Abstract
Inadequate access to medicines affected by un-controlled prices is a major concern in developing countries, including Pakistan, which lacks comprehensive data on medicine prices. Thus, the objective of this study was to evaluate the prices, availability and affordability of essential medicines in Lahore division, Pakistan. The survey was undertaken from November, 2016 till March, 2017 by including 50 medicines, 14 from the WHO/HAI core list and 36 supplementary medicines from national essential medicine list (NEML) at public (n = 16) and private (n = 16) health facilities. The prices, availability and affordability of selected medicines were measured using a variant of the WHO/HAI standard methodology available on HAI website and WHO/HAI manual. A questionnaire was used for data collection from Lahore division. The prices were compared to International reference prices (IRPs) and the daily wage of a lowest paid unskilled government worker was used to calculate medicine affordability. Data suggested poor availability of originator brands (OB) in public and private sector facilities, i.e., 6.8% and 55.0%, respectively. Similarly, low availability was observed for lowest price generics (LPGs), both in public (35.3%) and private sector (20.3%) facilities–far below the WHO global action plan targets of 80% availability of essential medicines by 2025. In private sector, 53% OB and 38% LPG medicines were found excessively priced. The cost of standard treatment with OBs was unaffordable, i.e., above a single daily wage (1.4 day’s wages) was demanded to purchase the standard treatment for the selected diseases in case of OBs medicines. Whereas, the cost of LPGs medicine required to purchase the standard treatment of the selected diseases was 0.6 day’s wage (median), below a single daily wage. In conclusion, access to essential medicines, especially at public sector facilities was affected by low availability, particularly of OBs in comparison to LPGs. Thus, the better availability of LPGs might be a rational basis of transition into a generic system of prescribing that may improve the availability and accessibility of essential medicines in Lahore division. Medicine prices in Lahore division were found higher in comparison to IRPs. Thus, the efforts must be made to formulate patient’s pocket friendly drug pricing policy that favors price cuts and improves affordability.
Highlights
In developing countries, the budget allocated to the purchase of medicines contributes significantly to the overall health care costs and may account for almost 50–95% non-personnel costs [1]
We found that the overall availability of surveyed medicines in public sector was 6.8% only for originator brands (OBs) and 35.3% for the lowest price generics (LPGs) (Table 1)
The availability of medicines in private sector retail pharmacies for 50 surveyed medicines was relatively better in case of OBs i.e. 55% and relatively lower in case of LPGs i.e. 20.3%, Table B in S1 Text
Summary
The budget allocated to the purchase of medicines contributes significantly to the overall health care costs and may account for almost 50–95% non-personnel costs [1]. In Pakistan, 32% of the health expenditure is borne by public sector, while 64% is borne by patient’s out of pocket payments that may account for unaffordability of medicines in this region [2]. The higher prices of medicines are considered as one of the major barriers to access medicines, even the essential medicines [2]. Availability and affordability are considered to be the key prerequisites for universal access to medicines [3]. A very few studies have been reported from Pakistan that deal with the ever-growing issue of increased/higher drug prices which may impact the affordability and availability of drugs [4]. Thirteen percent (13%) of Pakistan’s population lives below the poverty line, i.e. less than 1USD per day, the earning that is not sufficient to obtain even basic medicines such as aspirin for long term use [5]
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