Transcript Medicine price survey in

Medicine price survey in
Lebanon, 2004
undertaken by
Dr Rita Karam, Ministry of Health
Marg Ewen (on behalf of Dr Karam)
WHO/HAI post-medicine price survey regional workshop,
Cairo 7-9 January 2007
Lebanon, 2004
Country background

Population in millions: 4

% of rural population: 85 %

Total adult literacy rate: 88 %

GDP per capita: 5611 US $

Total health expenditure: 10.4 % of GDP


(excluding foreign residents & refugees)
Government health expenditure 29.3% of total health
expenditure
Public sector – medicines supplied by MoH (free) and NSSF
(75-80% of patient price reimbursed)
Lebanon, 2004
Methodology
•
Number of medicines surveyed: 32
Core 26
Supplementary 6
• Year of MSH reference price used: 2002
•
Number of regions surveyed: 4
• Total number of facilities sampled:
Sector (patient prices)
Number
Public
20
Private retail pharmacies
40
Other
NS
Lebanon, 2004
Availability
Public
IB
LPG
IB
LPG
0%
0%
95%
84%
%
Median availability
Private
100
75
Pub-IB
Pub-LPG
50
Pri-IB
Pri-LPG
25
0
Salbutamol
Amitriptyline
Lebanon, 2004
Cephalexin
Prices: summary MPRs and examples
Procurement
Median MPR
IB
LPG
5.9
1.2
Public
IB
ciprofloxacin
LPG
free
Private
IB
LPG
12.9
6.1
104
29.3
metronidazole
4.7
42
31.7
beclometasone
0.6
3.3
1.4
IB = innovator brand
LPG = lowest priced generic
Lebanon, 2004
Affordability (No. of days’ wages)
Daily wage (US$)
= $6.60
Amoxicillin 500mg tabs, 21
Public
IB
Private
LPG
free
I IB
B
LPG
1.4
0.5
Captopril 25mg tab, 90
3
1.2
Ranitidine 150mg tabs, 60
8.2
1.2
Lebanon, 2004
Price components
Official figures: imported medicine
Type of charge
Charge basis
Amount of
charge
FOB
Price of
dispensed
quantity
Cumulative %
mark-up
2000
0%
Shipping/insurance
percent
7.5%
2150
7.5%
Customs/clearance
percent
11.5%
2397
19.86%
Importers mark-up
percent
10%
2637
31.85%
Pharmacy mark-up
percent
30%
3428
71.4%
1000
0%
Official figures: locally manufactured medicine
Manufacturer’s selling price
Distributor’s mark-up
percent
10%
1100
10%
Pharmacy mark-up
percent
30%
1430
43%
Lebanon, 2004
Main Findings




Public sector procurement prices vary from
acceptable to high
Availability of medicines in the public sector is
extremely poor
Availability of medicines in private retail
pharmacies is good
Prices are very high for both generics and
innovator brands in the private sector
Lebanon, 2004
Recommendations






Develop a National Drug Policy
Annual budget allocation for essential medicines
in the public sector
Unify public sector procurement, use tenders
Streamline the public sector supply system
Review the pricing scheme in order to lower
prices
Permit and encourage generic substitution
Lebanon, 2004
Follow-up activities
2004:
 Committee of 4 pharmacists compared
FOB prices of about 2200 imported
medicines with prices paid by Saudi Arabia
& Jordan. Outcome: 1100 meds (25% of
all registered medicines) had FOB price
reduced by 20-30%
 Budget increased for cancer, HIV & other
specialised medicines from $14M per
annum to $40M
Lebanon, 2004
2005: Implemented a new pricing structure for all
imported medicines, estimated to reduce patient prices by
3-15%
FOB $
Shipping
Insurance
Customs
Clearance
Importer
Markup
Pharmacy
Markup
Cumulat.
Markup
6%
10%
10%
30%
66%
4.5%
8.5%
10%
30%
62%
$50 - $100 3.5%
7.5%
9%
27%
54%
> $100
6.5%
8%
24%
46%
0- $10
$10 - $50
2.5%
Lebanon, 2004
2006:
Information on patient prices & pharmacy margin included
on MoH website. Updated every 2 weeks.
2007:
 First Lebanese National Formulary to be distributed in
April to all doctors & pharmacists. Comparative
information on brand/generic products registered in
Lebanon, strength/dosage form, country of origin, price
and coverage by NSSF. To be updated annually.
 Project to review price structure of locally manufactured
medicines (700, generics, prices quite low)
2008/2009:
Implementing a re-pricing scheme for all medicines –
reducing the FOB price
Lebanon, 2004