Poor countries pay more for medicines – study

Secondly, low- and middle-income countries purchase more expensive branded generic drugs rather than unbranded quality-assured generics. In the U.S., most drugs are either on-patent medicines or unbranded generics. But in many developing countries more expensive brand-name generics are widely used, because people are concerned about unsafe or counterfeit drugs.

Chalkidou said less stringent regulation meant the quality of the drugs was also not as high.

“Without regulation, people perceive the products don’t work, so pay extra money for things they think will work and won’t work either,” Chalkidou explained.

In the poorest countries, unbranded generics are only 5% of the pharmaceutical market by volume—in comparison to the U.S. where unbranded quality-assured generics are 85 percent of the market by volume.

Three, there is little competition in the supply of essential medicines in low- and middle-income countries. The largest seller of products like contraceptives, cancer medicines, and antiparasitics can account for upwards of 85% of all sales in some countries.

“We’re talking about access to common medications for pain or high blood pressure, not the latest cutting-edge cancer drugs,” Glassman said.

“It’s not as exciting to talk about procurement as new health technologies or biotech breakthroughs,” she continued. “But drug purchasing is incredibly important, and if it’s done badly you end up with the poorest countries in the world paying some of the highest drug prices.”

A global analysis shows that world consumption of pharmaceutical products increased dramatically from US$ 70 billion to US$ 317 billion in the period between 1975 and 2000. During this period the world’s per capita consumption of medicines increased from US$ 17 to US$ 53.

Yet more than 80% of all pharmaceutical products are consumed by the 15% of the world population living in industrialised countries, a figure which reflects a grossly uneven distribution of pharmaceutical consumption across the world.

Also, despite the increased world consumption, problems remain in ensuring the availability and affordability of medicines, including those which are essential for treating the majority of common diseases prevailing in low and middle-income countries.

The reasons for this are complex. They are not only related to financial constraints, but also to the attitudes of key actors in the health sector – a sector which comprises a network of relationships between the government, public and private providers in the health and pharmaceutical sectors, an important volume of industrial activity and the consumer.

The report notes that governments, non-governmental organizations, and households in many low-income countries struggle continuously to ensure and secure access to even the most basic life-saving medicines, especially in rural areas.

In low-income countries therefore, the most urgent concerns relate to the need to attain affordability and equity of access with respect to these vital pharmaceuticals, and beyond that to attain the same for a somewhat wider range of “essential medicines”.

According to the World Health Organisation (WHO), essential medicines are those that satisfy the priority health care needs of the population. They are selected based on public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. They should be available in health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford.

The report notes that affordability of medicines by individual patients in low-income countries is an important factor influencing access to care and treatment.

“Seeking care is more commonly a question of buying medicines than of consulting a qualified health worker,” the report says.

It adds: “Drug prices, which are sometimes actually higher than those in high-income countries, often have to be met entirely by sick persons or their households.”

The report notes that for decades, the public health sector in developing countries was mainly financed by the government, and the public health sector commonly provided medicines free of charge. But this is changing because diminishing budgets have increasingly led to drug shortages in the national health system, particularly in rural areas. The widespread supply of free drugs has collapsed.

“This is the principal reason why health care in low-income countries is today predominantly financed privately,” it says.

The report says it is important that prices of drugs are brought to the lowest attainable level through promoting competition among quality generic medicines where off-patent items are concerned, negotiation of prices, and therapeutic competition for on-patent medicines.

Other interventions include use of the provisions stipulated under the Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) where necessary to increase affordability of medicines still under patent, reduction of duties and taxes, and reduced wholesale and retail margins.

“It is equally important to provide transparent price information for healthcare providers and consumers so that the community knows how to find the most affordable products when they are needed,” the experts say.

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