Medicine Pricing, Availability and Affordability

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Medicine Pricing, Availability and Affordability
in THAILAND Report of a survey conducted in
Bangkok (Capital), Phitsanulok (North),
Suratthani (South), and Nakornrachaseema
(Northeast). Cha-oncin Sooksriwong,
Dr.PH. November 10, 2008
Worasuda Yoongthong,
M.Sc.
Advanced Technical Briefing Seminar on Medicine
Prices, Availability and Price Regulation New
Delhi, India 10-14 November, 2008
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Content

• INTRODUCTION
• METHODOLOGY
• RESULTS DISCUSSION
• 1. Public sector prices
• 2. Private sector prices
• 3. Comparison of patient prices in the public
  and private sectors
• 4. Price components
• 5. International price comparison
• 6. Affordability
• CONCLUSION RECOMMENDATIONS

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METHODOLOGY

• The survey of the prices, availability and
  affordability of medicines in THAILAND was
  conducted using the standardized WHO/HAI
  methodology (WHO/HAI 2003).
• Data was collected during October and December
  2006.
• Prices data was collected for
• 1. Public sector procurement prices and patient
  prices
• 2. Private sector procurement prices and patient
  prices
• For each substance, 2 products were monitored,
  namely
• - Innovator brand,
• Lowest price generic equivalent.
• Selection of medicines
• WHO/HAI core list

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Selection of medicine outlets
13 Nakornrachaseema 38 Phitsanulok 52
Bangkok 64 Suratthani
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RESULTS

• 1. Availability of medicines in the public and
  private sector
• 2. Public sector prices
• 2.1 Procurement prices
• 2.2 Patient prices
• 2.3 Comparison of procurement prices with
  patient prices
• 3. Private sector prices
• 3.1 Procurement prices
• 3.2 Patient prices
• 3.3 Comparison of procurement prices with
  patient prices
• 4. Comparison of patient prices in the public and
  private sectors
• 4.1 Procurement prices
• 4.2 Patient prices
• 5. Price components
• 6. International price comparison
• 7. Affordability of standard treatment regimens

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1. Availability of medicines
Table 1 Summary of median availability of WHO/HAI
CORE LIST medicines
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2. Public sector prices 2.1 Procurement prices

• 2.2 Patient prices

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2. Public sector prices 2.3 Comparison of
procurement prices with patient prices
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Annex 5 List of Procurement price ratios, Public
sector, all 43 medicines (1 outlet)
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Annex 6 List of Patient price ratios, Public
sector, all 43 medicines (1 outlet)
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3. Private sector prices 3.1 Procurement prices

• 3.2 Patient prices

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3. Private sector prices3.3 Comparison of
procurement prices with patient prices
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4. Comparison of prices in the public and private
sectors 4.1 Procurement prices

• 4.2 Patient prices

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List of Brand which Procurements MPR over than
Median MPR in public site
(Median MPR 9.51)
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5. Price components

• Table 10 presents the price components of 3 drugs
  (1, 2, and 3) of same generic name in the public
  and private sectors.
• Each generic composed of one imported product
  (Innovator Brand) and 2 generic equivalents
  (Generic). Their trade names were replaced by
  alphabets A-I.
• Drug gr.1 Atenolol tab. 50 mg
• Core list National Essential Drug group A
• Antihypertension (Beta-Blocker)
• Drug gr.2 Diclofenac tab. 25 mg
• Core list National Essential Drug group B
• Anti-Inflammatory Analgesics (NSAIDS)
• Drug gr.3 Carbamazepine tab. 200 mg
• Core list National Essential Drug group B
• Anticonvulsants.

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In the public sector, the mark-up for the
imported generic products were ranged as
Generic drug Manufacturers selling price
Original Imported price
27.88 to 867.69
0 to 2185.71
Hospital Procurement price
Hospital procurement price
28.06 to 41.18
30.0 to 316.67
Retail price to patient
Retail price to patient
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In the private sector, the mark-up for the
imported generic products were ranged as
Generic drug Manufacturers selling price
Original Imported price
64.23 to 833.85
2.74 to 566.67
Wholesaler Procurement price
Wholesaler procurement price
6.67 to 31.15
0 to 1.59
Pharmacy Procurement price
Pharmacy Procurement price
13.04 to 40.26
20.0 to 150.0
Retail price to patient
Retail price to patient
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6. International price comparison with other
countries
Gap between LPG and Brand
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7. Affordability of standard treatment regimens

• The affordability of treatment for 24 common
  conditions was estimated as the number of days'
  wages of the lowest paid unskilled government
  worker needed to purchase medicines prescribed at
  a standard dose.
• For chronic diseases, the affordability of a
  30-day supply of medicines was determined.
• The monthly salary of the lowest paid government
  worker was 5,230 Baht Baht or 211.5 Baht per
  day.

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24 common conditions
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Table Actual prices of treatment in Baht
currency
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IN CONCLUSION

• 1. We found problems on
• -Thailand has no system to control the
  procurement prices and patient prices both in the
  public and private sectors.
• -The mark up prices at any supply chain can be
  set up freely
• -Variation in prices of the same drug sold at
  different places.
• 2. We found that it seems to have no problems on
  drug affordability and availability.

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Suggestion

• For further study
• If it is not sure whether the pricing system in
  Thailand is a problem or how should we solve this
  problem, we should gather more knowledge by
  simulate a model to study the effects of
  different pricing strategies on the stakeholders
  such as pharmaceutical industries, the FDA, the
  national health insurance payers, the government
  budget, and the consumers.
• For policy makers
• The government should make a decision to exercise
  a policy to regulate the drug pricing, in order
  to maximize the government budget and the
  fairness of the society. There should be a close
  corporation with the health care financing
  policy. A drug pricing strategy should be
  selected where appropriate.

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Acknowledgements

• Thai FDA
• WHO / HAI
• Area supervisors
• Hospital pharmacists
• Drugstore owners
• Public health pharmacists at Provincial Health
  Offices
• Mr.Siriwat Suwattanapreeda

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THE END Thank You for Your Kind
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