Date Published: April 25, 2019
Publisher: Public Library of Science
Author(s): Amna Saeed, Hamid Saeed, Zikria Saleem, Yu Fang, Zaheer-Ud-Din Babar, Luzia Helena Carvalho.
Inadequate access to medicines affected by un-controlled prices is a major concern in developing countries, including Pakistan, which lacks comprehensive data on medicine prices. Thus, the objective of this study was to evaluate the prices, availability and affordability of essential medicines in Lahore division, Pakistan. The survey was undertaken from November, 2016 till March, 2017 by including 50 medicines, 14 from the WHO/HAI core list and 36 supplementary medicines from national essential medicine list (NEML) at public (n = 16) and private (n = 16) health facilities. The prices, availability and affordability of selected medicines were measured using a variant of the WHO/HAI standard methodology available on HAI website and WHO/HAI manual. A questionnaire was used for data collection from Lahore division. The prices were compared to International reference prices (IRPs) and the daily wage of a lowest paid unskilled government worker was used to calculate medicine affordability. Data suggested poor availability of originator brands (OB) in public and private sector facilities, i.e., 6.8% and 55.0%, respectively. Similarly, low availability was observed for lowest price generics (LPGs), both in public (35.3%) and private sector (20.3%) facilities–far below the WHO global action plan targets of 80% availability of essential medicines by 2025. In private sector, 53% OB and 38% LPG medicines were found excessively priced. The cost of standard treatment with OBs was unaffordable, i.e., above a single daily wage (1.4 day’s wages) was demanded to purchase the standard treatment for the selected diseases in case of OBs medicines. Whereas, the cost of LPGs medicine required to purchase the standard treatment of the selected diseases was 0.6 day’s wage (median), below a single daily wage. In conclusion, access to essential medicines, especially at public sector facilities was affected by low availability, particularly of OBs in comparison to LPGs. Thus, the better availability of LPGs might be a rational basis of transition into a generic system of prescribing that may improve the availability and accessibility of essential medicines in Lahore division. Medicine prices in Lahore division were found higher in comparison to IRPs. Thus, the efforts must be made to formulate patient’s pocket friendly drug pricing policy that favors price cuts and improves affordability.
In developing countries, the budget allocated to the purchase of medicines contributes significantly to the overall health care costs and may account for almost 50–95% non-personnel costs . In Pakistan, 32% of the health expenditure is borne by public sector, while 64% is borne by patient’s out of pocket payments that may account for unaffordability of medicines in this region . Thus, the higher prices of medicines are considered as one of the major barriers to access medicines, even the essential medicines . Whereas, availability and affordability are considered to be the key prerequisites for universal access to medicines .
The present study clearly demonstrated that both OBs and LPGs of the surveyed essential medicines were excessively priced in private sector pharmacies in Lahore Division, the most populous division of Pakistan. Moreover, the present survey was carried out over an extended period of time (i.e.4-5 months) at different health facilities, therefore, it provided a realistic assessment of the overall situation faced by the patients on daily basis. The overall availability of OBs was extremely poor in public sector medicine outlets in comparison to private sector medicine outlets, while for LPGs it was better compared to OBs, but still very skimpy in both sectors. Similarly, the treatment of common diseases was found affordable with LPGs but unaffordable with OBs. When we compared our data with other middle-income countries (Egypt, India, Lebanon and China), Pakistan was positioned at number three, after India and Lebanon, in terms of medicine’s affordability, though these differences seemed trivial due to small sample size.