Abstract
BackgroundMalaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components.Methods and FindingsThe methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB) prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%–76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high—25%–38% and 100%–140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector.ConclusionsThe free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and affordability, promotion of generic medicines and improved availability of medicines in the public sector are required.
Highlights
The price of medicine is considered one of the most important obstacles to access [1]
Among a total of 48 medicines included in the survey, 28 belong to the core list medicines suggested by World Health Organization (WHO)–Health Action International (HAI) for international comparison, and 20 were added as supplementary drugs
The supplementary list was finalized after expert opinion and feedback from international experts and a national advisory group
Summary
The price of medicine is considered one of the most important obstacles to access [1]. The purchase of medicines contributes significantly to the health care budget of developing countries, and drug expenditures may amount to 50%–90% of nonpersonnel costs [2]. The ‘‘Health Adjusted Life Expectancy’’ at birth, is comparable to that of industrialized countries [3] Malaysia has achieved this level by using only a few percentage of its gross domestic product on healthcare [4]. Malaysia’s stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components. An important reason for this problem is that prices are often too high for people or government-funded health systems to afford. Without government intervention, there is nothing to help to push down prices
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
