Medicine Prices, Availability,Medicine Prices, Availability,
Affordability and Price ComponentsAffordability and Price Components
in
Kazakhstan, Kyrgystan,
Tajikistan & Uzbekistan
Margaret Ewen
Health Action International
WHO/HAI Project on Medicine Prices & Availability
improve the availability and
affordability of essential medicines
•Develop a reliable methodology for collecting andanalysing price and availability data across healthcaresectors in a country
•Price transparency; survey data on a freely accessiblewebsite allowing international comparisons
•Advocate for appropriate pricing policies and monitortheir impact
• Launched WHA 2003
• Measures medicine
prices
availability
affordability
component costs
• 55+ surveys to date in allregions of the world
Medicine PricesMedicine Prices
a new approach to measurementa new approach to measurement
www.haiweb.org/medicinepriceswww.haiweb.org/medicineprices
Methodology - Data collection
•Systematic sampling: now at least 6 regions, minimumof 5 pharmacies/facilities per sector per region
•Public sector facilities, private retail pharmacies and‘other’ sectors (e.g. dispensing doctors or NGO sector)
•Prices of 30 pre-selected commonly used medicines –now14 global + 16 regional
•Predetermined dose form & strength, & recommendedpack size
•Supplementary medicines highly encouraged, adapted tolocal needs
•Prices of originator brand and lowest price generic
•All components of price from manufacturer to retaileridentified
Data analysis
•Price calculated as Median Price Ratio (MPR)
local price compared to MSH International
Drug Price Indicator Guide (procurement prices offeredto developing countries)
•Availability calculated as number of facilities having thatproduct on the day of data collection (%)
•Affordability assessed for ten pre-selected courses oftreatment compared to daily wage of lowest paidunskilled government worker
Public sectorProcurement price
Public sector
Patient price
Originatorbrand
Lowestpricedgeneric
Originatorbrand
Lowestpricedgeneric
Kazakhstan Nov04
3.85
4.84
Kyrgyzstan Feb05
No data collected
Tajikistan Feb05
No data collected
2.38
Uzbekistan Dec04
2.41
No data collected
Median price ratio, public sector, glibenclamide 5mg tabsMedian price ratio, public sector, glibenclamide 5mg tabs
Public sectorProcurement price
Public sector
Patient price
Originatorbrand
Lowestpricedgeneric
Originatorbrand
Lowestpricedgeneric
Kazakhstan
6
0.79
Kyrgystan
1.03
Tajikistan
1.84
Uzbekistan
2.8
Median price ratio, public sector, ciprofloxacin 500mgMedian price ratio, public sector, ciprofloxacin 500mg
Patient prices, private retail pharmaciesfluconazole 150mg tabsPatient prices, private retail pharmaciesfluconazole 150mg tabs
Patient prices, private retail pharmaciesco-trimoxazole paed susp. 8+40mg/mlPatient prices, private retail pharmaciesco-trimoxazole paed susp. 8+40mg/ml
Public sector
Private sector
Originator
Generic
Originator
Generic
Kazakhstan
0%
0%
0%
40%
Kyrgyzstan
0%
53%
Tajikistan
0%
5%
0%
5%
Uzbekistan
0%
73%
Availability: amitriptyline 25mg tabsAvailability: amitriptyline 25mg tabs
Affordability: captopril 25mg x 2 tab/day30 days treatment, private retail pharmaciesAffordability: captopril 25mg x 2 tab/day30 days treatment, private retail pharmacies
Taxes & duties on medicinesTaxes & duties on medicines
Kazakhstan
Kyrgyzstan
Tajikistan
Uzbekistan
Value Added Tax (VAT)
20%
20%
Import tax
0.15%
Customs Duty
5%
0-10%a
Customs Procedure
0.15%
0.15%
Central Government Tax
5%
City Tax
1%b
Retail Tax
4.08%c
Cumulative Taxes and Duties
0.15%
4.24%
27%
26-39%
Net Income Taxd
30%
20%
20%
12%
Other Taxes
1.5%e
a. Preferential rates for certain countries (e.g., Ukraine, Russia)
b. The 1% Dushanbe city tax is applied at the retail point.
c. Includes 4% retail sales tax, 0.08% road tax,
d. Taxes paid on net profits only
e. Emergency tax from gross revenues
Policy options include…Policy options include…
•Off-patent medicines - purchase low priced quality generics,public and private sector
•Patented medicines – equitable prices, use the flexibilities oftrade agreements to introduce generics while a patent is inforce, internal reference pricing
•Where there is little competition, consider regulating prices -from manufacturers’ selling price to margins in wholesaleand retail.
•Aid generic competition eg fast-tracking, waiveregistration fees
•Permit generic substitution and provide incentives for thedispensing of generics
•Educate doctors and consumers on availability andacceptability of generics, and publicise the price ofgenerics
•Stop taxing essential medicines
•Separate prescribing and dispensing
Multiple policy optionsMultiple policy options