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INTRODUCTION

• Price of a medicine has impact on affordability and therefore access to essential medicines.

• Sound data for price, availability and affordability of essential medicine is not available for Haryana State.

• Hence, the present study was undertaken to – Study the prices and availability of commonly

used medicines in public and private sector– Affordability of medicines for common ailments

for ordinary people of the State

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GEOGRAPHIC REGIONS SURVEYED

<-- indicates survey region

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METHODS• Survey was conducted according to the methodology described in the

manual –The Prices of Medicine, WHO-HAI, 2003.

• Survey was conducted in November-December 2004. Data was collected from six districts –Panchkula, Faridabad, Yamunanagar, Panipat, Rohtak & Hissar

• In each area five public facilities and five private pharmacies near to public facilities were surveyed.

• Total of 30 public and 30 private facilities were surveyed.

• A total of 32 medicines (27 from core list of Manual and 5 supplementary medicines) were surveyed.

• For each medicine, 3 products were surveyed – Innovator Brand (IB), Most Sold Generic equivalent (MSG) and Lowest Priced Generic (LPG).

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• Two ‘trained’ data collectors surveyed all the facilities and collected the procurement price from public sector and the price patient pays, from private sector.

• Data entry was done in an excel workbook and it generated some automated analysis.

• Results are expressed in comparison to international reference price.

• Prices are expressed in Median Price Ratio (MPR).

• The MPR is the median unit price across the facilities surveyed in a sector (in local currency) divided by the international reference price (also in local currency).

• Affordability was calculated using daily wages of Unskilled Regular Govt worker.

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Median Price Ratio (MPR) in Public Sector (Procurement Price) and

Private Sector (Sale Price)

IB MSG LPG IB MSG LPGMPR for all medicines NA NA 0.33 3.55 1.83 1.74Enalapril tab 5mg NA NA 0.16 NA 1.55 1.54Ranitidine cap/tab 150 mg NA NA 0.25 0.44 0.44 0.44Omeprazole cap/tab 20 mg NA NA 0.06 NA 0.48 0.23Ciprofloxacin 500 mg cap/tab NA NA 0.57 NA 5.83 2.08Carbamazepine 200 mg tab/cap NA NA NA 1.77 1.83 1.74Glibenclamide 5 mg cap/tab NA NA 0.35 3.55 3.55 3.5

Public Sector Private Sector MPR

6

0

5

10

15

20

25

30

Procurement Only Private sector

18

7 7

3

14 15

3

9

20

0

5

10

15

20

25

No. of Medicines found in 0%

facilities

No. of Medicinesfound in 1%- 50%

facilities

No. of Medicinesfound in 51%-100% facilities

Nu

mb

er o

f M

edic

ine

IB

MSG

LPG

Availability of medicines in Private Sector

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COMPARATIVE AVAILABILITY OF MEDICINES

Public vs Private Sector

0 0

19

11

2527

0

5

10

15

20

25

30

No

. of

med

icin

es

Private sector

Sector

Comparative avalability of medicines

IB

MSG

LPG

Public sector

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AVAILABILITY & AFFORDABILITY OF LOWEST PRICED GENERIC

Condition Medicine Availability in Public Sector

(%)

Affordability in Private Sector (# days work for unskilled government

worker)

Diabetes Glibenclamide

1 BD X 30 days

83.3 % 0.3 days

Hypertension Atenolol

1 OD X 30 days

90% 0.3 days

Adult Resp.Infections.

Amoxicillin

1 TDS X 7 days

73.3% 0.3 days

Pediatrics Resp. Infections.

Co-Trimoxazole suspension

1TSF BD X 7 days

6.7% 0.1 days

Gonorrhoea Ciprofloxacin

1 OD X 1day

80% 0 days

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MEDICINES AFFORDABILITY

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OTHER INTERESTING FINDINGS Price variation of drugs in Private sector (Sale Price) and Public

sector (Procurement Price)

• Variation in prices of IB, MSG and LPG brands of Ciprofloxacin , a price controlled drug

• No variation in prices of IB, MSG and LPG brands of Ranitidine, a price controlled drug.

• Even the same brand of medicine found being sold at different prices in different areas.

S. No Medicine Procurement Price per unit in INR

Sale Price per unit in INR

Variation

1. Ciprofloxacin tablet 500 mg

0.8216 8.40 (Cipla) 10 times

2. Ceftriaxone injection 1g

21.84 73.00 (Aristo) 4 times

3. Diazepam tablet 5 mg

0.05148 1.76 (Roche) 35 times

4. Amoxicillin cap/tab 250 mg

0.5304 4.00 (Rexcel) 8 times

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Price variation of same generic medicine in different regions (when medicines are found in min of 2 outlets)

 

S. No. Medicine Name Min MPR in INR Max MPR in INR

1 Albendazole tab 400 mg 3.19 (Rohtak)

10.49 (Panchkula)

2 Atenolol 50 mg tab/cap 1.69 (Rohtak)

4.75 (Panchkula)

3 Cephalexin 250 mg tab/cap 1.05 (Rohtak)

2.82 (Panchkula)

4 Diazepam 5 mg tab 2.52 (Yamunanagar) 7.16 (Panipat)

OTHER INTERESTING FINDINGS (cont)

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CONCLUSIONS

• Haryana’s public health sector was found efficient in procurement of medicines.

• Medicines are supplied free of cost in public facilities to all the patients (outdoor and indoor).

• Availability of medicines in the public sector was found comparatively less than the private sector.

• Innovator brands were found being sold comparatively at higher price than their lowest price generic equivalents

• Prices of generic medicines also vary and the cheapest generic equivalent is not always the most sold.

• Price of generic drugs which the patient pays, varies from region to region (example already given).

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THOUGHTS ON IMPLICATIONS FOR POLICY

• Public procurement system to be expanded so that availability of medicines is augmented in Public sector.

• Generic prescription and dispensing be encouraged to achieve good affordability .

• Uniformity in various taxes and duties levied on medicines through out the country.

• Effective regulatory mechanism to achieve uniformity in prices charged from the patients.