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Current and Emerging Pharmaceutical Policy Issues in NonIndustrialized Countries

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Current and Emerging Pharmaceutical Policy Issues in Non-Industrialized Countries ... Influence of Pharmaceutical Companies. Intense marketing pressure ... – PowerPoint PPT presentation

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Title: Current and Emerging Pharmaceutical Policy Issues in NonIndustrialized Countries


1
Current and Emerging Pharmaceutical Policy Issues
in Non-Industrialized Countries
  • Pharmaceutical Policy Seminar
  • October 4, 2004

2
Overview
  • Pharmaceuticals in health systems
  • Current pharmaceutical policy issues
  • Health sector reform
  • Decentralization
  • Globalization and trade
  • ICIUM2004 Global agenda for improving medicines
    use

3
Global Pharmaceutical Market of 466 Billion in
2003
N America, Europe, Japan 88
4
Pharmaceutical Spending as of Total Health
Spending
Greece
Germany
Italy
Developed countries
France
Spain
(7 - 20)
Denmark
UK
United States
Netherlands
Norway
Bulgaria
Czech Rep.
Transitional countries
Hungary
Croatia
(15 - 30)
Poland
Estonia
Slovenia
Lithuania
Mali
Egypt
China
Indonesia
Thailand
Developing countries
Tunisia
Jordan
(24 - 66 )
Argentina
South Africa
0
10
20
30
40
50
60
70
5
Health and Pharmaceutical Expenditures by Region
(1990)
6
Current Pharmaceutical Policy Challenges and
Changes
  • Challenges
  • Government inefficiency, poor management,
    corruption
  • Limited access to essential medicines
  • Changes in health system context
  • Health reform
  • Decentralization
  • Implementation of WTO/TRIPS
  • New emphasis on access programs

7
Health Reform Increasing Shift in Services to
the Private Sector
  • Character of the private market and types of
    providers vary by country
  • Established insurance markets
  • Emerging insurance markets
  • Private purchase markets
  • Government role also varies
  • Degree of engagement as policymaker
  • Market power as purchaser
  • Setter and enforcer of standards

8
Private Pharmaceutical Sector in Developing
Countries
Government (MOH)
Professional Organizations
lobbying
support,
lobbying
Drug Industry
taxes
payments
marketing
promotion
payments
Consumers
Providers
treatment
9
Decentralization Rhetoric and Reality
  • Intended benefits
  • Decisions are more locally appropriate
  • Services are more efficient
  • Greater financial accountability
  • Inherent problems
  • Lack of political commitment to health
  • Technical capacity at district level
  • Decentralization of corruption?

10
Influence of Pharmaceutical Companies
  • Intense marketing pressure
  • Sponsorship of educational programs
  • Promotional material and product samples
  • Detailing visits
  • Indirect-to-consumer advertising
  • Weak regulatory control
  • Content of ads and product inserts
  • Ethical practices

11
Open Markets WTO and TRIPS
  • World Trade Organization (WTO)
  • Begun in 1995, now 147 Members (April 2004)
  • Rules of trade between nations
  • Trade-Related Aspects of Intellectual Property
    Rights (TRIPS)
  • Before TRIPS Diversity in patent laws
  • Patents for products, processes, or both
  • Patent term varied from none to gt 20 years
  • After TRIPS Uniformity in patent laws
  • Minimum 20 years
  • Both product and process patents required

12
Implications of WTO and TRIPS
  • Expansion of private sector markets
  • Flood of foreign products
  • Potential decreased access to essential drugs
  • Reduced generic competition
  • Increased prices
  • Less government financing
  • Pressures for inappropriate use
  • Increased marketing and promotion
  • Lack of relevant product information
  • Inappropriate incentives

13
ICIUM 2004
14
ICIUM 2004 Global Agenda for Policy and Research
in Use of Medicines
15
Background and Context
  • International Conference on Improving Use of
    Medicines, Chiang Mai, 1997
  • 272 participants from 46 countries
  • Milestone in defining global agenda
  • Joint Research Initiative on Improving Use of
    Medicines (JRIIUM), 1997-2004
  • Research in ICIUM 1997 priority areas
  • Build capacity for intervention research
  • Global context
  • Health reform, privatization, decentralization
  • Access initiatives, financing innovations

16
Objectives of ICIUM 2004
  • Review past and current initiatives to improve
    use of medicines
  • Evidence-based consensus on which interventions
    are successful
  • Prioritized global agenda
  • Short-term policy implementation
  • Long-term policy development
  • Key research gaps
  • Dissemination and implementation

17
ICIUM 2004 Accomplishments
  • 472 policymakers and researchers from 70
    countries
  • 322 abstracts posters, 290 oral presentations
  • Recommendations for implementation and research
    in over 20 topic areas including access to
    essential medicines, AMR, adult health, child
    health, malaria, TB, HIV
  • All materials available at www.icium.org

18
Top 10 ICIUM Recommendations
  • Involve all stakeholders in developing,
    implementing, and monitoring National Medicines
    Policy and National AMR Policy
  • Expand health insurance and medicines coverage to
    vulnerable populations
  • Implement tailored interventions and systems
    changes to improve public private sector
    prescribing
  • Establish policies and incentives to promote use
    of generic medicines, and develop systems to
    guarantee product quality
  • Implement short-course therapy for pediatric
    pneumonia and evaluate for other infections

19
Top 10 ICIUM Recommendations
  • Monitor essential medicines prices and price
    components
  • Support consumers with unbiased information about
    medicines medicines prices
  • Enforce regulations concerning drug promotion and
    consumer advertising
  • Improve quality of service in private pharmacies
    using standards of care, regulation, enforcement,
    training
  • Implement systems to assure adherence as an
    integral part of expanded access programs (ARV,
    TB, malaria)
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