1 Paying the Price Margaret Ewen Health Action International Europe.

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Presentation transcript:

1 Paying the Price Margaret Ewen Health Action International Europe

2 Public sector Procurement price Public sector Patient price OriginatorGenericOriginatorGeneric captopril 25mg tab Kenya (2001) Morocco (2004) free Indonesia (2004) Mongolia (2004) phenytoin 100mg cap Indonesia (2004) glibenclamide 5mg tab Chad (2004) Median price ratios, public sector

3 Median price ratios, atenolol 50mg tab, private retail pharmacies private retail pharmacies

4 Public sectorPrivate sector OriginatorGenericOriginatorGeneric Chad (2004) 4%0%18%0% Maharashtra (2005) 0% 10% Mongolia (2004) 0% 4% Philippines (2002) 15%0%9%1% Indonesia (2004) 0% 2%0% Morocco (2004) 25%65%5%50% Availability: beclometasone inhaler 50mcg/dose

5 Affordability: fluoxetine 40mg tab/day 30 days treatment, private retail pharmacies 96 »

6 EML Availability Public sector facilities OriginatorGeneric Uganda (2004)yes0% Mali (2004)yes0% Indonesia (2004)no13%0% Affordability Private retail pharmacies OriginatorGeneric 5.6 days2.0 days 4.2 days2.7 days 4.1 days- salbutamol inhaler 0.1mg/dose: availability vs affordability

7 Taxes on Medicines Tajikistan (private sector, imported medicine) VAT 20% Customs duty 5% Tax 1-5% + transport charges, wholesale & retail mark-ups Eliminate taxes: cumulative mark-up 123% 74% Peru (private sector, imported medicine) VAT 12%, IGV 19%, Municipal promotion tax 2% + insurance, import, wholesale & retail mark-ups Eliminate taxes: cumulative mark-up 238% 149% Indonesia VAT 10% - charged twice

8 Public sector component costs Chad ( official rates for generics) Statistics tax 2% Central Medical Store mark-up 16% Regional Medical Store mark-up 25% Health facility mark-up 30% Cumulative mark-up: 92% Peru VAT 12%, IGV 19%, Municipal promotion tax 2% Insurance 2% Importers mark-up 20% Health facility mark-up 25% Cumulative mark-up: 108% (some medicines/programmes 40%)

9 Malaysia: atenolol 50mg tab private retail pharmacies

10 Malaysia: atenolol 50mg tab dispensing doctors Generic (patient price 32 RM) Originator (patient price RM)

11