7.45 Lebanon 0.10 6.21 Oman 0.084#2 5.22#2 Sudan 0.066#1 4.10#1 n = 0 n = 1 n = 1 n = 0 n = 5 Median Price/Ratio NA NA NA NA NA NA NA NA 0.10 6.21 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.12 7.27 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.011 0.68 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.27 16.8 High/Low Ratio NA NA NA NA NA NA NA NA 24.5 24.5 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price


Table 46: EURO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 22



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.14#1 8.70#1 0.16 9.94 0.22 13.7 Belgium 0.041-

0.062#2 2.55-3.85#2

Czech Republic 0.072 4.47 Denmark 0.014#1 0.87#1 0.042-

0.13 2.61-8.07

0.056 2.61

Finland 0.082 5.09 0.15 9.32 France 0.092#1 5.71#1 0.086-

0.093#3 5.34-5.78#3

0.14 8.70

Germany 0.24-0.38

14.9-23.6


0.090 5.40-5.59

0.087 5.40

Norway 0.055 3.42 0.069-0.090

4.29-5.59

0.069 4.29

Poland 0.030 1.86 Portugal 0.049-

0.072#4 3.04-4.47#4

0.071 4.41

Slovakia 0.043#1 2.67#1 0.058 3.60 Slovenia 0.11 6.83 Spain 0.051#1 3.17#1 0.062 3.85 Sweden 0.017 1.06 0.058 3.60 United Kingdom NHS eMIT

0.0065#1

0.40#1



0.054 3.35

Ex-factory /

Manufacturer Procurement Wholesale Reimbursement Retail / Patient

n = 6 n = 2 n = 9 n = 8 n = 16 Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Median Price/Ratio 0.048 2.95 NA NA 0.055 3.42 NA NA 0.068 4.22 Mean Price/Ratio 0.066 4.11 0.010 0.64 0.083 5.16 NA NA 0.087 5.40 Lowest Price/Ratio 0.027 1.68 0.0065 0.40 0.017 1.06 0.041 2.55 0.030 1.86 Highest Price/Ratio 0.14 8.70 0.014 0.87 0.20 12.4 0.38 23.6 0.22 13.7 High/Low Ratio 5.2 5.2 2.2 2.2 11.8 11.8 9.3 9.3 7.3 7.3

#1 : INCO-term unknown #2 : Value Added Tax (VAT) 12%, unknown if it is included in price

#3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 69% of Retail/Patient Price


Table 47: SEARO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 1



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio India Tamil Nadu

0.0019#1

0.12#1



Table 48: WPRO Region: Price and MSH price ratio Atenolol 50mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 0.31 -

0.41#2 19.3-25.5#2




ANNEX XVI: Ciprofloxacin 500mg cap/tab Table 49: Prices Ciprofloxacin 500mg cap/tab per country (prices in US$ per cap/tab, excl taxes)

Country WHO Region

World Bank Category

Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date



Retail / Patient


NA NA 0.0372 NA

Australia

WPRO High-income 1.02#2

AU$ 1.09

05-2010 Austria EURO High-income 1.14#1

1.27 1.71 € 0.74

03-2010 Bahrain EMRO High-income 0.98 #7 BHD 0.37 #10

unknown Belgium EURO High-income 0.44-0.48 #3 € 0.74


income 0.052 #1

BRL 1.68


CA$ 1.01

04-2010 Czech Republic EURO High-income 0.32 € 0.76

04-2009 Denmark EURO High-income 0.24 #1

0.32 € 0.76



1.04 #4 1.60 € 0.76



income 0.35#1 0.38 0.47 € 0.74


SEARO Low-income 0.019#1 INR 45.4 03-2010

India NPPA

SEARO Low-income 0.13 INR 45.4


03-2010 Country WHO





Retail / Patient


NA NA 0.0372 NA


0.087

IRR 9741 2008-2009

Ireland EURO High-income 1.47 € 0.70 01-2010

Italy EURO High-income 1.51 € 0.74 04-2010


0.39 0.50 JOD 0.70 #10 unknown


0.49 0.61 € 0.70 01-2010


0.45 #8

LBP 1489 03-2010


0.46#1

0.50 0.59 € 0.68


income 0.94-1.02 0.94 MAD 7.69 #10

unknown Netherlands EURO High-income 0.14-0.15 0.14 € 0.76


05-2010 Norway EURO High-income 1.22

0.83-0.89 1.24 NOK 6.05


income 0.46#9

OMR 0.38 04-2010


0.38 € 0.63 07-2008



0.42#1 0.61 € 0.69 09-2008



#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price

#3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price

Country WHO Region

World Bank Category



Wholesale Reimburse-ment

Retail / Patient


NA NA 0.0372 NA



0.19#1

0.24 ZAR 7.32


0.27 € 0.76

05-2010 Sudan EMRO Low-income 0.15#1

NA



income 0.53 TND 1.22 #11

unknown United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales

EURO High-income 0.11 £ 0.66 04/05-2010



£ 0.66

04/05-2010 United States Veterans Affairs


NA




n = 8 n = 6 n = 11 n = 11 n = 24 Median Price 0.39 0.055 0.49 NA 0.49

Mean Price 0.49 0.094 0.65 NA 0.64 Lowest Price 0.10 0.019 0.083 0.11 0.087 Highest Price 1.14 0.24 1.47 1.65 1.71 High/Low Ratio 11.4 12.6 17.7 15.0 19.7




#8: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price




Table 50: MSH price ratio Ciprofloxacin 500mg cap/tab per country Country pppWH

O Region

World Bank Category

Ciprofloxacin 500mg Ex-factory / Manufacturer


Retail / Patient


NA NA 0.0372 = 1.00

Australia



34.1 45.9

Bahrain EMRO High-income 26.3#7 Belgium EURO High-income 11.8-12.9#3 Brazil AMRO Upper-middle-

income 1.40#1

Canada AMRO High-income 30.6

Czech Republic EURO High-income 8.60 Denmark EURO High-income 6.45 #1

8.60

Finland EURO High-income 2.58 5.11 France EURO High-income 28.5#1

28.0 #4 43.0

Germany EURO High-income 32.3-44.4 Hungary EURO Upper-middle-

income 9.41#1 10.2 12.6

India Tamil Nadu


India NPPA

SEARO Low-income 3.49


2.34


income 10.5 13.4


Country WHO Region

World Bank Category

Ciprofloxacin 500mg (0.0372 US$ = 1.00) Ex-factory / Manufacturer


Retail / Patient


13.2 16.4


12.1#8


12.4#1

13.4 15.9


25.3-27.4 25.3

Netherlands EURO High-income 3.76-4.03 3.76 New Zealand WPRO High-income 2.69#1 Norway EURO High-income 32.8

22.3-23.9 33.3


12.4#9


10.2


income 11.3#1 16.4


income 5.11#1

6.45

Spain EURO High-income 4.57#1

7.26


Sweden EURO High-income 2.23 7.80 Tunisia EMRO Lower-middle-

income 14.2





#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price #5 : Reimbursement is 69% of Retail/Patient Price

#6 : VAT/GST varies throughout states in USA, unknown if it is included in price


#8: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #9 : VAT/GST unknown, unknown if it is included in price


Country WHO Region

World Bank Category

Ciprofloxacin 500mg (0.0372 US$ = 1.00) Ex-factory / Manufacturer


Retail / Patient










Table 51: AFRO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1

Ciprofloxacin 500mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0372) Ex-factory / Manufacturer




Table 52: AMRO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 4



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.052#1 1.40#1 Canada 1.14 30.6 United States Veterans Affairs

0.058#1 1.56#1


0.45#2 12.1#2



Table 53: EMRO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 8



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Bahrain 0.98#2 26.3#2 Iran 0.087 2.34

Jordan 0.39 10.5 0.50 13.4 Lebanon 0.45#3 12.1#3 Morocco 0.94-

1.02 25.3-27.4

0.94 25.3

Oman 0.46#2 12.4#2 Sudan 0.15#1 4.03#1 Tunisia 0.53 14.2 n = 0 n = 1 n = 1 n = 1 n = 7 Median Price/Ratio NA NA NA NA NA NA NA NA 0.50 13.4 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.56 15.2 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.087 2.34 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.98 26.3 High/Low Ratio NA NA NA NA NA NA NA NA 11.3 11.3 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price

#3: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price


Table 54: EURO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 22




0.48#2 11.8-12.9#2

Czech Republic 0.32 8.60 Denmark 0.24#1 6.45 #1 0.32 8.60 Finland 0.096 2.58 0.19 5.11 France 1.06#1 28.5#1 1.04#3 28.0#3 1.60 43.0 Germany 1.20-

1.65 32.3-44.4


0.15 3.76-4.03

0.14 3.76

Norway 1.22 32.8 0.83-0.89

22.3-23.9

1.24 33.3

Poland 0.38 10.2 Portugal 0.68#4 18.3#4 0.99 26.6 Slovakia 0.42#1 11.3#1 0.61 16.4 Slovenia 1.04 27.9 Spain 0.17#1 4.57#1 0.27 7.26 Sweden 0.083 2.23 0.29 7.80 United Kingdom NHS eMIT

0.044#1 1.18#1


0.11 2.96


Ex-factory /

Manufacturer Procurement Wholesale Reimbursement Retail / Patient

n = 6 n = 2 n = 9 n = 7 n = 16 Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Median Price/Ratio 0.44 11.8 NA NA 0.50 13.4 NA NA 0.53 14.2 Mean Price/Ratio 0.60 16.1 0.14 3.82 0.73 19.6 NA NA 0.71 18.9 Lowest Price/Ratio 0.17 4.57 0.044 1.18 0.083 2.23 0.11 2.96 0.14 3.76 Highest Price/Ratio 1.14 30.6 0.24 6.45 1.47 39.5 1.65 44.4 1.71 45.9 High/Low Ratio 6.71 6.71 5.45 5.45 17.7 17.7 15.0 15.0 12.2 12.2 #1 : INCO-term unknown #2 : Value Added Tax (VAT) 12%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 69% of Retail/Patient Price


Table 55: SEARO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 2




0.019#1 0.51#1

India NPPA

0.13 3.49



Table 56: WPRO Region: Price and MSH price ratio Ciprofloxacin 500mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 1.02#2 27.4#2 New Zealand 0.10#1 2.69#1 n = 1 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA



ANNEX XVII: Glibenclamide 5mg cap/tab Table 57: Prices Glibenclamide 5mg cap/tab per country (prices in US$ per cap/tab, excl taxes)

Country WHO Region

World Bank Category

Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date



Retail / Patient


NA NA 0.0045 NA

Australia

WPRO High-income 0.12-0.15#2

AU$ 1.09


0.11 0.16 € 0.74

03-2010 Bahrain EMRO High-income 0.23 #6 BHD 0.37 #8

unknown Brazil AMRO Upper-middle-

income 0.0078#1

BRL 1.68


CA$ 1.01

04-2010 Czech Republic EURO High-income 0.013#1 0.013 € 0.76


0.057#3 0.087 € 0.76





0.010

IRR 9741 2008-2009




0.036 0.046 JOD 0.70 #8 unknown


0.014#1

0.015 0.015 € 0.68

02-2008


Country WHO Region

World Bank Category




Retail / Patient


NA NA 0.0045 NA


0.061-0.10 0.061 MAD 7.69 #8 unknown

Netherlands EURO High-income 0.080-0.082 0.080 € 0.76 05-2010


0.052#7

OMR 0.38 04-2010


0.015 € 0.63 07-2008



0.014#1 0.015 € 0.69 09-2008

Slovenia EURO High-income 0.080#1 0.081 0.15 € 0.74 12-2008


0.021#1

0.028 ZAR 7.32


0.031 € 0.76


NA

2009 Tunisia EMRO Lower-middle-

income 0.033 TND 1.22 #8

unknown United Kingdom NHS eMIT


£ 0.66

04/05-2010 United Kingdom Drug Tariff Scotland / Drug Tariff England&Wales

EURO High-income 0.055 £ 0.66 04/05-2010



NA

2009-2010



#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 95% of Retail/Patient Price



#7: VAT/GST unknown, unknown if it is included in price


Country WHO Region

World Bank Category




Retail / Patient


NA NA 0.0045 NA









Table 58: MSH price ratio Glibenclamide 5mg cap/tab per country Country WHO


Glibenclamide 5mg Ex-factory / Manufacturer


Retail / Patient


NA NA 0.0045 = 1.00

Australia



24.4 35.6

Bahrain EMRO High-income 51.1#6 Brazil AMRO Upper-middle-

income 1.73#1


Czech Republic EURO High-income 2.89#1 2.89 France EURO High-income 13.6#1

12.7#3 19.3

Germany EURO High-income 44.4-48.9 India Tamil Nadu



2.22


income 8.00 10.2


3.11#1

3.33 3.33


13.6-22.2 13.6

Netherlands EURO High-income 17.8-18.2 17.8 Oman EMRO Upper-middle-

income 11.6#7

Poland EURO Upper-middle-

income 3.33


Country WHO Region

World Bank Category

Glibenclamide 5mg Ex-factory / Manufacturer


Retail / Patient


NA NA 0.0045 = 1.00


income 3.11#1 3.33

Slovenia EURO High-income 17.8#1 18.0 33.3 South Africa AFRO Upper-middle-

income 4.67#1

6.22


6.89


Tunisia EMRO Lower-middle-income

7.33



United Kingdom Drug Tariff Scotland / Drug Tariff England&Wales














#7: VAT/GST unknown, unknown if it is included in price

Table 59: AFRO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1

Glibenclamide 5mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0045) Ex-factory / Manufacturer




Table 60: AMRO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 5




#1 1.73#1


0.018#1 4.00#1


0.28#2 62.2#2


0.19#2 42.2#2



Table 61: EMRO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 7




Jordan 0.036 8.00 0.046 10.2 Morocco 0.061-

0.10 13.6-22.2

0.061 13.6



Table 62: EURO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 15



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.094#1 20.9#1 0.11 24.4 0.16 35.6 Czech Republic 0.013#1 2.89#1 0.013 2.89 France 0.061#1 13.6#1 0.057#2 12.7#2 0.087 19.3 Germany 0.20-

0.22 44.4-48.9

Ireland 0.10 22.2 Italy 0.12 26.7 Lithuania 0.014#1 3.11#1 0.015 3.33 0.015 3.33 Netherlands 0.080-

0.082 17.8-18.2

0.080 17.8

Poland 0.015 3.33 Portugal 0.064#3 14.2#3 0.067 14.9 Slovakia 0.014#1 3.11#1 0.015 3.33 Slovenia 0.080#1 17.8#1 0.081 18.0 0.15 33.3 Spain 0.020#1 4.44#1 0.031 6.89 United Kingdom NHS eMIT

0.0087#1

1.93#1


0.055 12.2

n = 7 n = 1 n = 4 n = 5 n = 11 Median Price/Ratio 0.020 4.44 NA NA 0.091 20.1 NA NA 0.067 14.9 Mean Price/Ratio 0.042 9.40 NA NA 0.077 17.0 NA NA 0.069 15.3 Lowest Price/Ratio 0.013 2.89 NA NA 0.015 3.33 0.055 12.2 0.013 2.89 Highest Price/Ratio 0.094 20.9 NA NA 0.11 24.4 0.22 48.9 0.16 35.6 High/Low Ratio 7.2 7.2 NA NA 7.3 7.3 4.0 4.0 12.3 12.3 #1 : INCO-term unknown #2 : Reimbursement is 65% of Retail/Patient Price



Table 63: SEARO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 1




0.00073#1

0.16#1



Table 64: WPRO Region: Price and MSH price ratio Glibenclamide 5mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 1



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 0.12-

0.15#1 26.7-33.3#1

n = 0 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA

#1 : Goods and Services Tax (GST) 10%, unknown if it is included in price


ANNEX XVIII: Omeprazole 20mg cap/tab Table 65: Prices Omeprazole 20mg cap/tab per country (prices in US$ per cap/tab, excl taxes)

Country WHO Region

World Bank Category

Omeprazole 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date



Retail / Patient


NA NA 0.0328 NA

Australia


AU$ 1.09


0.41 0.55 € 0.74

03-2010 Bahrain EMRO High-income 0.69#7 BHD 0.37 #8

unknown Belgium EURO High-income 0.13-0.19#3 € 0.74


income 0.027#1

BRL 1.68


CA$ 1.01


04-2009 Denmark EURO High-income 0.047#1

0.076-0.16 0.076 € 0.76



0.49#4 0.74 € 0.76



income 0.47#1 0.50 0.61 € 0.74




Country WHO Region

World Bank Category




Retail / Patient


NA NA 0.0328 NA


0.069 IRR 9741 2008-2009




0.54 0.68 JOD 0.70 #8 unknown


0.28 0.36 € 0.70 01-2010


0.21#1

0.22 0.26 € 0.68


income 0.31-1.66 0.31 MAD 7.69 #8




0.24-0.63 0.24 NOK 6.05


income 0.39#7

OMR 0.38 04-2010


0.40 € 0.63 07-2008

Portugal EURO High-income 0.41#5 0.59 € 0.74 04-2010


0.11#1 0.17 € 0.69 09-2008

Slovenia EURO

High-income 0.54 € 0.74 12-2008


Country WHO





Retail / Patient


NA NA 0.0328 NA


0.45#1

0.61 ZAR 7.32


0.14 € 0.76


NA



income 0.58 TND 1.22 #8



£ 0.66


EURO High-income 0.11 £ 0.66 04/05-2010



NA

2009-2010 United States Kentucky MEDICAID








#6: VAT/GST varies throughout states in USA, unknown if it is included in price #7 : VAT/GST unknown, unknown if it is included in price #8: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)


Table 66: MSH price ratio Omeprazole 20mg cap/tab per country Country WHO


Omeprazole 20mg Ex-factory / Manufacturer


Retail / Patient


NA NA 0.0328 = 1.00

Australia



12.5 16.8

Bahrain EMRO High-income 21.0#7 Belgium EURO High-income 3.96-5.79#3 Brazil AMRO Upper-middle-

income 0.82#1


Czech Republic EURO High-income 7.32 Denmark EURO High-income 1.43#1

2.32-4.88 2.32


14.9#4 22.6


income 14.3#1 15.2 18.6

India Tamil Nadu



2.10


income 16.5 20.7


8.54 11.0


Country WHO Region

World Bank Category



Retail / Patient


NA NA 0.0328 = 1.00


6.40#1

6.71 7.93


9.45-50.6 9.45

Netherlands EURO High-income 1.01-2.65 1.01 New Zealand WPRO High-income 1.86#1 Norway EURO High-income 6.10

7.32-19.2 7.32


11.9#8


12.2


income 3.35#1 5.18


income 13.7#1

18.6


4.27



income 17.7











Country WHO Region

World Bank Category



Retail / Patient


NA NA 0.0328 = 1.00








Table 67: AFRO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1

Omeprazole 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0328) Ex-factory / Manufacturer




Table 68: AMRO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 4




0.14#1 4.27#1


0.27#2 8.23#2



Table 69: EMRO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 7




Jordan 0.54 16.5 0.68 20.7 Morocco 0.31-

1.66 9.45-50.6

0.31 9.45



Table 70: EURO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 22




0.19#2 3.96-5.79#2

Czech Republic 0.24 7.32 Denmark 0.047#1 1.43 #1 0.076-

0.16 2.32-4.88

0.076 2.32


1.09 11.9-33.2


0.087 1.01-2.65

0.033 1.01

Norway 0.20 6.10

0.24-0.63

7.32-19.2

0.24 7.32

Poland 0.40 12.2 Portugal 0.41#4 12.5#4 0.59 18.0 Slovakia 0.11#1 3.35#1 0.17 5.18 Slovenia 0.54 16.5 Spain 0.089#1 2.71#1 0.14 4.27 Sweden 0.035 1.07 0.076 2.32 United Kingdom NHS eMIT

0.040#1 1.22#1





Price Ratio Price Ratio Price Price Ratio Price Ratio Price United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales

0.11 3.35

n = 6 n = 2 n = 9 n = 8 n = 16 Median Price/Ratio 0.29 8.69 NA NA 0.28 8.54 NA NA 0.26 7.93 Mean Price/Ratio 0.27 8.38 0.044 1.33 0.38 11.5 NA NA 0.34 10.4 Lowest Price/Ratio 0.089 2.71 0.040 1.22 0.035 1.07 0.033 1.01 0.033 1.01 Highest Price/Ratio 0.47 14.3 0.047 1.43 1.07 32.6 1.09 33.2 0.74 22.6 High/Low Ratio 5.3 5.3 1.2 1.2 30.6 30.6 33.0 33.0 22.4 22.4 #1 : INCO-term unknown #2 : Value Added Tax (VAT) 12%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 69% of Retail/Patient Price


Table 71: SEARO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 1




0.0050#1

0.15#1



Table 72: WPRO Region: Price and MSH price ratio Omeprazole 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2




1.02#2 28.4-31.1#2




ANNEX XIX: Salbutamol inhaler 100mcg/dose Table 73: Prices Salbutamol inhaler 100mcg/dose dose per country (prices in US$ per dose, excl taxes)

Country WHO Region

World Bank Category

Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes) Exchange rate used ($1,00=x) Price date



Retail / Patient


NA NA 0.0090 NA

Australia


AU$ 1.09


0.014 0.027 € 0.74

03-2010 Bahrain EMRO High-income 0.024#5 BHD 0.37 #7

unknown Brazil AMRO Upper-middle-

income 0.013 #1

BRL 1.68


CA$ 1.01

04-2010 Czech Republic EURO High-income 0.013 #1

€ 0.76


0.080-0.090 0.080 € 0.76



0.021#3 0.032 € 0.76



income

0.013 0.014 € 0.74 03-2010

India NPPA

SEARO Low-income 0.0047 INR 42.8 05-2008


0.013 IRR 9741

2008-2009 Ireland EURO High-income 0.014 € 0.70

01-2010


Country WHO





Retail / Patient


NA NA 0.0090 NA



0.0060 0.0076 JOD 0.70 #7 unknown


0.014 0.014 € 0.70 01-2010


0.014#1

0.015 0.015 € 0.68


income 0.023-0.032 0.023 MAD 7.69 #7




0.034-0.12 0.034 NOK 6.05


income 0.0041#6

OMR 0.38 04-2010


0.047 € 0.63 07-2008



0.014#1 0.015 € 0.69 09-2008

Slovenia EURO High-income 0.013#1 0.014 0.027 € 0.74 12-2008


0.013#1

0.015 ZAR 7.32


0.021 € 0.76

05-2010






#7 : Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)

Country WHO Region

World Bank Category




Retail / Patient


NA NA 0.0090 NA


NA

2009 United Kingdom NHS eMIT


£ 0.66

04/05-2010 United Kingdom Drug Tariff Scotland

EURO High-income 0.011 £ 0.66 04/05-2010

United Kingdom Drug Tariff England&Wales

EURO High-income 0.026 £ 0.66 04/05-2010





Table 74: MSH price ratio Salbutamol inhaler 100mcg/dose per country Country WHO


Salbutamol inhaler 100mcg/dose Ex-factory / Manufacturer


Retail / Patient


NA NA 0.0090

Australia



1.56 3.00

Bahrain EMRO High-income 2.67#5 Brazil AMRO Upper-middle-

income 1.44#1


Czech Republic EURO High-income 1.44#1

Denmark EURO High-income 7.22 #1

8.89-10.0 8.89


2.33#3 3.56


income

1.44 1.56

India NPPA

SEARO Low-income 0.52


1.44


income 0.67 0.84


1.56 1.56


Country WHO Region

World Bank Category

Salbutamol inhaler 100mcg/dose Ex-factory / Manufacturer


Retail / Patient


NA NA 0.0090


1.56#1

1.67 1.67


2.56-3.56 2.56

Netherlands EURO High-income 0.82-1.33 0.82 New Zealand WPRO High-income 1.33# Norway EURO High-income 1.78

3.78-13.3 3.78


0.46#6


5.22

Portugal EURO High-income 1.00 #4 1.44 Slovakia EURO Upper-middle-

income 1.56#1 1.67

Slovenia EURO High-income 1.44#1 1.57 3.00 South Africa AFRO Upper-middle-

income 1.44#1

1.67


2.33




United Kingdom Drug Tariff Scotland






#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price







Retail / Patient



Table 75: AFRO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region AFRO n = 1

Salbutamol inhaler 100mcg/dose (prices in US$ per dose, excl taxes; MSH reference price US$ 0.0090) Ex-factory / Manufacturer




Table 76: AMRO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region AMRO n = 2



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Brazil 0.013#1 1.44#1 Canada 0.029 3.22 n = 0 n = 1 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA #1 : INCO-term unknown


Table 77: EMRO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region EMRO n = 6




Jordan 0.0060 0.667 0.0076 0.844 Morocco 0.023-

0.032 2.56-3.56

0.023 2.56

Oman 0.0041#2

0.456#2

Sudan 0.019#1 2.11#1 n = 0 n = 1 n = 1 n = 1 n = 5 Median Price/Ratio NA NA NA NA NA NA NA NA 0.013 1.44 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.014 1.59 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.0041 0.456 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.024 2.67 High/Low Ratio NA NA NA NA NA NA NA NA 5.9 5.9 #1 : INCO-term unknown #2 : VAT/GST unknown, unknown if it is included in price


Table 78: EURO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region EURO n = 21



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.013#1 1.44#1 0.014 1.56 0.027 3.00 Czech Republic 0.013#1 1.44#1 Denmark 0.065#1 7.22 #1 0.080-

0.090 8.89-10.0

0.080 8.89


0.11 6.67-12.2

Hungary 0.013 1.44 0.014 1.56 Ireland 0.014 1.56 Italy 0.019 2.11 Latvia 0.014 1.56 0.014 1.56 Lithuania 0.014#1 1.56#1 0.015 1.67 0.015 1.67 Netherlands 0.0074-

0.012 0.82-1.33

0.0074 0.82

Norway 0.016 1.78 0.034-0.12

3.78-13.3

0.034 3.78

Poland 0.047 5.22 Portugal 0.0093 1.00#3 0.013 1.44 Slovakia 0.014#1 1.56#1 0.015 1.67 Slovenia 0.013#1 1.44#1 0.014 1.56 0.027 3.00 Spain 0.013#1 1.44#1 0.021 2.33 United Kingdom NHS eMIT

0.0078#1

0.87#1

United Kingdom Drug Tariff Scotland

0.011 1.22


0.026 2.89





n = 7 n = 2 n = 8 n = 8 n = 15 Median Price/Ratio 0.013 1.44 NA NA 0.014 1.56 NA NA 0.021 2.33 Mean Price/Ratio 0.015 1.62 0.036 4.04 0.014 1.58 NA NA 0.026 2.93 Lowest Price/Ratio 0.013 1.44 0.0078 0.87 0.013 1.44 0.0074 0.82 0.0074 0.82 Highest Price/Ratio 0.022 2.44 0.065 7.22 0.016 1.78 0.12 13.3 0.080 8.89 High/Low Ratio 1.7 1.7 8.3 8.3 1.2 1.2 16.2 16.2 10.8 10.8 #1 : INCO-term unknown #2 : Reimbursement is 65% of Retail/Patient Price #3 : Reimbursement is 69% of Retail/Patient Price


Table 79: SEARO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region SEARO n = 1



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio India NPPA

0.0047 0.522

n = 0 n = 0 n = 0 n = 0 n = 1 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA


Table 80: WPRO Region: Price and MSH price ratio Salbutamol inhaler 100mcg/dose dose (prices in US$ per dose, excl taxes) WHO Region WPRO n = 2




0.092#2 8.33-10.2#2




ANNEX XX: Simvastatin 20mg cap/tab Table 81: Prices Simvastatin 20mg cap/tab per country (prices in US$ per cap/tab, excl taxes) Country WHO


Simvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date



Retail / Patient


NA NA 0.0629 (only IDA) NA

Australia


AU$ 1.09


0.27 0.38 € 0.74

03-2010 Belgium EURO High-income 0.068 - 0.11 #3 € 0.74


income 0.028 #1

BRL 1.68


CA$ 1.01



0.045 - 0.098 0.045 € 0.76



0.33 #4 0.51 € 0.76



income 0.23#1 0.27 0.38 € 0.74


income 0.10

IRR 9741 2008-2009




Country WHO Region

World Bank Category

Simvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date



Retail / Patient




0.45 0.56 JOD 0.70 #9 unknown


0.12 0.16 € 0.70 01-2010


0.55 #7

LBP 1489 03-2010


0.24#1

0.26 0.31 € 0.68


income 0.33 - 0.69 0.33 MAD 7.69 #9

unknown Netherlands EURO High-income 0.015 - 0.077 0.015 € 0.76


05-2010 Norway EURO High-income 0.29 0.22 - 0.23 0.35 NOK 6.05


income 0.54#8

OMR 0.38 04-2010


0.27 € 0.63 07-2008

Portugal EURO High-income 0.29-0.32 #5 0.47 € 0.74 04-2010


0.14#1 0.21 € 0.69 09-2008



0.10#1

0.14 ZAR 7.32


0.15 € 0.76

05-2010 Country WHO World Bank Simvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate



#2 : Goods and Services Tax (GST) 10%, unknown if included #3 : Value Added Tax (VAT) 12%, unknown if it is included in price #4 : Reimbursement is 65% of Retail/Patient Price #5 : Reimbursement is 69% of Retail/Patient Price

#6 : VAT/GST varies throughout states in USA, unknown if included

#7: VAT 10%, unknown if included; pharmacist margin US$ 0.0155, unknown if it is included in price #8 : VAT/GST unknown, unknown if it is included in price


Region Category Ex-factory / Manufacturer


Retail / Patient

used ($1,00=x) Price date




NA



income 0.47 TND 1.22 #9



£ 0.66


EURO High-income 0.061 £ 0.66 04/05-2010



NA









Table 82: MSH price ratio Simvastatin 20mg cap/tab per country Country WHO


Simvastatin 20mg - MSH price ratio Ex-factory / Manufacturer


Retail / Patient


NA NA 0.0629 = 1.00

Australia



4.29 6.04

Belgium EURO High-income 1.08 - 1.75 #3 Brazil AMRO Upper-middle-

income 0.45#1


Czech Republic EURO High-income 4.61 Denmark EURO High-income 0.091 #1

0.72 - 1.56 0.72


5.25 #4 8.11

Germany EURO High-income 6.52 -10.3 Hungary EURO Upper-middle-

income 3.66#1 4.29 6.04


1.59


income 7.15 8.90


1.91 2.54


8.74 #7


3.82#1

4.13 4.93


Country WHO Region

World Bank Category



Retail / Patient


NA NA 0.0629 = 1.00


5.25 - 10.9 5.25

Netherlands EURO High-income 0.24 - 1.22 0.24 New Zealand WPRO High-income 0.38#1 Norway EURO High-income 4.61 3.50 - 3.66 5.56 Oman EMRO Upper-middle-

income 8.59#8

Poland EURO Upper-middle-

income 4.29

Portugal EURO High-income 4.61 – 5.09 #5 7.31 Slovakia EURO Upper-middle-

income 2.23#1 3.34


income 1.59#1

2.23


2.38



income 7.47











#7: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #8 : VAT/GST unknown, unknown if it is included in price

Country WHO Region

World Bank Category



Retail / Patient


NA NA 0.0629 = 1.00








Table 83: AFRO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AFRO n = 1

Simvastatin 20mg (prices in US$ per cap/tab, excl taxes; MSH reference price US$ 0.0629) Ex-factory / Manufacturer




Table 84: AMRO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region AMRO n = 5




0.060#1 0.95#1


0.21#2 3.34#2


0.17#2 2.70#2



Table 85: EMRO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EMRO n = 7



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Iran 0.10 1.59 Jordan 0.45 7.15 0.56 8.90 Lebanon 0.55#2 8.74#2 Morocco 0.33-

0.69 5.25-10.9

0.33 5.25

Oman 0.54#3 8.59#3 Sudan 0.070#1 1.11#1 Tunisia 0.47 7.47 n = 0 n = 1 n = 1 n = 1 n = 6 Median Price/Ratio NA NA NA NA NA NA NA NA 0.51 8.03 Mean Price/Ratio NA NA NA NA NA NA NA NA 0.43 6.76 Lowest Price/Ratio NA NA NA NA NA NA NA NA 0.10 1.59 Highest Price/Ratio NA NA NA NA NA NA NA NA 0.56 8.90 High/Low Ratio NA NA NA NA NA NA NA NA 5.6 5.6 #1 : INCO-term unknown #2: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #3 : VAT/GST unknown, unknown if it is included in price


Table 86: EURO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region EURO n = 22



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Austria 0.23#1 3.66#1 0.27 4.29 0.38 6.04 Belgium 0.068 -

0.11#2 1.08 - 1.75#2

Czech Republic 0.29 Denmark 0.0057

#1 0.091#1 0.045 -

0.098 0.72 -1.56

0.045 0.72

Finland 0.014 0.22 0.027 0.43 France 0.37#1 5.88#1 0.33#3 5.25#3 0.51 8.11 Germany 0.41 -

0.65 6.52 - 10.3

Hungary 0.23#1 3.66#1 0.27 4.29 0.38 6.04 Ireland 0.94 14.9 Italy 0.22 3.50 Latvia 0.12 1.91 0.16 2.54 Lithuania 0.24#1 3.82#1 0.26 4.13 0.31 4.93 Netherlands 0.015 -

0.077 0.24 - 1.22

0.015 0.24

Norway 0.29 4.61 0.22 - 0.23

3.50 - 3.66

0.35 5.56

Poland 0.27 4.29 Portugal 0.29 -

0.32#4 4.61-5.09#4

0.46 7.31

Slovakia 0.14#1 2.23#1 0.21 3.34 Slovenia 0.36 5.72 Spain 0.094#1 1.49#1 0.15 2.38 Sweden 0.016 0.25 0.062 0.99 United Kingdom Drug Tariff Scotland/ Drug Tariff England&Wales

0.061 0.97



0.015#1 0.24#1




Retail / Patient

n = 6 n = 2 n = 9 n = 8 n = 16 Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio

Median Price/Ratio 0.23 3.66 NA NA 0.27 4.29 NA NA 0.25 3.90 Mean Price/Ratio 0.22 3.46 0.010 0.17 0.28 4.49 NA NA 0.24 3.85 Lowest Price/Ratio 0.094 1.49 0.0057 0.091 0.014 0.22 0.015 0.24 0.015 0.24 Highest Price/Ratio 0.37 5.88 0.015 0.24 0.94 14.9 0.65 10.3 0.51 8.11 High/Low Ratio 3.9 3.9 2.6 2.6 67.1 67.1 43.3 43.3 34.0 34.0

#1 : INCO-term unknown #2 : Value Added Tax (VAT) 12%, unknown if it is included in price #3 : Reimbursement is 65% of Retail/Patient Price #4 : Reimbursement is 69% of Retail/Patient Price


Table 87: SEARO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region SEARO n = 0



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio n = 0 n = 0 n = 0 n = 0 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA


Table 88: WPRO Region: Price and MSH price ratio Simvastatin 20mg cap/tab (prices in US$ per cap/tab, excl taxes) WHO Region WPRO n = 2



Price Ratio Price Ratio Price Ratio Price Ratio Price Ratio Australia 1.02#2 16.2#2 New Zealand 0.024#1 0.38#1 n = 1 n = 0 n = 0 n = 1 n = 0 Median Price/Ratio NA NA NA NA NA NA NA NA NA NA Mean Price/Ratio NA NA NA NA NA NA NA NA NA NA Lowest Price/Ratio NA NA NA NA NA NA NA NA NA NA Highest Price/Ratio NA NA NA NA NA NA NA NA NA NA High/Low Ratio NA NA NA NA NA NA NA NA NA NA



ANNEX XXI: Atorvastatin 20mg cap/tab Table 89: Prices Atorvastatin 20mg cap/tab per country (prices in US$ per cap/tab, excl taxes) All prices listed are for Pfizer brands (Lipitor, Sortis, Tahor, Torvast; unless otherwise stated) Country WHO


Atorvastatin 20mg (prices in US$ per cap/tab, excl taxes) Exchange rate used ($1,00=x) Price date

Ex-factory / Manufacturer Pfizer

Procurement Pfizer

Wholesale Pfizer

Reimburse-ment Pfizer

Retail / Patient Pfizer/ Generic


No MSH reference price available: reference is country price Simvastatin 20mg (see specifications in price ratio table)

Australia


Lipitor AU$ 1.09


Sortis 1.64

Sortis 2.09

Sortis € 0.74 03-2010

Canada PAHO High-income 1.89 Lipitor

CA$ 1.01 04-2010

Czech Republic EURO High-income 1.99 Sortis 0.43 Generic

€ 0.76 04-2009

Denmark EURO High-income 1.22#1

Lipitor 1.26-1.40

Lipitor 1.28

Lipitor € 0.76 05-2010

Finland EURO High-income 0.85 Lipitor

1.18 Lipitor 0.41 Generic

€ 0.73 02-2010

Germany EURO High-income 0.46-0.71 Sortis

€ 0.74 04-2010


0.67 Generic

€ 0.74 03-2010

Ireland EURO High-income 1.83 Lipitor

€ 0.70 01-2010

Italy EURO High-income 1.89 Torvast

€ 0.74 04-2010


Country WHO Region

World Bank Category



Procurement Pfizer

Wholesale Pfizer






1.87 Lipitor

2.36 Lipitor 1.09 Generic

JOD 0.70 #7 unknown


0.66 Sortis

0.79 Sortis 0.29 Generic

€ 0.70 01-2010


2.12#5 Lipitor 0.89#5 Generic

LBP 1489 03-2010


1.38#1

Sortis

1.46 Sortis


€ 0.68 02-2008


1.09-1.15 Tahor

1.09 Tahor

MAD 7.69 #7 unknown

Netherlands EURO High-income 1.35 Lipitor

1.35 Lipitor

€ 0.76 05-2010

New Zealand WPRO High-income 0.11#3 Lipitor

NZ$ 1.38 05-2010

Norway EURO High-income 1.28 Lipitor

0.30#4 Lipitor

1.30#4 Lipitor

NOK 6.05 05-2010


3.14#6

Lipitor

1.48#6 Generic

OMR 0.38 04-2010


Country WHO Region

World Bank Category



Procurement Pfizer

Wholesale Pfizer






0.34 Generic

€ 0.63 07-2008


1.51#1 Sortis


€ 0.69 09-2008

Slovenia EURO High-income 1.16 Sortis

€ 0.74 12-2008


1.06#1

Lipitor 1.13

Lipitor ZAR 7.32

04-2010 Spain EURO High-income 1.50

Lipitor € 0.76 05-2010

Sweden EURO High-income 1.66 Lipitor

1.75 Lipitor

SEK 7.19 05-2010


1.31 Tahor 0.93 Generic

TND 1.22 #7 unknown



Lipitor £ 0.66

04/05-2010



Lipitor NA

2009-2010



#2 : Goods and Services Tax (GST) 10%, unknown if it is included in price #3 : Reimbursed amount for New Zealand is exclusive of 0.50 US$ co-payment per tablet #4 : Difference between retail/patient price and reimbursed amount is co-payment

#5 : VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #6 : VAT/GST unknown, unknown if it is included in price #7: Date of price information unknown, exchange rate is year average 2008 (comparable with MSH reference price)


n = 5 n = 2 n = 10 n = 8 n = 17 Pfizer

n = 11 Generic

Median Price 1.38 --- 1.37 --- 1.51 0.62 Mean Price 1.11 1.98 1.35 --- 1.68 0.70 Lowest Price 0.11 1.22 0.66 0.30 0.79 0.29 Highest Price 1.51 2.73 1.87 1.89 3.14 1.48 High/Low Ratio 13.7 2.24 2.8 6.3 4.0 5.1


Table 90: Country price ratio Atorvastatin 20mg cap/tab per country (SMV = Simvastatin; ATV = Atorvastatin) Country WHO

Region Atorvastatin 20mg – Country price ratio (Country price ATV/Country price SMV) Ex-factory / Manufacturer Prices

Ratio

Procurement Prices

Ratio

Wholesale Prices

Ratio

Retail / Patient Prices Pfizer

Ratio Pfizer

Retail / Patient Prices generic

Ratio generic

SMV ATV SMV ATV SMV ATV SMV ATV ATV Austria EURO 0.23#1 1.49#1 6.48 0.27 1.64 6.07 0.38 2.09 5.50 Czech Republic

EURO 0.29 1.99 6.86 0.43 1.48

Denmark EURO 0.0057#1 1.22#1 214.0 0.045 1.28 28.4 Finland EURO 0.014 0.85 60.7

0.027 1.18

43.7

0.41

15.19

Hungary EURO 0.38 0.67 1.76 Ireland EURO 0.94 1.83 1.95 Italy EURO 0.22 1.89 8.59 Jordan EMRO 0.45 1.87 4.16 0.56 2.36 4.21 1.09 1.95 Latvia EURO 0.12 0.66 5.50 0.16 0.79 4.94 0.29 2.31 Lebanon EMRO 0.55#2 2.12#2 3.85 0.89#2 1.62 Lithuania EURO 0.24#1 1.38#1 5.75 0.26 1.46 5.62 0.31 1.51 4.87 0.62 2.00 Morocco EMRO 0.33 1.09 3.30 Nether-lands

EURO 0.015 1.35 90.0

New Zealand

WPRO 0.024#1 0.11#1 4.58

Norway EURO 0.29 1.28 4.41 0.35 1.30#3 3.71 Oman EMRO 0.54#4 3.14#4 5.81 1.48#4 2.74 Poland EURO 0.27 0.34 1.26 Slovakia EURO 0.14#1 1.51#1 10.8 0.21 1.94 9.24 0.52 2.48 Slovenia EURO 0.36 1.16 3.22 South Africa

AFRO 0.10#1 1.06#1 10.6 0.14 1.13 8.07

Spain EURO 0.15 1.50 10.0 Sweden EURO 0.016 1.66 103.8 0.062 1.75 28.2 Tunisia EMRO 0.47 1.31 2.79 0.93 1.98



AMRO 0.060#1 2.73#1 45.5


Ex-factory Procurement Wholesale Retail/patient Pfizer Retail/patient generic

n = 5 n = 2 n = 10 n = 18 n = 11 Median Ratio

6.48 --- 5.56 5.66 1.98

Mean Ratio

7.64 129.8 20.4 14.8 3.16

Lowest Ratio

4.58 45.5 1.95 2.79 1.26

Highest Ratio

10.8 214.0 103.8 90.0 15.2

High/Low Ratio

2.4 4.7 53.2 32.3 12.1

SMV = Simvastatin; ATV = Atorvastatin (Lipitor, Sortis, Tahor, Torvast or generic for retail/patient prices) #1 : INCO-term unknown

#2: VAT 10%, unknown if it is included in price; pharmacist margin US$ 0.0155, unknown if it is included in price #3 : Retail/patient price is exclusive of US$ 1.00 co-payment per tablet #4 : VAT/GST unknown, unknown if it is included in price


ANNEX XXII: Esomeprazole 20mg cap/tab Table 91: Prices Esomeprazole 20mg cap/tab per country All prices listed are for AstraZeneca brands (Nexium, Nexiam, Inexium) Country WHO


Esomeprazole 20mg (prices in US$ per cap/tab, excl taxes)

Exchange rate used ($1,00=x) Price date Ex-factory /

Manufacturer Procurement Wholesale Reimburse-

ment Retail / Patient


No MSH reference price available: reference is country price Omeprazole 20mg (see specifications in price ratio table)

Australia


Nexium AU$ 1.09


Nexium 1.19

Nexium 1.61

Nexium € 0.74 03-2010

Bahrain EMRO High-income 2.30#5 Nexium

BHD 0.37#6 unknown

Belgium EURO High-income 0.26-0.39#3 Nexiam

€ 0.74 03-2010

Czech Republic EURO High-income 1.11#1

Nexium 1.40

Nexium € 0.76 04-2009

Denmark EURO High-income 0.89#1

Nexium 0.88-1.13

Nexium 0.92 Nexium

€ 0.76 05-2010

Finland EURO High-income 0.81 Nexium

1.14 Nexium

€ 0.73 02-2010

Germany EURO High-income 0.91-1.45 Nexium

€ 0.74 04-2010


0.81#1 Nexium

0.85 Nexium

1.00 Nexium

€ 0.74 03-2010

Ireland EURO High-income 1.41 Nexium

€ 0.70 01-2010


1.26 Nexium

1.59 Nexium

JOD 0.70#6 unknown


1.76 Nexium

MAD 7.69#6 unknown

Netherlands EURO High-income 0.88 Nexium

0.88 Nexium

€ 0.76 05-2010

Norway EURO High-income 0.74 Nexium

0.77 Nexium

0.77 Nexium

NOK 6.05 05-2010


Country WHO


Esomeprazole 20mg (prices in US$ per cap/tab, excl taxes)

Exchange rate used ($1,00=x) Price date Ex-factory /

Manufacturer Procurement Wholesale Reimburse-

ment Retail / Patient


No MSH reference price available: reference is country price Omeprazole 20mg (see specifications in price ratio table)


1.69#5

Nexium OMR 0.38 04-2010

Portugal EURO High-income 0.74#4 Nexium

1.09 Nexium

€ 0.74 04-2010


1.17#1 Nexium

1.53 Nexium

€ 0.69 09-2008

Slovenia EURO High-income 0.85#1

Nexium 0.92

Nexium 0.98

Nexium € 0.74 12-2008


1.10#1

Nexiam 1.14

Nexiam ZAR 7.32


Nexium 1.34

Nexium € 0.76 05-2010


Nexium NA

2009 Sweden EURO High-income 1.44

Nexium 1.53

Nexium SEK 7.19 05-2010


1.23 Nexium

TND 1.22#6 unknown



Nexium

£ 0.66 04/05-2010



Nexium NA

2009-2010







n = 7 n = 3 n = 9 n = 8 n = 17 Median Price 1.08 0.89 1.14 --- 1.34

Mean Price 1.02 1.79 1.08 --- 1.34 Lowest Price 0.81 0.73 0.74 0.26 0.77 Highest Price 1.17 3.76 1.44 1.45 2.30 High/Low Ratio 1.4 5.2 1.9 5.6 3.0


Table 92: Country price ratio Esomeprazole 20mg cap/tab per country OMP = Omeprazole; EMP = Esomeprazole (Nexium or Nexiam) Country WHO

Region Esomeprazole 20mg – Country price ratio Ex-factory / Manufacturer Prices

Ratio

Procurement Prices

Ratio

Wholesale Prices

Ratio

Retail / Patient Prices

Ratio

OMP EMP OMP EMP OMP EMP OMP EMP Austria EURO 0.36#1 1.05#1 2.92 0.41 1.19 2.90 0.55 1.61 2.93 Bahrain EMRO 0.69#2 2.30#2

3.33

Czech Republic

EURO xx 1.11#1

xx 0.24 1.40

5.83

Denmark EURO 0.0631 0.89#1 14.1 0.076 0.92 12.1 Finland EURO 0.15 0.81 5.40 0.26 1.14 4.38 Hungary EURO 0.47#1 0.81#1 1.72 0.50 0.85 1.70 0.61 1.00 1.64 Ireland EURO 1.07 1.41 1.32 Jordan EMRO 0.54 1.26 2.33 0.68 1.59 2.34 Morocco EMRO 0.31 1.76 5.68 Nether- lands

EURO 0.033 0.88 26.7

Norway EURO 0.20 0.74 3.70 0.24 0.77 3.21 Oman EMRO 0.39#2 1.69#2 4.33 Portugal EURO 0.63 1.11 1.76 Slovakia EURO 0.11#1 1.17#1 10.6 0.17 1.53 9.00 Slovenia EURO xx 0.85#1 xx 0.54 0.92 1.70 xx 0.98 xx South Africa

AFRO 0.45#1 1.10#1 2.44 0.61 1.14 1.87

Spain EURO 0.089#1 1.08#1

12.1 0.14 1.34

9.57

Sudan EMRO 0.16#1 0.73#1 4.56 Sweden EURO 0.035 1.44 41.1 0.076 1.53 20.1 Tunisia EMRO 0.58 1.23 2.12 United States Veterans Affairs

AMRO 0.14#1 3.76#1 28.9



Ex-factory Procurement Wholesale Retail/Patient n = 5 n = 3 n = 9 n = 16

Median Ratio

2.92 14.1 2.33 4.36

Mean Ratio

5.96 15.9 6.89 7.19

Lowest Ratio

1.72 4.56 1.32 1.64

Highest Ratio

12.1 28.9 41.1 26.7

High/Low Ratio

7.0 6.3 31.1 16.3



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