A human rights-based approach to the reimbursement of expensive medicines

Perehudoff, Katrina; Toebes, Brigit; Hogerzeil, Hans V

doi:10.2471/blt.15.166371

Cited by 17 publications

(18 citation statements)

References 6 publications

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“…These mechanisms could also help stem the wave of spurious human-rights based litigation rising in some Latin American countries where many court cases claim access to publicly-funded, high-priced medicines using the misguided argument that the right to health entails immediate access to any treatment regardless of its price. [33–36] In previous work the authors have identified trends in UHC legislation for access to medicines. [10] We suggest that these same strategies could be embedded in NMPs to avoid deleterious medicine litigation; these trends are: articulating clear patient rights to access medicines proven to be cost-effective, and ensuring efficient and effective complaints procedures.…”

Section: Discussionmentioning

confidence: 99%

The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries

2019

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Persistent barriers to universal access to medicines are limited social protection in the event of illness, inadequate financing for essential medicines, frequent stock-outs in the public sector, and high prices in the private sector. We argue that greater coherence between human rights law, national medicines policies, and universal health coverage schemes can address these barriers. We present a cross-national content analysis of national medicines policies from 71 countries published between 1990–2016. The World Health Organization’s (WHO) 2001 guidelines for developing and implementing a national medicines policy and all 71 national medicines policies were assessed on 12 principles, linking a health systems approach to essential medicines with international human rights law for medicines affordability and financing for vulnerable groups. National medicines policies most frequently contain measures for medicines selection and efficient spending/cost-effectiveness. Four principles (legal right to health; government financing; efficient spending; and financial protection of vulnerable populations) are significantly stronger in national medicines policies published after 2004 than before. Six principles have remained weak or absent: pooling user contributions, international cooperation, and four principles for good governance. Overall, South Africa (1996), Indonesia and South Sudan (2006), Philippines (2011–2016), Malaysia (2012), Somalia (2013), Afghanistan (2014), and Uganda (2015) include the most relevant texts and can be used as models for other settings. We conclude that WHO’s 2001 guidelines have guided the content and language of many subsequent national medicines policies. WHO and national policy makers can use these principles and the practical examples identified in our study to further align national medicines policies with human rights law and with Target 3.8 for universal access to essential medicines in the Sustainable Development Goals.

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Section: Discussionmentioning

confidence: 99%

The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries

2019

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“…This policy was probably needed as a first and fast approach to allow access to health care in the historical context of a repressed demand for healthcare services, where specialized and expensive oncologic care was excluded. How to allocate resources in a cost‐effective way while keeping peoples’ right to be covered when suffering an oncologic condition will be the main policy challenge for the coming years …”

Section: Discussionmentioning

confidence: 99%

“…How to allocate resources in a cost-effective way while keeping peoples' right to be covered when suffering an oncologic condition will be the main policy challenge for the coming years. [38,39]…”

Section: Discussionmentioning

confidence: 99%

Sharp rise in the expenditures of targeted drugs in Ecuador: five-year (2010-2014) consumption of oncologic drugs in public and private hospitals

Durán

Elseviers

Stichele

et al. 2018

J Pharm Health Serv Res

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Objective In Ecuador, a new constitutional mandate (2008) allowed the government to implement free universal access to health care, including oncologic drugs. As most Latin American countries, Ecuadorian healthcare system is fragmented between public and private providers, posing a special challenge to collect valid drug utilization data. Data from the public and the private healthcare sectors were collected to examine the utilization of oncologic drugs in Ecuador over a 5‐year period (2010–2014). Methods Oncologic drugs were extracted from individual dispensing data collected in the six largest Ecuadorian cancer hospitals. Drug utilization indicators include the yearly proportion of patients using selected therapeutic groups (targeted drugs, chemotherapy and hormonal drugs), and the mean and total expenditures, by healthcare sector. Key findings Total number of patients ranged from 12 060 in 2010 to 12 769 in 2014. Median age was 56 years; 60.3% were women. Twenty‐three drugs were classified as targeted (monoclonal antibodies, protein kinase inhibitor, vismodegib, vorinostat and abiraterone), 43 as chemotherapy and 11 as hormonal. Patients using chemotherapy decreased from 56% to 52%. Proportion of patients using chemotherapy drugs was 30% lower in the public than in the private sector. Total expenditures on cancer drugs showed a constant increase from USD 17 912 865 in 2010 to USD 40 514 947 in 2014. Patients using targeted drugs doubled from 8% to 14% in 5 years. Targeted drugs accounted for 76% of total expenditures in 2014. Conclusion Although only a small, but increasing proportion of patients used targeted drugs, it leads to a sharp rise in expenditures. In 2014, it represented three‐quarters of the total oncologic drugs expenditures. Differences in chemotherapy consumption between public and private sectors could reflect difficulties in public procurement, shortages and a faster, poorly controlled adoption of new drugs. If unmanaged, this is a possible threat to the health budget in the coming years.

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“…214 For example, the mere fact that a disease is rare does not provide a human-rights-based justifi cation for the immediate reimbursement of a treatment with a less-favourable marginal cost-eff ectiveness than other treatments for other diseases. 215 It has been proposed that new expensive treatments should be added to reimbursement packages on the basis of the marginal cost-eff ectiveness criteria (cost per quality adjusted life-year gained) as other medicines. 216 However, the Commission notes that societies might choose to apply diff erent norms in particular circumstances, such as in relation to end-of-life care.…”

Section: Transparency Is Essential To Eff Ective Data Analysis and Dementioning

confidence: 99%

Essential medicines for universal health coverage

et al. 2017

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A human rights-based approach to the reimbursement of expensive medicines

Cited by 17 publications

References 6 publications

The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries

The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries

Sharp rise in the expenditures of targeted drugs in Ecuador: five-year (2010-2014) consumption of oncologic drugs in public and private hospitals

Essential medicines for universal health coverage

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