Improving Access to Essential Medicines for Mental, Neurological, and Substance Use Disorders in Sub-Saharan Africa Workshop Summary (2014) / Chapter Skim
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5 Challenge: High Pricing and Poor Financing
5 Challenge: High Pricing and Poor Financing
Pages 69-86
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From page 69... ...
• Implementation of simpler and clearer regulations, requirements, and procedures. • Streamlined procurement of medicines at efficient prices and passing along of low procurement prices to patients, leading to a decrease in the overall unit cost of medicines.
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From page 70... ...
In many SSA countries, medicines are available at no cost in the public sector. However, in cases Ewen surveyed where purchase price data were available for the public sector, patients paid just over twice the international reference price for amitriptyline.
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From page 71... ...
Affordability of medicines becomes a challenge when availability in the public sector is low and patients can only purchase their medicines in the private sector. The median price paid by patients for the lowest priced generic equivalent for carbamazepine was up to 10 times the MSH international reference price.
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From page 72... ...
Lastly, Ewen noted that reference pricing policies might increase the affordability of medicines by setting maximum median local price ratios to that of MSH. Ewen observed that countries sometimes introduce pricing policies without careful consideration of the various options and the potential impact of each option relative to their national situation.
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From page 73... ...
. Applying this concept to essential medicines, Daniel Chisholm, health economist in the Department of Mental Health and Substance Abuse at WHO, said the dimensions could be as follows: what is the range of medicines on the essential medicines list or which conditions are prioritized; the proportion of people who actually have access to those medicines; and who is paying for the medicines (e.g., public versus private, out-ofpocket, health insurance)
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From page 74... ...
LESSONS LEARNED FOR ADDRESSING HIGH PRICING AND POOR FINANCING As previously mentioned, five example programs addressing access to medicines were presented during the workshop to facilitate exploration of best practices and lessons learned from other programs. The examples were selected by planning committee members and included two countrylevel programs, an infectious disease project, and two noncommunicable
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From page 75... ...
, Ghana • The NHIS increased the affordability and usage of medicines and health care services for patients by providing access and financial coverage to basic health care for residents in Ghana through district-level and private health insurance schemes (NHIA, 2012)
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From page 76... ...
. • Linking ADDOs with health insurance schemes has reduced the out-of-pocket payments for individuals.
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From page 77... ...
Given frequent stock-outs in the public sector, patients many times will purchase medicines in the private sector at higher costs or do without their medications. A few participants suggested that regulatory cost containment measures and negotiated prices around profit margins and differential pricing might increase the accessibility and affordability of medicines to patients.
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From page 78... ...
Finally, Chisholm described the discussions for the challenge of poor access to affordable medicines for both the insured and uninsured. Many participants suggested that promotion of MNS medicines for inclusion on country-specific essential medicines list and health insurance schemes might increase coverage for these medicines.
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From page 79... ...
Health; for analysis may making evidence- conduction of impacting pricing Regular and regulatory vary by country.c,d based decisions. market analysis, and financing of continuing analysis bodies; health c,d,e including analysis medicines for and data updates.c,d insurers; of need, usage, MNS associated prices, personnel, disorders.c,d,e national health availability, researchers.a,b,c,d,e quality, manufacturers, distributors, and supply chain elements.a,b,c,d,e 1 This table presents challenges and opportunities discussed by one or more workshop participants.
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From page 80... ...
Lack of or low Increased priority Increased focus on Increased funding WHO; patient N/A public and private of funds for MNS MNS disorders, and resource advocacy investment in disorders at including allocation for MNS- groups; Ministry MNS disorders, governmental balanced attention related services. of Health; including low levels.
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From page 81... ...
Lack of or low Increased priority Increased focus on Greater availability Pharmaceutical N/A public and private by supra-national MNS disorders, of competitively companies; investment in and including priced medicines. nongovernmental MNS disorders, nongovernmental, balanced attention Increased public agencies; including low not-for-profit, and relative to other awareness and professional donor interest.c,d,e for-profit diseases.b,c,d,e advocacy.b,c,d,e associations; partners.b,c,d,e physician groups.a,b,c,d,e 81
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From page 82... ...
A weak Increased Increased number Lower prices for Manufacturers; N/A pharmaceutical competition and of stakeholders MNS disorder regulators; trade market for MNS lower barriers to involved in medicines.c,d ministries; disorder entry into the medicines for regional trading medicines, market to include MNS disorders. blocs; tax including a lack of sharing of best More affordable authorities.a,b,c,d,e price competition, practices.a,b,c,d product options poor government for MNS regulation of disorders.
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From page 83... ...
A weak Strengthened Full Reduced level and WHO N/A pharmaceutical governance and implementation range of mark-ups. prequalification market for MNS regulations.b,c,e and enforcement Delisting of poorer system and good disorder of simpler and quality products governance for medicines, clearer from medicines medicine including a lack of regulations, lists.d,e principles; price competition, requirements, and regulatory poor government procedures.
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From page 84... ...
Poor access to Promotion of Increased needs- Reduced out-of- Ministry of Bundle medicines affordable MNS medicines based coverage pocket payments Health; Ministry with other aspects medicines for both for inclusion on and financial for MNS of Finance; of care (e.g., nonthe insured and essential medicine protection.d,e medicines. Ministry of pharmaceutical uninsured, lists and disease Reduction of the Trade; insurers; tools, including management in treatment gap.c,d,e advocacy monitoring)
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From page 85... ...
Poor access to Streamlined Decrease in End-payers pay Ministry of N/A affordable government overall unit cost close to Health; Ministry medicines for both procurement of per end-user.c,d international of Finance; the insured and medicines at reference prices for Ministry of uninsured, efficient prices the public sector.c,d,e Trade; insurers; including while passing international unaffordable out- along low partners; public– of-pocket procurement private expenses, and prices to patients partnershipsa,b,c, d,e catastrophic and promoting spending for the exemption of insured.b,c,d,e taxes on MNS medicines.c,d,e a Michelle Akande b Francois Bompart c Dan Chisholm 85 d Margaret Ewen e Frances Jensen
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