Transcript Pooled Procurement and other strategies to secure drug supply at

Pooled Procurement and
Other Strategies to Secure
Drug Supply at the
Lowest Cost for IOP
Clinics
Michele Forzley, JD, MPH
December 16, 2003
St. Jude Research Hospital
International Outreach Program
Memphis, TN
Overview
 1. The problem
 2. Global solutions and background
 3. Pooled procurement
 3. Country specific support
 4. Where to start?
The Problem
 It is difficult for the international sites
to obtain necessary drugs with the
highest quality at the lowest cost.
Underlying Causes Are the
Foundations for Solutions
 1. Clinic capacity
 2. Health system capacity
 3. RPM
 4. Finance $$
 5. Global problem
 6. Trade
 7. Legal
Global Solutions
a.
b.
c.
d.
e.
Theoretical background
WHO framework for access to essential
medicines
Rational selection
Affordable prices
Sustainable financing
Reliable health and supply systems
New element - global transport
Global Solutions
 1. Build capacity/infrastructure
 2. Grants, foundations, and
global public health actors
 3. Training, Tools & Resources
 4. Essential medicines strategy
 5. ICD category
 6. Tariffs and transportation costs
 7. Impact of trade environment
Build Capacity/Infrastructure nationally and at the clinics
 1. Skills development- training on
projections/ sourcing/trade/ ….
 2. Local DRA- essential meds, registries.
 3. National Advisory Board.
 4. Garner existing resources,WHO/UNICEF
price/supplier information, tech. assistance.
 5. Quality – WHO Collaborating Centers.
Training
1. International procurement and basics of pooled
procurement
2. Developing supply projections and management
of drug supply
3. Work with local experts example in MidEast - Abu
Ghazaleh Casin Center for Trade Policy
Capacity Building (Amman)
Develop Tools and Resources
 1. Cure for Kids training vehicle
 2. Manuals, software
 3. Custom and ready made
 4. Electronic and traditional
Grants, Foundations, and
Global Public Health Actors
1. Gates, Rockefeller.
2. UNICEF, PAHO, GFATM, EMRO, IFPMA,
WTO, USAID-MSH.
3. Donations - in kind and cash.
a. Outright donations.
b. Industry, national oil company, Arab Funds (for
development) and associations such as Jordanian
Pharma Manufact. Assoc.
c. NIH research funding.
Acquisition of Essential
Medicines Is a Global Problem
 Integrate pediatric oncology medicines into
national and WHO essential medicines lists.
 Upgrade cancer registries in each country NIH funding.
 Research in order to prioritize needs for
local morbidities.
 Separate ICD category?
 Orphan or neglected disease? Public fund?
Trade Matters
 Reduce tariffs and transportation costs
 Lobby to prevent unintended consequences
of bi-laterals- see US-Morocco bi-lateral 20
year patent
 CAFTA, FTAA
Pooled Procurement
Drug Management Cycle
1. Selection/formulary
2. Procurement
3. Distribution
4. Use – Standard treatment guidelines
Existing MOH-MOH Models
 1989 Maghreb
 Gulf Cooperation Council- Bahrain,
Kuwait, SA, Oman, Qatar, UAE 2002$178million – 30% price reduction
 Organization of Eastern Caribbean States
37% price reduction - 9 states
 ACAME Assoc. de Central D’Achats de
Medicament (Sub-Saharan Africa)
 WHO Pilot Procurement Project
 PAHO Virtual Procurement
Best Practices for Pooled
Procurement
 Transparent and credible system
 Guarantee prompt payment to suppliers
 International competition
 Reliable MIS for tendering and contracting
 Active participation from client clinics
 Existing umbrella organization
 Quality assurance system
Best Practices continued
 Common language among members
 Convertible currencies among members
 Legal/policy mechanism
 Direct remittance > base costs
 Uniform drug needs- based on P & I
 Variation in what is pooled- information to
resources
Strategies and Levels of
Pooling
 1.St. Jude clinics – just for medicines
 2. Foundation based pools- e.g. AFINCA
and AGIR
 3. Clinics join cancer hospital pools
 4. Clinics join MOH based pools devoted to
essential medicines, e.g. GCC
 What is pooled is also a strategy
Day-to-day Operations
1. Legal contracting
2. Direct negotiations with vendors
3. International sourcing e.g. China- - supply
contracts
4. TRIPS flexibilities - work with national
governments/WTO/technical cooperation
5. Compounding and contract manufacturing
6. Emerging pharmaceutical/generics industry of
Jordan, Brazil, India, Morocco
7. Wholesale drug/warehousing companies in
other countries/regions
Where to Start?
 1. National Assessment.
– Trade and IP issues.
– Status of local pharmaceutical system.
 2. Drug assessment/what are the needs?
 3. Get everyone on board- clinics, national
stakeholders, assemble national advisory
group, develop and implement pooling
organization.
Trade and IP Assessment
TRIPS
IP Law
Jordan
Yes
Yes
Lebanon
Yes
Yes
Morocco
Yes
Yes
Syria
Egypt
?
Yes
?
?
Bi-lateral with
US?
Yes
? terms
No
Yes
? terms
No
Yes
Drug Assessment
 Methotrexate – example
– Patented or branded in each country?
– Local generic supply?
– Local production capacity? GMP?
– Import OK?
 Clinic inventory and projections
Next Steps and Questions
Thank you for your attention!
Michele Forzley, JD, MPH
301-565-0538
[email protected]