Figure - available from: Frontiers in Pharmacology
This content is subject to copyright.
The overall price and affordability of essential medicines in China. Notes: Red indicates the MPRs of essential medicines with a red dotted line as the threshold, and blue indicates the affordability of essential medicines with a blue dotted line as the threshold. MPR, median price ratio.
Source publication
Background: Essential medicine is a vital component to assure universal access to quality healthcare. However, the trend of affordability to essential medicines in China and its regional differences were not yet fully understood. This study aimed to systematically evaluate the price and affordability of essential medicines, their progress, and regi...
Citations
... It was found that the median affordability of essential medicines in China was equal to 0.88 day's wage for the lowest-paid unskilled government worker. This suggests that essential medi cines would become unaffordable if they cost more than the equivalent of one day's wage for the lowest-paid unskilled government worker [28]. ...
The role of essential medicines is to smoothen life and overall improvement of health in society. However, increased demand for medications and the role of patent rights are forcing a lack of access to essential medicines. Innovations in crucial times helped solve many population issues. Despite the availability of medication technology, there is a shortage or non-availability of essential medicines in various parts of the world. This is indirectly attributed to the existing patent laws and intellectual property rights. This paper argues in favour of and against the pharmaceutical sector’s patent laws in the context of access to medicines. Further, access to medicine is discussed in the context of the non-availability of medications among the vulnerable population in India and the world. The Indian setup helps in acquiring world technologies in various business negotiations. There is also a need for support in terms of resources and ecosystems in India for further development. Given that multi-national companies are interested in the Indian market, many things can be done quickly. However, the gain in the patent rights may not help solve the issues of access to essential medicines. Public financing for research can be much more useful for access to medicine. Overall, patent rights must not be a hurdle for addressing public health issues in the process of increasing access to medicines.
... There is a critical need for policy interventions to regulate mark-up on medicines in the community pharmacy sector to improve medicine affordability and accessibility in Zimbabwe [4,5,24]. Comparable situations of high prices and constrained access to medicines have also been observed in other LMICs, such as Ethiopia, South Africa, and China [25][26][27]. The prevailing free-market economy grants practitioners unrestricted power to determine medicine prices. ...
Background
Medicine pricing in the community pharmacy sector in Zimbabwe significantly influences accessibility to health care. In this pilot survey, we investigated how community pharmacies in Zimbabwe apply various mark-up strategies to essential and non-essential medicines, and gathered community pharmacists’ perspectives on mark-up regulation.
Methods
Using an adapted methodology endorsed by the World Health Organization and Health Action International for studying medicine prices and availability, we conducted a quantitative cross-sectional pilot survey for 46 medicines (31 essential and 15 non-essential) identified using the Zimbabwe Essential Medicines List and classified according to the Vital, Essential, and Non-essential (VEN) tool. We conducted the pilot survey in 92 community pharmacies in the metropolitan area of Harare, Zimbabwe.
Results
We gathered a total of 92 responses from 167 distributed questionnaires. The most prevalent mark-up strategy was the cost-plus fixed percentage.The median mark-up for all medicines in the community pharmacies was 60% (interquartile range 50- 82%). We found a statistically significant difference in the median mark-up by essentiality of medicines (p < 0.001), essential medicines had a median mark-up price of 62% while non-essential medicines had a mark-up of 56%. Antipsychotics had the highest mark-up at 82%, while anti-neoplastic medicine had the lowest at 36%. Overall, 55% of the community pharmacists did not support mark-up regulation.
Conclusion
Mark-up strategies varied across community pharmacies in the metropolitan area of Harare. Without mark-up regulation, essential medicines remain significantly expensive in Zimbabwe. We recommend mark-up regulation in Zimbabwe’s community pharmacy sector and emphasize the effective use of multiple pricing strategies to reduce medicine prices. .
... First, the long-term impacts of NEMP vary from the short-term outcomes and exhibit considerable regional variations. Recent reviews have shown that despite a long-term decrease in median price ratios (31), the availability of essential medicines has not improve and remains low after a decade of NEMP implementation (32). This issue is even more pronounced in some western and rural areas, where the accessibility and affordability challenges have persisted or worsened (31)(32)(33)(34). ...
... Recent reviews have shown that despite a long-term decrease in median price ratios (31), the availability of essential medicines has not improve and remains low after a decade of NEMP implementation (32). This issue is even more pronounced in some western and rural areas, where the accessibility and affordability challenges have persisted or worsened (31)(32)(33)(34). Given that, there is a necessity for more comprehensive and consistent long-term surveillance data from these areas (32). ...
... Third, the implementation of NEMP may exert disproportionate impacts across various medicine categories. Notably, the availability Frontiers in Public Health 03 frontiersin.org of systematic hormonal preparations and nervous system medications was lower than other types, while the affordability of antineoplastic and immunomodulating agents remained less than optimal (31,32). Prior research has often been limited to a narrow selection of medicines, leaving a gap in the understanding of effects on none-NEML pharmaceuticals and traditional Chinese medicines (TCMs). ...
Background
China’s National Essential Medicines Policy (NEMP) has been implemented for over 15 years; yet empirical evidence on its long-term impacts is lacking, particularly in remote and rural regions. This study aims to assess the short-and long-term effects of NEMP on the drug availability, price, and usage in a deprived rural county in southwestern China.
Methods
A quasi-experimental design was employed, featuring a single-group pre-and-post comparison. We gathered 74,436 procurement records spanning from 2009 to 2016 from the drug warehouses of local medical institutions. Pharmaceutical data were analyzed quarterly, considering various policy and therapeutic attributes. Fisher’s Drug Price Index (DPI-F) was calibrated for the retail and wholesale prices of a consistent collection of 405 medications. We conducted interrupted time-series analysis to examine the immediate and enduring impacts of NEMP’s initial (commencing in January 2011) and second (starting from December 2015) stages.
Results
After initiation of NEMP, the number of available essential medicines surged by 115 but subsequently faced a steady quarterly decline (−9.1) in township healthcare centers (THCs, primary care). Conversely, county hospitals (secondary care) initially saw a reduction of 40 in drug availability but later exhibited a steady increase (+4.2 per quarter) up to the second-stage NEMP. Regarding price, THCs encountered abrupt (−26.1%/−15.9% in retail/wholesale price) and sustained (−0.2%/−0.3% per quarter) price drops after NEMP. The immediate price change after NEMP in county hospitals were milder but significant in non-essential medicines, and long-term declines were also observed in all drugs. As for total sales, a significant long-term disparity emerged between THCs (+0.9% per quarter) and county hospitals (+3.3% per quarter). Following the second-stage NEMP, retail prices in county hospitals further decreased, although wholesale prices did not; however, following price upward trends were observed in both THCs and county hospitals. Lastly, the influences of NEMP varied across different therapeutical categories of medicines.
Conclusion
NEMP has successfully regulated drug prices in primary and secondary healthcare facilities in remote and rural areas, both short-term and long-term. However, a remarkable disparity in medicine availability and utilization was observed between different levels of facilities over time. Continuous monitoring is essential, with increased attention needed on the uneven impacts of the policy on diverse drugs, facilities, regions, and demographics.
Background
With the remarkable effect of controlling the increase in drug costs by the first batch of National Key Monitoring and Rational Use Drugs (first NKMRUDs), the National Health Commission of the People’s Republic of China releases the second NKMRUDs to further strengthen the reasonable use of drugs. Unfortunately, the second NKMRUDs include some drugs of National Volume-based Procurement and National Essential Medicines, which challenges the management of pharmaceutical affairs on the three kinds of drugs.
Objective
The main objective of this study was to investigate the prevalence of the second NKMRUDs and explore their monitoring indicators.
Methods
An adapted WHO methodology for point prevalence surveys was conducted for the second NKMRUDs. For the monitoring indicators, we sought to explore whether the defined daily dose (DDD) and days of therapy (DOT) can be suitable for the second NKMRUDs through comparing differences between DDD and DOT with the prescribed daily dose (PDD).
Results
Among the 935 included patients, 29.20% of the patients received at least one of the second NKMRUDs. A total of 273 patients were administered with 487 times of the second NKMRUDs. Among them, 162 , 62 , and 49 patients were receiving one, two, and three or more agents, respectively. The most commonly prescribed second NKMRUDs were compound amino acids, budesonide, and ceftazidime. The total DDDs and DOTs of the second NKMRUDs were 3360.68 and 1819.80, respectively, with the PDDs of 1865.26. The deviations (80.17%) of DDDs from PDDs were significantly greater than those (−2.44%) of DOTs.
Conclusion
The prevalence of the second NKMRUDs was obtained by using the adapted PPS methodology at a tertiary university hospital. The DOT indicator is found to more accurately reflect actual consumption than the DDD indicator for second NKMRUDs. It is recommended to use the DOT indicator to monitor second NKMRUDs.
