Antiretroviral purchasing and prescription practices in Mexico: constraints, challenges and opportunities

Abstract

Salud Publica Mex 2015;57 suppl 2:S171-S182. AbstractObjective. This study examines the antiretroviral (ARV) market characteristics for drugs procured and prescribed to Mexico's Social Protection System in Health beneficiaries between 2008 and 2013, and compares them with international data. Materials and methods. Procurement information from the National Center for the Prevention and the Control of HIV/AIDS was analyzed to estimate volumes and prices of key ARV. Annual costs were compared with data from the World Health Organization's Global Price Reporting Mechanism for similar countries. Finally, regimens reported in the ARV Drug Management, Logistics and Surveillance System database were reviewed to identify prescription trends and model ARV expenditures until 2018. Results. Results show that the first-line ARV market is concentrated among a small number of patented treatments, in which prescription is clinically adequate, but which prices are higher than those paid by similar countries. The current set of legal and structural options available to policy makers to bring prices down is extremely limited. Conclusions. Different negotiation policies were not successful to decrease ARV high prices in the public health market. The closed list approach had a good impact on prescription quality but was ineffective in reduc- The Mexican health system includes various statecontrolled social security institutions that provide integral healthcare and social services to workers in the formal sector, including the Mexican Social Security Institute (IMSS), the Institute for Social Security and Services for State Workers (ISSSTE), specific funds for the army, the police and the national petroleum agency. In addition, the Ministry of Health and State Health Secretariats (SSa/SeSa) manage clinics and hospitals, accessed by the uninsured population as well as, since 2003, SPSS beneficiaries. 2,3In 2012, 71 599 individuals receive ARV through public channels, out of which almost 60% receive it through the SPSS and 30% through the IMSS.1 Others patients receive it through the remaining public institutions. Although the country's HIV/AIDS response is coordinated at national level, in effect each public health institution finances and operates its own separate care program with its own ARV supply chain. As part of the SPSS, ARV are financed by the Fund for the Protection Against Catastrophic Expenditures (FPGC), which covers high complexity interventions for SPSS beneficiaries while their procurement, purchase and distribution are managed by the National Center for the Prevention and the Control of HIV/AIDS (Censida in Spanish), based on patients' prescription history (figure 1). SSa/SeSa hospitals and stand-alone HIV/STI clinics, known as Capasits, receive ARV from the national level, but can't purchase drugs themselves. Despite these independent financing, procurement and distribution processes, clinical guidelines regarding ARV dispensation for first, second and third line treatments are nationally defined and followed by clin...

Policy approaches to improve availability and affordability of medicines in Mexico – an example of a middle income country

“…Chaumont et al reported that for several originator antiretrovirals, like lopinavir + ritonavir, atazanavir, and tenofovir, prices in Mexico are higher than other middle-income countries and sometimes even higher than high-income countries [44]. In a survey of affordability and availability of medicines in Mexico City the prices of several generic and originator brand products were 2 to 5 times higher than in other LATAM countries [10].…”