Balancing medicine prices and business sustainability: analyses of pharmacy costs, revenues and profit shed light on retail medicine mark-ups in rural Kyrgyzstan

Waning, Brenda; Maddix, Jason; Soucy, Lyne

doi:10.1186/1472-6963-10-205

Cited by 8 publications

(7 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There were seldom any differences in the mark-ups between District and Capital regions apart from a few country-specific findings, in contrast to previous work in Kyrgyzstan that showed wholesalers charging more for distant facilities 17. In the China (Shaanxi) public sector, Capital wholesale mark-ups pushed up total mark-ups particularly for locally manufactured products.…”

Section: Discussioncontrasting

confidence: 77%

Insulin price components: case studies in six low/middle-income countries

et al. 2019

View full text Add to dashboard Cite

IntroductionUnderstanding price components for insulin products can help design interventions to improve insulin affordability in low/middle-income countries.MethodsAn adapted WHO/Health Action International standardised methodology was used in Brazil (Rio de Janeiro), China (Hubei and Shaanxi Provinces), Ghana, India (Haryana State), Indonesia and Uganda. Selected insulin products had their prices traced backwards through the supply chain from public and private sector retail outlets in the capital city and a district town, supplemented with key informant interviews.ResultsCumulative mark-ups ranged from 8.7% to 565.8% but the magnitude of mark-ups was country specific and variable within and across sectors and regions. The proportion of the patient price attributed to the manufacturer’s selling price varied from 15.0% to 92.0%. Pricing regulations in China, India and Indonesia reduced wholesale and retail mark-ups but did not guarantee low prices. Most countries had removed import duties (Ghana, India, Indonesia, Uganda), but additional tariffs of 3.5% were still applied in Ghana. Value-added tax in the private sector ranged from 5% to 20% across the countries.ConclusionThere are no clear trends in the mark-ups applied to insulin or specific differences in the price structure. A uniform approach to improving insulin access through regulating price components is unlikely to be successful, but elimination of duties and taxes, price regulation and greater price transparency could help influence prices and hence affordability.

show abstract

Section: Discussioncontrasting

confidence: 77%

Insulin price components: case studies in six low/middle-income countries

et al. 2019

View full text Add to dashboard Cite

show abstract

“…A 2007 survey of a pharmacy network in remote Kyrgyzstan revealed retail mark-ups in the range of 32 to 244% for the network's top 50 medicines (i.e. those that accounted for more than 50% of their profits) [9].…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, major concerns with regard to equity and accessibility remain [8]. First, since a high proportion of the population lives in rural Kyrgyzstan, ensuring access to health care-including medicinesin remote areas is a challenge [9,10]. Second, out-of-pocket (OOP) payments for health services have been steadily increasing in the new millennium, with considerable growth in the financial burden after 2009, in particular for the poorest population groups and in the two largest cities -Bishkek and Osh [11,12].…”

Section: Introductionmentioning

confidence: 99%

Affordable and equitable access to subsidised outpatient medicines? Analysis of co-payments under the Additional Drug Package in Kyrgyzstan

Vogler

Schneider

Dedet

et al. 2019

Int J Equity Health

View full text Add to dashboard Cite

Background: Out-of-pocket (OOP) payments can constitute a major barrier for affordable and equitable access to essential medicines. Household surveys in Kyrgyzstan pointed to a perceived growth in OOP payments for outpatient medicines, including those covered by the benefits package scheme (the Additional Drug Package, ADP). The study aimed to explore the extent of co-payments for ADP-listed medicines and to explain the reasons for developments. Methods: A descriptive statistical analysis was performed on prices and volumes of prescribed ADP-listed medicines dispensed in pharmacies during 2013-2015 (1,041,777 prescriptions claimed, data provided by the Mandatory Health Insurance Fund). Additionally, data on the value and volume of imported medicines in 2013-2015 (obtained from the National Medicines Regulatory Agency) were analysed. Results: In 2013-2015, co-payments for medicines dispensed under the ADP grew, on average, by 22.8%. Co-payments for ADP-listed medicines amounted to around 50% of a reimbursed baseline price, but as pharmacy retail prices were not regulated, co-payments tended to be higher in practice. The increase in co-payments coincided with a reduction in the number of prescriptions dispensed (by 14%) and an increase in average amounts reimbursed per prescription in nearly all therapeutic groups (by 22%) in the study period. While the decrease in prescriptions suggests possible underuse, as patients might forego filling prescriptions due to financial restraints, the growth in average amounts reimbursed could be an indication of inefficiencies in public funding. Variation between the regions suggests regional inequity. Devaluation of the national currency was observed, and the value of imported medicines increased by nearly 20%, whereas volumes of imports remained at around the same level in 2013-2015. Thus, patients and public procurers had to pay more for the same amount of medicines. Conclusions: The findings suggest an increase in pharmacy retail prices as the major driver for higher co-payments. The national currency devaluation contributed to the price increases, and the absence of medicine price regulation aggravated the effects of the depreciation. It is recommended that Kyrgyzstan should introduce medicine price regulation and exemptions for low-income people from co-payments to ensure a more affordable and equitable access to medicines.

show abstract

“…Finally, it is also interesting to note that other mechanisms may be at play in defining the retail drug price in developing countries. For example, Russo and McPake (2010) highlight that much of the drug prices in private pharmacies in Mozambique is made by local mark-ups, which contribute to up of two-thirds of the price (also Waning et al 2010). Even when present, statutory profits and cost ceilings are applied unevenly because of lack of control and suppliers' collusion.…”

Section: Discussionmentioning

confidence: 99%

With the help of a foreign ally: biopharmaceutical innovation in India after TRIPS

Angeli

2013

Health Policy and Planning

View full text Add to dashboard Cite

This article investigates the implications of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS), which reached full-fledged implementation in 2005, for the patenting activity of Indian biopharmaceutical companies. The Indian biopharmaceutical industry is well-known for its generic producers, whose business models capitalize on the opportunity to reverse-engineer patented compounds and produce them at low costs through process innovation. By strengthening intellectual property rights, TRIPS determined a major regulative change, which presents the characteristics of an institutional shock. The examination of the patenting and alliance activity of 123 Indian biopharmaceutical firms between 1999 and 2009 reveals two important insights. First, the innovation outcome of Indian biopharmaceuticals has sharply increased during the transition to TRIPS-compliant regulation, suggesting that Indian companies have been capable and willing to transit from an imitation-based to an innovation-based business model. Second, those biopharmaceutical firms holding cross-border alliances to foreign partners have proved significantly more successful at enhancing their innovative capability. This research delivers a multifold contribution to the policy debate surrounding the enforcement of TRIPS in emerging economies. First, it suggests that such regulatory change may have encouraged biopharmaceutical innovation in India, despite the sceptical voices who did not foresee any benefits because of inherent inertia of the industry. Second, by arguing and testing the advantages of foreign partnerships, this research highlights that the much feared return of pharmaceutical foreign companies to India could instead favour adaptation to institutional change. Implications for Indian public health are particularly critical. The impact of TRIPS on drug pricing and on the capability--and willingness--of Indian biopharmaceuticals to invest in local health conditions are two crucial points of discussion.

show abstract

Balancing medicine prices and business sustainability: analyses of pharmacy costs, revenues and profit shed light on retail medicine mark-ups in rural Kyrgyzstan

Cited by 8 publications

References 18 publications

Insulin price components: case studies in six low/middle-income countries

Insulin price components: case studies in six low/middle-income countries

Affordable and equitable access to subsidised outpatient medicines? Analysis of co-payments under the Additional Drug Package in Kyrgyzstan

With the help of a foreign ally: biopharmaceutical innovation in India after TRIPS

Contact Info

Product

Resources

About