Pharmaceutical Systems Research Articles

Secure and transparent pharmaceutical supply chain using permissioned blockchain network

ABSTRACT This paper proposes a secure and transparent pharmaceutical supply chain system using a permissioned blockchain network. This work focuses on (i) Enhancing the security of origin information across the supply chain with proper identification and authentication among the supplier, distributor, and other members of the system, (ii) Secure storing of the Supply Drugs Information (SDI) in the blockchain in a distributed manner, (iii) Traceability and transparent sharing of information across supply chain system. This proposed work also performs automatic transactions between suppliers and the distributors, tracking the provenance, adequate verification, and reducing supply chains’ risk. The proposed system has been implemented using Hyperledger fabric and evaluated using Hyperledger Calliper to test its performance. Finally, we analyzed the proposed work's performance in terms of throughput, transaction latency, and network load. The results have shown that better transaction processing power and security than other existing systems of the blockchain.

Pharmaceutical Supply Chain Practices and Its Associated Factors in Public Health Facilities, West Gojjam Zone, Ethiopia: Cross-Sectional Study.

Background: Effective pharmaceutical supply chain practices help to minimize stockout, losses due to expiry, and pilferage. Besides, it helps to ensure the availability of the pharmaceutical in an adequate quantity and improving the quality of services provided. This study aimed to assess the status of the pharmaceutical supply chain practices and associated factors from the healthcare professional's perspective in public health facilities. Methods: A descriptive cross-sectional study design, complemented with a qualitative study, was conducted in public health facilities between April 30 and June 30, 2018. The data were collected with self-administering questionnaires and face-to-face interviews. Epidata and SPSS version 20 was utilized for quantitative data entry and analysis, respectively. Simple and multiple linear regressions were done. A variable with a P-value less than .05 was considered as significantly associated. Twenty-seven key informants were interviewed for qualitative study and the data were analyzed using the thematic analysis method. Result: A total of 425 questionnaires were distributed to respondents and 413 questionnaires were filled and returned successfully. Supplier relationship management and information sharing and technology were underperformed supply chain practices with a mean value of 2.64 and 2.39, respectively. On the contrary, inventory management was a better-performed supply chain practice with a mean of 3.22. The linear regression analysis revealed that the Integrated Pharmaceutical Logistics System [IPLS] skill of the staff and management support were the factors significantly associated with the performance of most supply chain practices. Additional, in-depth interviews exposed that the shortage of budget, poor management support, and lack of staff commitment were the major challenges for most supply chain practices. Conclusion: Generally, the study revealed that most of the supply chain practices were poorly executed in public health facilities. Besides, the pharmaceutical supply chain practices were compromised by budget constraints, staff ignorance, and lack of administrative support.

Phytobiotic Potential of Flower Essential Oil of Melissa officinalis on Multi-Drug Resistance Bacteria common to Human and Animal

Essential oils are natural therapeutic agents, as they are rich sources of terpenoids and polyphenols. This study was aimed at evaluation of the synergistic potential of the phytochemicals in the essential oil obtained from the flower of Melissa officinalis on clinically isolated uropathogens. The research led to identification of various organic compounds from the essential oil of the vegetable part investigated. The main constituents identified were: phytol (49.9%), τmuurolol (13.0%), l-calamenene (8.8%), octyl butyl phthalate (8.6%), β- ionol (4.6%), and thymol (4.0%). In the antibacterial study, the highest inhibitory effect of the essential oil was observed against P. aeruginosa (20 mm), The results indicated that the flower essential oil has high antimicrobial potential and could be alternative sources of natural therapeutic agents. The sample can be exploited as natural antimicrobial and antioxidant in real pharmaceutical and pharmacognosy systems.

Chemical composition, structural properties, rheological behavior and functionality of Melissa officinalis seed gum

In the present work, the chemical composition, structural properties, rheological behavior and biological activity of a novel polysaccharide extracted from Melissa officinalis seeds were examined. Melissa officinalis seed gum (MOSG) is mainly composed of galactose and mannose. The weight average molecular weight of MOSG was found to be 1.36 × 107 g/mol. The zeta potential of MOSG was −44.26 ± 0.67 mV (at pH = 7). A time-dependent and strong shear-thinning behavior was observed for MOSG dispersions at different concentrations (0.5, 1 and 1.5% (w/w)). The intrinsic viscosity of MOSG was 3.45 dL/g. MOSG could effectively scavenge free radicals with certain dose-effect relationships. MOSG can be employed as gelling agent, stabilizer and antioxidant in food, cosmetic and pharmaceutical systems.

Nifuroxazide-loaded cubosomes exhibit an advancement in pulmonary delivery and attenuate bleomycin-induced lung fibrosis by regulating the STAT3 and NF-κB signaling: A new challenge for unmet therapeutic needs

Pulmonary fibrosis (PF) is a chronic progressive disease that portends a very poor prognosis. It has been suggested that STAT3 is a potential target in PF. This study highlights the importance of cubosomes as a drug delivery system in enhancing the bioavailability of nifuroxazide (NXZD), a poorly soluble STAT3 inhibitor. NXZD-loaded cubosomes (NXZD-LC) were in vitro and in vivo evaluated. In vitro, cubosomes presented a poly-angular nanosized particles with a mean size and zeta potential of 223.73 ± 4.73 nm and − 20.93 ± 2.38 mV, respectively. The entrapment efficiency of nifuroxazide was 90.56 ± 4.25%. The in vivo pharmacokinetic study and the lung tissue accumulation of NXZD were performed by liquid chromatography-tandem mass spectrometry after oral administration to rats. The nanoparticles exhibited a two-fold increase and 1.33 times of bioavailability and lung tissue concentration of NXZD compared to NXZD dispersion, respectively. In view of this, NXZD-LC effectively attenuated PF by targeting STAT3 and NF-κB signals. As a result, NXZD-LC showed a potential anti-inflammatory effect as revealed by the significant decrease in MCP-1, ICAM-1, IL-6, and TNF-α and suppressed fibrogenic mediators as indicated by the significant reduction in TGF-β, TIMP-1, and PDGF-BB in lung tissues. Besides, NXZD-LC improved antioxidant defense mechanisms and decreased LDH and BALF total protein. These effects contributed to decreased collagen deposition. To conclude, cubosomes represent an advantageous pharmaceutical delivery system for enhancing pulmonary delivery of poorly soluble drugs. Additionally, repurposing NXZD as an antifibrotic agent is a promising challenge and new therapeutic approach for unmet therapeutic needs.

Development and characterization of a dry reservoir-hydrogel-forming microneedles composite for minimally invasive delivery of cefazolin

Cefazolin (CFZ) is one of the most extensively used cephalosporins. This antibiotic exerts its bactericidal activity by interfering with bacterial cell wall formation, leading to bacteriolysis. CFZ is highly polar, resulting in the drug having poor oral bioavailability. Accordingly, the antibiotic is administered via intramuscular or intravenous injections, which are both painful and invasive. Due to these limitations, there is an impetus to explore alternative drug delivery platforms which offer a minimally invasive approach to delivery CFZ into and across the skin. The current work presents the development of a composite pharmaceutical system composed of hydrogel-forming microneedles (MNs) in tandem with CFZ dry reservoirs. The hydrogel system was fabricated from Gantrez® S-97 and Carbopol® 974P NF crosslinked with PEG 10,000. Swelling kinetic studies showed that the hydrogel system developed was capable of achieving 4000% swelling in PBS pH 7.4. In addition, results from a solute diffusion study showed that CFZ was able to achieve ≈100% cumulative permeation across the swollen hydrogel film. When formulated into MNs, the hydrogel system was capable of breaching the stratum corneum, resulting in intradermal insertion of the hydrogel forming MNs into ex vivo neonatal porcine skin, as evidenced from optical coherence tomography. In addition, two different CFZ loaded dry reservoirs consisting of directly compressed tablets (DCT) and lyophilised (LYO) wafers were formulated and characterised. These dry reservoir systems showed fast dissolution, dissolving in phosphate buffer saline pH 7.4 in less than one minute. In vitro permeation studies, using full thickness ex vivo neonatal porcine skin were conducted. HPLC analysis demonstrated the dry reservoir combination consisting of DCT with hydrogel-forming MNs was capable of achieving up to 80 µg CFZ delivery into the epidermis within 2 h of application. In addition, DCT reservoir coupled with hydrogel-forming MNs were able to deliver CFZ up to 1.8 mg into and across the skin at 24 h. Should this system be translated into clinical practice, it may provide a minimally invasive strategy to administer CFZ for the treatment of infections such as septic arthritis, osteomyelitis and cellulitis.

Research on government subsidy strategies for new drug R&D considering spillover effects

This paper studies the pharmaceutical production supply chain system composed of upstream and downstream pharmaceutical enterprises, and explores the impact of government subsidy strategies on the new drug research and development (R&D) decision variables and profits of pharmaceutical enterprises as well as social welfare, when considering both the horizontal spillover effects within the industry and the vertical spillover effects between industries. Comparing and analyzing the impact of these strategies including non-government subsidy strategy, pharmaceutical enterprise innovation input subsidy strategy, pharmaceutical enterprise innovative product subsidy strategy, patient price subsidy strategy, and patient medical insurance subsidy strategy. By establishing a four-stage Cournot duopoly model incorporating spillover effects, the equilibrium solutions are obtained by backward induction, and the impact of spillover effects on decision variables is investigated accordingly. Studies have shown that: (a) Government subsidy strategies can promote pharmaceutical enterprises’ R&D investment and have a positive incentive effect on the pharmaceutical enterprises’ profits and social welfare. (b) The patient medical insurance subsidy strategy is the optimal subsidy strategy, which can generate higher profits for pharmaceutical enterprises and higher social welfare. (c) The horizontal and vertical spillover effects have different effect on decision variables, enterprises’ profits and social welfare under various subsidy strategies.

Impact on Pharmaceutical Industry due to Sudden Pandemic Attack (COVID-19)

: The coronavirus disease (COVID-19) was first detected in Wuhan, China, in the month of December 2019. Further, in March 2020, the COVID-19 epidemic was described by the World Health Organisation (WHO) as a global pandemic. COVID-19 quickly spread around the world in the following months, affecting about 2.5 million individuals by April 2020. World markets, including the pharmaceutical industry, were devastated by this pandemic. Although no specific solution for this emerging infectious disease is currently available, the pharmaceutical industry is helping policymakers meet unmet COVID-19 desires, ranging from research and advancement initiatives on possible prevention methods to the management of the supply chain of drugs in times of crisis. Changes in demand, commodity shortages, contact adjustments, etc., are hindering developments in the mechanism of technology, research and development and are putting an impact on the health market of COVID-19. Other implications of COVID-19 on the physical condition and pharmaceutical market may include acceptance delays, heading to self-sufficiency in the delivery chain, etc. In addition, the pharmaceutical markets are battling to sustain natural consumer flows, as the latest pandemic has had an effect on access to essential drugs at reasonable rates, which is the key priority of all pharmaceutical systems.

Physico-Chemical and Microbiological Studies on Jordanian Honey and Propolis as Potential Self-Preserving Pharmaceutical Systems

The aim of this project was to study the physico-chemical and antimicrobial properties of Jordanian honey and propolis in order to determine their potential as pharmaceutical preservation systems. This study undertook a physico-chemical analysis of several Jordanian honeys and one propolis type, in order to evaluate several physico-chemical properties including, pH and free acidity, moisture content, ash content and HydroxyMethylFurfural content in three honey samples, and total flavonoid content in the propolis sample. The antimicrobial activity of honey and propolis samples was then evaluated by determining the minimum inhibitory concentration (MIC) against Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 8739, Pseudomonas aeruginosa ATCC 9027 and Candida albicans ATCC 10231. Subsequently, Honey 1 (H1) was selected for further study and combined with propolis to test their potential synergistic activity. Finally, a preservative effectiveness test was conducted in order to assess the possibility of using honey and propolis as natural preservatives in aqueous dosage forms, such as syrups. The results of this study showed that all the tested honey samples and propolis possessed significant antimicrobial activity against the standard test microorganisms, and that honey with propolis exhibited synergistic activity that enhanced their antimicrobial activity and resulted in up to 90% reduction in their MIC values. This study also confirmed that honey and propolis could be used as a natural preservative system for pharmaceutical formulae. Our results reveal the possibility of using honey-propolis mixtures as natural preservatives in oral aqueous pharmaceutical dosage forms and other local application products.

Анализ системы фармацевтической помощи населению Новосибирской области

Introduction. Uneven placement of pharmacy organizations on the territory of the Novosibirsk region, want of pharmaceutical staff, especially in remote areas, falling living standards, an increase in general morbidity of the population, limited material and financial health care resources in the Novosibirsk region necessitated an assessment of the pharmaceutical care system in order to develop measures to improve it, preserve constitutional rights and guarantees for residents. Aim. Development and testing of a methodology for analyzing the system of pharmaceutical care for the population of the Novosibirsk region. Materials and methods. SWOT analysis was used for the assessment. Based on the content analysis of scientific medical and pharmaceutical literature, regulatory documents of the Government of the Russian Federation, the Ministries of Health of the Russian Federation and the Novosibirsk region, a questionnaire was compiled in which various aspects of the pharmaceutical care to the population of the Novosibirsk region were characterized. A group of experts (heads of pharmacy chains, heads of pharmacies, chiefs or deputies, specialists of the Department of Drug Provision of the Population of the Ministry of Health of the Novosibirsk region – a total of 35 people) were asked to evaluate (rank) the proposed characteristics in a SWOT matrix. Results. It has been established that the strengths of pharmaceutical care to the population of the Novosibirsk region (the top among them are the developed infrastructure for providing the population with pharmaceutical care; the approval and implementation of federal programs on the strategy of drug provision to the population and the development of healthcare in the Russian Federation and the Novosibirsk region) exceed by 1.26 times the weaknesses of the system (insufficient financing of drug provision to the population of the region; insufficient provision of the population with pharmacy organizations and medical and obstetric stations in rural settlements of the Novosibirsk region, etc.). Possibilities of the pharmaceutical care system in the Novosibirsk region (organization of dispensing medicines by medical staff through out-patient clinics in rural settlements of the Novosibirsk region, in which there are no pharmacy organizations; an increase in the proportion of municipal and urban districts provided with medicines dispensing outlets in relation to all municipal and urban entities of the Novosibirsk region to 100%, etc.) by 1.13 times prevails over threats (an increasing staff shortage in the pharmaceutical industry, a pandemic of a new coronavirus infection, etc.). Conclusion. Pharmaceutical care for the population of the Novosibirsk region is characterized by the predominance of strengths over weaknesses, while potential opportunities exceed threats. This imples the necessity to further improve pharmaceutical care, use its resource capabilities and enhance its strengths.

Research on Cooperative Benefit Distribution Mechanism of Pharmaceutical Supply Chain with the Participation of Third-Party Logistics Service Providers

With the cancellation of the policy of “approval of third-party drug logistics business”, a large number of powerful enterprises that meet the conditions of modern pharmaceutical logistics have entered the pharmaceutical logistics. In this context, the introduction of third-party logistics service providers into the pharmaceutical supply chain system makes the problem study more practical. A three-level pharmaceutical supply chain operation mode was constructed, which was composed of pharmaceutical manufacturers, pharmaceutical distributors, third-party logistics service providers and retail pharmacies/ hospitals. By using game model, the relevant indicators under independent decision-making and cooperative decision-making can be compared and analyzed. The results show that in a certain range of cooperative cost, the performance index of pharmaceutical supply chain cooperative decision is significantly higher than that of independent decision. On this basis, considering two conditions that every supply chain member can obtain more benefits than that of independent decisions and the relative leadership of supply chain members, the cooperation benefits of pharmaceutical supply chain are reasonably distributed by three-distribution method based on profit distribution factors. Combined with the results, the elements affecting the profit distribution factor are explored, and the value range of the profit distribution factor is continuously reduced until the final result is determined and applied in practice, so as to ensure the stable cooperative operation of the pharmaceutical supply chain system.

Application of the membrane bioreactor process in upgrading a norfloxacin pharmaceutical wastewater treatment system

Application of the membrane bioreactor process in upgrading a norfloxacin pharmaceutical wastewater treatment system

Assessment of Knowledge, Practices, and Challenges of Pharmaceuticals Inventory Control Among Pharmacy Professionals Working in Selected Public Health Facilities of West Arsi Zone, Oromia, Ethiopia.

Background:Good pharmaceutical inventory control enables health facilities (HFs) to provide complete health care by ensuring the availability of safe, effective, and affordable pharmaceuticals and related supplies of the required quality, inadequate quantity, at the required place and at all times. It boosts patients’ trust in the HFs and motivates working staff. However, it needs well-trained and skilled professionals. The aim of the current study was, therefore, assessing knowledge, practice, and challenges of pharmacy professionals conducting inventory control in selected public health facilities of West Arsi Zone, Oromia regional state for the year 2016 to 2018.Method:A mixed-methods study design was used to assess pharmacy professionals’ knowledge, skills, and challenges in applying inventory management methods. A semi-structured questionnaire was implemented for quantitative, whereas an open-ended question was employed for key informants (KIs) to explore qualitative data.Result:Ninety percent of pharmacy professionals knew about VEN analysis concepts and 70% about ABC analysis. However, none of them had a concept of FSN and XYZ analysis. Among the respondents who knew the concept, 75% had gained knowledge through formal training and 10% of them learned from on-job training. When they asked about the methods of inventory control, 60% responded as they did not hear about it. Of those who said “Yes” on being asked to mention at least 1 method of it, 80% could not able to correctly mention the methods used in inventory control. However, 44%, 62.5%, and 75% of respondents had practiced ABC, VED, and ABC-VED matrix analysis respectively. The challenges that prevented these professionals from practicing pharmaceutical inventory control in their HFs were grouped into price-related, training-related, human resource-related, and managerial-related factors.Conclusion:Inventory control is the heart of the pharmaceutical supply system. Without its healthy action, HFs’ goal attainment will not be viable. Problems of sick pharmaceutical inventory control are directly related to a lack of knowledge and appreciation of it by the concerned bodies. The current finding revealed almost all pharmacy professionals included in the study had little knowledge about how to manage their inventories. Managers’ unwillingness to cooperate and facilitate necessary resources prevented the professionals from doing inventory control.

Recovery of Nitrification Performance of a Full-Scale Pharmaceutical Wastewater Treatment System by Relieving the Stresses of High Organic and Oxytetracycline Loadings

Recovery of Nitrification Performance of a Full-Scale Pharmaceutical Wastewater Treatment System by Relieving the Stresses of High Organic and Oxytetracycline Loadings

Pharmaceutical Nano-Delivery Systems: A Review

Nanotechnology is the science that deals with the processes that occurs at molecular level and of nanolength scale size.Reduction of drugs toxicity and enhancement of their bioavailability, biocompatibility, stability and appropriate release are of high opportunities to be accomplished by size reduction, which make pharmaceutical field highly interesting in nanotechnology. Formulation and preparation of highly advanced nano-materials as drug delivery systems achieve the desired therapeutic objective. Current review will discuss in brief types of pharmaceutical nano-sized drug delivery systems by focusing on the specificity and the nature of each type.

Study on Protection of the Right to Health, Access to Medicines and the Construction of the Rule of Law for Medicine Patents

The Access to Medicines is related to the basic rights of people's rights to life and health. It has been widely recognized by international conventions and has become a basic duty of the state to ensure and improve the level of citizens' access to medicines. At the same time, in the face of increasingly widespread uncertainties in modern society, building a fair and efficient legal system for medicines access is a necessary measure to promote citizens' trust in the government and maintain the legitimacy of power. In the conditions of 1.3 billion population and an unbalanced and inadequate economic development, China strives to ensure that its citizens’ medicines are economically affordable through continuous improvement of the legal system and arrangements, and to encourage local pharmaceutical companies to develop and manufacture better-quality medicines. On the premise of respecting the status of market players and property rights of pharmaceutical companies, China comprehensively uses diversified tools such as information, standards, market access, and competition law enforcement to establish a legal system for medicines accessibility from two channels: supply guarantee and price control. Particular attention is paid to the adjustment of the medical and social insurance and essential medicines systems. In recent years, China has focused on improving the pharmaceutical patent system, promoting the balanced development of local original research medicines and generic medicines, as well as the overall optimization and upgrading of the pharmaceutical industry through the protection of patent rights and appropriate restrictions. Driven by the economic and trade agreement reached between China and the United States in 2020, China's Patent Law will introduce a drug patent term extension system and a drug patent linkage system, and further improve the legal mechanism to encourage innovative activities of pharmaceutical companies.

Biocompatible nanosponges for drug targeting in pancreatic cancer

Cancer is a collective name for diseases distinguished by uninhibited or uncharacteristic cell proliferation. Its development is influenced by a succession of mutations which leads to invasive malignancies. Most people with cancer do not receive a diagnosis and treatment until the condition has worsened. Cyclodextrin-based nano sponges are unique nanosized structures made of cross-linkers having a three-dimensional network. The type of cross-linker may easily alter the polymer mesh's polarity and size. Due to uncontrolled cell proliferation and non-targeted therapy, traditional drug delivery systems are not so effective or promising in treating cancer. In treating pancreatic, breast, and prostate diseases, a tailored pharmaceutical delivery system may help deliver the drug effectively. The non-toxic, biodegradable substance in nano sponges is also well-tolerated in cell culture conditions. The release and entrapment efficiency can be easily modified by altering the structure to produce extended or fast release kinetics. In this research, we have explored the potential of β-Cyclodextrin, and diphenyl carbonate in designing an effective drug delivery system in the form of Nano sponge; the preparation method, structural analysis and possible future applications is the main focus of the article.

Structural modelling and ranking the warehouse activities in a pharmaceutical supply chain system

Storage and inventory management of drugs in a pharmaceutical industry is a complex process and it constitutes major part of costs, specifically when talking for the distribution of generic medicines. Therefore, warehouse management for generic medicine has to be looked from its basic concept for its design and operation. This article proposes a framework to redesign a warehouse for storage and distribution of generic medicines through exploratory case study. Field survey has been performed and bottleneck involved in the warehouse of a pharmaceutical industry has been identified using interpretive structural modelling (ISM) and fuzzy analytical hierarchy process (FAHP). The decisions made in the process mainly depend upon the dynamics of the different activities involved and their interrelationships. ISM establishes interrelationships between different activities and FAHP prioritises most sluggish sub-activities of warehouse. The findings highlight that quality control activities are heavily responsible for bottlenecks.

Consumers' access to information about medicine prices and availability as an enabler of last mile medicine access: A scoping review.

Information about where medicines are in stock and how much they cost facilitates consumers’ timely access to affordable medicines by enabling price comparisons and the identification of stockists. Our aims were to: (1) Review how consumer access to price and availability information is engaged within the Medicine Access discourse and (2) identify factors associated with the existence of interventions that provide consumers with medicine availability and price information. We conducted two scoping reviews. We reviewed 26 medicine access and pharmaceutical system strengthening frameworks to assess how they conceptualise information access. We then reviewed four interventions that provide consumers with availability and price information to identify the factors associated with these interventions’ existence. We found that in the medical access discourse, information is mainly cast as helpful to entities that ensure medicine access for populations. Information as an enabler of medicine procurement for consumers/households is less emphasised. We then identified the following eight factors that facilitate consumer access to reliable medicine price and availability information: the recognition of a medicine access problem that can be mitigated by consumer access to information; cross-sectoral collaboration; the willingness of medicine sellers to disclose their inventory information; having information quality control measures; appropriate incentives for intervention adoption; enabling legal environments; systems of pooling information; and access to digital information technology infrastructure. We recommend that more theoretical and implementation attention ought to be directed at how medicine price and medicine availability information can empower individual consumers to make sound purchasing decisions.

The Impact of Pharmaceutical Electronic Bidding Procurement on Prices of Medicines: A Systematic Review

An electronic bidding system promises to save resources in procurement procedures for many industries. While the results of previous studies in several countries sounded promising, it is concerning that more evidence would be needed to support changes in practice for the pharmaceutical sector. The objective of this study was to determine the prevalence of price saving in bidding-based electronic procurement setting and to clarify the main factors contributing to drug price changes. A comprehensive literature search was retrieved from five databases (Scopus, PubMed, ProQuest, Web of Science, Medline) to identify articles that studied the prices of medicines as a case study before and after the implementation of the electronic bidding system. Articles that were published in English from January 2012 to December 2021 were eligible for inclusion. The result showed that a total of 3214 records articles were identified in the electronic databases after the exclusion of duplicate articles. After the initial review, we found 13 studies that fulfilled our inclusion criteria. The review presented the important information suggesting that the use of the electronic bidding system likely results in a reduction in procurement prices of medicines. The prevalence of price saving for pharmaceutical procurement ranged from 7.24 % to 40 %. Additionally, the following factors were indirectly associated with drug price changes; bid volume, procurement location, contract characteristics, level of competitiveness and procurement organization. Further research may need to examine the functioning of e-bidding policies to address problems like supply disruptions to preserve the integrity of bidding-based pharmaceutical systems.