Access to Essential Medicines situation in different states of India

1
Access to Essential Medicines
Dr. Anita Kotwani Patel Chest Institute University
of Delhi INDIA
2
Baseline surveys for access to essential medicines

• Seven surveys conducted in different states to
  find the prices and availability of essential
  medicines in public and private sector utilizing
  a WHO-HAI standardized robust methodology
• 2003Rajasthan
• Oct 04- Jan 05 6 surveys (Chennai, Haryana,
  Karnataka, Maharashtra (2), West Bengal)
• Prices expressed in reference to international
  reference price (IRP) as Median Price Ratio and
  availability as median
• Public sector Procurement prices low, less than
  the IRP
• Median availability was very poor in all states
  (0 - 12.5), Chennai, capital city - 30
  Rajasthan - 40
• provides free medicines to a few categories

3
Scenario in the private sector

• Median availability of generic was 95 in
  Rajasthan and Chennai city other states it was
  51- 77
• Median MPRs for lowest priced generics was 1.3
  1.84
• Little variation in price of medicine from one
  state to another
• Few medicines were priced high e.g., amoxicillin,
  amitryptyline, atenolol, diazepam, diclofenac,
  hydrochlorthiazide
• Medicines are available at printed Maximum
  Retail Price
• Generic equivalents that are available in retail
  pharmacies have almost the same MRP as the most
  sold generic equivalents
• Margins of certain medicines in private sector
  seem very high
• Though prices are not very high compare to IRP,
  availability and affordability is a major issue

4
Medicine price components survey in Delhi 2007

• 4 major health providers in public sector
• Procurement for CG hospitals and dispensaries is
  done by external procurement agents fees of 10
  and 4.5 are charged 4.5 is then subject to a
  service tax and education cess these charges are
  taken from the actual drug budget
• Erratic/no supply results in local purchase of
  medicines by facilities that results into
  expensive purchases for medicines
• NDMCs (a small public sector) technical tender
  restricts eligible suppliers, limits competition,
  results in high rates for medicines
• Private sector mark ups are higher than
  established (8/10 for W.S 16/20 R), more so
  for retailers
• For branded generics retailer margin can be
  500
• Trade schemes are common for both scheduled non
  scheduled medicines increase the cumulative mark
  ups
• No transparency in fixing MRP by manufacturer
• Taxes excise duty is 16 and 2 education cess
  . 4 VAT on all medicines purchased in public and
  private sector

5
Policies and initiatives by government to
increase transparency in the supply chain

• Transparent pooled procurement system by Tamil
  Nadu and Delhi
• Two-bid procurement system, technical bid
  qualification is a pre-requisite
• Supreme court has asked to bring all essential
  medicines under price control..ministry is
  revising the pricing policy

6
MeTA support in improving access to medicines

• Establish a working group for all players
  MoHFW, MCF, private sector, academics and civil
  societies
• Increase transparency in fixing MRP (maximum
  retail price) by the manufacturer.
  Meetings/workshops with government and
  pharmaceutical companies
• Undertake price surveys and component study and
  present results to all stakeholders
• Disseminate study results and prices of
  medicines in print, public domain
• Educate consumers about generic substitution,
  medicine prices and access