Lessons from international experience in controlling pharmaceutical expenditure III: regulating industry

Bloor, Karen; Maynard, Alan; Freemantle, Nick

doi:10.1136/bmj.313.7048.33

Cited by 62 publications

(23 citation statements)

References 10 publications

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“…Some countries, such as France and Italy, regulate drug prices directly through price control; others, such as Australia, use pharmacoeconomic analyses and reference pricing to determine the prices of drugs subsidized by the government [35,36]. Australia and the province of Ontario in Canada were also the first to include cost effectiveness data in decisions about reimbursement [37]. …”

Section: Discussionmentioning

confidence: 99%

Evaluating Drug Prices, Availability, Affordability, and Price Components: Implications for Access to Drugs in Malaysia

et al. 2007

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BackgroundMalaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components.Methods and FindingsThe methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB) prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%–76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high—25%–38% and 100%–140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector.ConclusionsThe free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and affordability, promotion of generic medicines and improved availability of medicines in the public sector are required.

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Section: Discussionmentioning

confidence: 99%

Evaluating Drug Prices, Availability, Affordability, and Price Components: Implications for Access to Drugs in Malaysia

et al. 2007

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“…8,9 Partly as a result of these factors, the price paid by the Australian government for pharmaceutical products is low compared with some other industrial ized nations. 10 However, Australia still pays higher prices for pharmaceutical products than many countries, with the result that consumer prices for pharmaceuticals are not as low as some commentators believe they should be. 11 For rheumatologists, the net effect of these policies is that, once listed, expensive drugs like biologic antirheumatic drugs cost the patient no more than other prescription drugs, removing affordability to the patient as a consideration in the use of such agents.…”

Section: Eric F Morand and Michelle T Leechmentioning

confidence: 96%

Successes, challenges and developments in Australian rheumatology

Morand

Leech

2015

Nat Rev Rheumatol

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Australia is a geographically vast but sparsely populated country with many unique factors affecting the practice of rheumatology. With a population comprising minority Indigenous peoples, a historically European-origin majority population, and recent large-scale migration from Asia, the effect of ethnic diversity on the phenotype of rheumatic diseases such as systemic lupus erythematosus (SLE) is a constant of Australian rheumatology practice. Australia has a strong system of universal healthcare and subsidized access to medications, and clinical and research rheumatology are well developed, but inequitable access to specialist care in urban and regional centres, and the complex disconnected structure of the Australian healthcare system, can hinder the management of chronic diseases.

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“…It is unfortunate that the structure of health funding in Australia and some other countries does not take into account such savings. 3 In a review of measures to control the pharmaceutical industry 4 , the authors concluded that price regulation is a relatively crude way of controlling expenditure on pharmaceuticals. The reviewers recognised the Australian efforts to utilise economic analyses to aid the decisions about subsidising new products.…”

Section: Pharmaceutical Reimbursement Policiesmentioning

confidence: 99%