Cheaper Medicines for the Better Off? A Comparison of Medicine Prices and Client Socioeconomic Status Between Chain and Independent Retail Pharmacies in Urban India.

Rosalind Miller,Catherine Goodman

doi:10.34172/ijhpm.2020.214

Abstract

Background: The growth of chain pharmacies in India, and other low- and middle-income countries (LMICs), is challenging the status quo of pharmacy retail markets which have historically been dominated by independent pharmacies. This raises the question of whether such organisations will have a positive impact on affordability and access to medicines. Methods: This paper draws on a standardised patient (SP) survey to measure the prices of medicines and expenditure on consultations for two tracer conditions (suspected tuberculosis [TB] in an adult and diarrhoea in an absent child) at a random sample of 230 chain and independent pharmacies in Bengaluru. Asset data were collected from 808 exit interviews with pharmacy customers to determine socioeconomic profiles of clients. Results: Chain pharmacies were found to provide lower priced medicines for patients seeking care for diarrhoea and TB, with expenditure also lower for diarrhoea patients, compared to independent pharmacies. This was seemingly driven by lower prices rather than number of medicines dispensed or prescribing habits. Despite the availability of cheaper medicines, chains served wealthier clients, compared to independent pharmacies.Conclusion: The findings indicate the potential for chains to contribute to improving medicine affordability as they expand. However, any attempt to leverage this organisational model for public health good would need to take account of the current client-mix of these pharmacies and be accompanied by appropriate regulatory constraints in order to realise the potential benefits for poorer groups.

Highlights

Retail pharmacies represent an important component of the health system in low- and middle-income countries (LMICs)
Price Individual medicines for diarrhoea were sold at a price below the maximum retail price (MRP) at both chains and independents, but the discount was larger for chains (0.9 rupees versus 0.15 rupees, P = .005) (Table 1)
For medicines sold for TB symptoms, there was weak evidence that chains had lower prices relative to the MRP

Summary

Introduction

Retail pharmacies represent an important component of the health system in low- and middle-income countries (LMICs). Owing to their geographical accessibility, long opening hours, and availability of medicines they are often patients’ first port of call when illness arises.[1] Pharmacy retail markets in LMICs have traditionally been dominated by local, independently owned pharmacies.[2,3] These pharmacies are widely used but their practice has been judged to be poor. Insufficient history taking, a lack of adherence to treatment guidelines, and inappropriate dispensing of medicines are commonplace.[1,4,5] up to 90% of the population in LMICs purchase medicines through out-of-pocket payments, with medicines accounting for the largest family expenditure item after food.[6] As a result, medicines are unaffordable for many

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