Reforming antiretroviral price negotiations and public procurement: the Mexican experience

Abstract

Since antiretroviral (ARV) medicines represent one of the most costly components of therapy for HIV in middle-income countries, ensuring their efficient procurement is highly relevant. In 2008, Mexico created a national commission for the negotiation of ARV prices to achieve price reductions for their public HIV treatment programmes. The objective of this study is to assess the immediate impact of the creation of the Mexican Commission for Price Negotiation on ARV prices and expenditures. A longitudinal retrospective analysis of procurement prices, volumes and type of the most commonly prescribed ARVs procured by the two largest providers of HIV/AIDS care in Mexico between 2004 and 2009 was carried out. These analyses were combined with 26 semi-structured key informant interviews to identify changes in the procurement process. Prices for ARVs dropped by an average of 38% after the first round of negotiations, indicating that the Commission was successful in price negotiations. However, when compared with other upper-middle-income countries, Mexico continues to pay an average of six times more for ARVs. The Commission's negotiations were successful in achieving lower ARV prices. However, price reduction in upper-middle-income countries suggests that the price decrease in Mexico cannot be entirely attributed to the Commission's first round of negotiations. In addition, key informants identified inefficiencies in the forecasting and procurement processes possibly affecting the efficiency of the negotiation process. A comprehensive approach to improving efficiency in the purchasing and delivery of ARVs is necessary, including a better clarification in the roles and responsibilities of the Commission, improving supply data collection and integration in forecasting and procurement, and the creation of a support system to monitor and provide feedback on patient ARV use.

Proposing a sequential comparative analysis for assessing multilateral health agency transformation and sustainable capacity: exploring the advantages of institutional theory

“…Problems of institutional legitimacy arise when policy-makers adhere to a particular set of institutions, regardless of their known inefficiencies, mainly because of the institution’s widespread support among trusted peers; this support arises because of the institution’s repeated track record of success, as well as peers’ subjective beliefs that it is the appropriate institution to select [2,5,7]. While alternative and more effective institutions may be present, they are avoided, even without engaging in rational cost-benefit analysis (ibid).…”

“…Chief among them is the realization that, to the author’s knowledge, there are no systemically clear methodological approaches for comparing and analyzing multilateral health agencies. While the works of Gómez [2], Gómez and Atun [15], and Chorev [16] compare several multilateral health agencies, they do not propose a systematic method for comparative analysis.…”

“…Yet, these UN agencies, such as the WHO, UNAIDS, and the World Bank, can also be compared to each other because of their similar path dependent challenges, such as institutional legitimacy and increasing returns . Historically, these path dependent constraints have hampered efforts to reform these agencies for greater effectiveness in providing technical and financial assistance while meeting country needs (ibid; [2]).…”

“…Consequently, Peabody [17] claims that an organizational culture arose whereby YAWS was perceived by WHO staff as the most legitimate and effective course of action to take in response to disease outbreaks (ibid). Gómez [2] and Peabody [17] also claim that over time, WHO staff learned and passed on this approach to other staff members.…”

“…These agencies find themselves in a difficult position, as the ongoing global recession has led to a decline in government and private sector contributions to these agencies at a time when country needs have increased. This problem has motivated scholars to examine the willingness and capacity of multilateral health agencies to overcome these challenges, transform and sustain their policy missions [1,2]. …”