ISI BERITA Merujuk pedhal tersebd dial,as, bersarna ini dengnn hormat disampaikan
haltal sbb:
1. Berdasarkan data lGntor W-|o
Wilayah Timur Mediteriania, deuasa ini jumlah penduduk Yaman yang berkisar 19,7 iuta orang llang s€kitar 71c/o diantananya tinggal di daerah pedesaan dan tkqkat buta hurufnya relatif tinggi dengan prosentase 55,7o/o. Yaman juga digolongkan ssbagai negara ber.endapatan perkapita rendah, dengan GDP nyra sekitar tJSi$ 659.00. EXsisi ldin, Yaman membelanjakan sekilar 5,5016 dafi GDP nya uniuk sektor kesehatan (pada tahun 2003) dengan total behnia kesetratan per kepatarrya mencapai US$ 32.00
2.
Befanja sektor srm$al or i'rarte expnditure Udang kesehatan dari prosentase total pengeluaran kcs€hdan diperkirakan befiisar 59% da tdrun 2003- Fasilitas kesehatan berupa rumah sakit (baik milik pemerintdr maupun snasila) tedapat di sejurrilah kota-kota besar (sepedi Sana'a, Aden dan Hodeklah) dan fasilitas kesehatan dibawah rumah sakit seperti poliklinik dan unil kesehatan umumnya tersedia sampai dacrah pcdc:laar. Namun demikian, pelayanan saklor kesehatan tidaklah gratis - pasktn harus rcmbalar baya konsultasi doktemya dan biaya untuk mendapatkan obat-obatannya dengan harga nnfl( up sekitar 109o (kecuali untuk sejunlah obat-obatan yang mcndaeattan subsldi yang dibcrikan kcpada pasien dengnn gratis).
3. Indusfi fannasi lokel (yang beriumbh 10 pabrik)
harrya rnampu rnemenuhi kebutuhan donestik sekitar 1O% *ia dan sebbifnya dlimpor dad negana-negaftl Arab, produsen fannasi di Eropa dan negr+negara Asia Selatan serta Asia Tenggara meldui perusahaan importir fannasi Yaman. Terdapat hal menarik bahwa produlr fanmsi yang diinpor dari negar&negara Asia (klrususnya lrdia dan Pakistan) harganya relatif lebih murah daripada yang diimpor dad negaftFnegara diluar lndia dan Pakisilan.
4- Gambaran urnrm produk-produk fannasi di Yeman ditandai dengan
masih
te6atasnya ketersediaan poduk-produk Fannasi di unit+nit kesehatar umum; pada toko penjualan produk-produk farmasU apotk $rasta, harga iual obatan-batan bermerak relatif mahal dan obd-obatan gcncdc bervariai harganya, mubi dari sangat murah sampai dengnn rnahal; serta, perEpbatan penyakit rnenggunakan obat-obatan generic relatif tefangkau hargarrya dibanrlingkan menggunakan obatobatan bermerek
5.
6.
Secara umurn, pada wilayeh yatg dinaungi oleh WHO Easfem lilditenanean Rqion ditandai dengpn kenyataan bahwa masyalakat terpaksa harus membayar biaya kesehatan/ pengobatannla jika rnendataqi fasilitas kesehatan swasila yang kadangkala harganya mahd dan kondisi hi memunculkan desakan kuat bagi pemerintah untuk campur tangnry' memperbaiki hebijakan farmasi nasionafnya dan kebijakan pcrrcntuan harya yang cbktifBagi prcduk-produk f;annasi impor sebelum rnemperoleh lfrn bercdar di Yaman, pihak di Yaman (Supenn Boad for Drugs ancl tyledtcall Applianes) mengirimken lim pemeriksanya rneniniau cara pembuatan obatobatan/ on the spot
berwenang
di pabrik-pabrik farmasinla untuk memastikan bahwa poduksi obatobatannya sudah mernont hi standar (di Indonesia, dikenal dengen pemberien fabel cara pemb,uatan obat yang baiU CPOB).
7.
Dilihat dad aspek ketefirngkauei haqe obat-obaten bagi masyaraftat di Yaman, diukur dari jumlah hari heria dan dikaitkan dengan perolehan gnii terendah pegawai pennrintah unsUlled yang akan digunakan untuk membayar biaya pengobatan
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suatu penyakiU aqr{e cnn&fun ataup{.tn pengobdan selama sebulan bagi kondisi/ penyekil yang kmniU drrcnic @trtlior, dengan gaii terendah pegmai pemedntah di tahr.rn 2006 addah sebesar 555 Yemena nlBls (setara US$ 2-81) per harinya. Dengan denikian, untuk mcmpcrdotr obet gorcric temurah di toko farrnasi/ apotilc akan nrrmkan tfaya krang dad gafr pernenrrya yang sebeser 555 Yemeni riyals, kecuali untuk pembelian amitriptyline (deprassion), captetil (hypertension), metfonrin (diabetee) dan carbrrp2sp* (cptlopry) yang msing-masing membutuhkan Uaya 1,8i 1,4:1,4; d*r, 1,1 dari upah habnnya. Sementara biaya pengobatan menggrurnakan obat-obatan bernerck adalah 2 sampai 12 lebih mdral harganya bilarnana rrnggunaken obgtobatan gernric. Pengobatan menggunakan obd.obdan bcr?ncrek umumrrya nrcrbutuhl n Uaya lebih dari 3 hari upah harian peganrai penFfitah, dengan bfrya tertinggi s:ld merryembuhkan
penyakit peptic ulcer mernakai ranitfdine (5,8 had dad upah hadannya), menyembuhkan hlperlension manggunaltan @Fn (5,4 hati dari upeh harbnnya) dan menyernbuhkan artbdtis nnnggundran didofenac (5 hari dad upah hariannya).
9.
Pembefian/ pengadan obd$atan gcnedc dilakukan deh ffp lhtional Prqnmfor fil/eidial Sr/npry dengm har3n Zffi lGUh rcnd*t dathada harga referensi intemasional. Namm denikbn, kofipornn hargn pada toko-toko penjual obatobatarV apotik milik suvasta urrrJrnnya tcrdapet dlldd cunuffiive nnr*-up sebesar 57,4Vo baak terhadap obat+batan lokal maupun irxpor dan baik terfiadap obatobatan gwredc nEupun bermerek. Angka 57,4% tersebuil ferdiri dari ma* up pada distributor sabcsar l()96 dan nn* up peda loketoko obet-obetan/ apotik esbeser 20%.
Pengamatanl
G€trn l(BRl
10. Dewasa ini juntah toko penjual obatobatan/ apotik di selunrh Yanun berkisar 10O0 buah dan iumlah/ jenis oba{obatm yang sudah ierdallar pada Kementerian Kesehatan oq. Snpnanr Mrd for & lgs atd *|edicall Afliarws berkisar 16.000 buah.
ll.Obatobatan yang diinrpor bcrasal dari rtegar*-nogara Arab (Suriah, Mcsir, Arab Saudi, Yodania dan PEA), negara-rng€fia Eropa (lnggeris, Peranciq Jennan dan Turki) dan negara-negara Ash (C}ilna, Korta Selatan, India, Pakisilan. Malalaia dan sebagian kecil dari Indonecia). Produk farmasil obat-obatan dari lndonesia yang sudah mag.rlr dan beterhr di Yaman dixodultsi obfi PT- Intedat (dengan agonnya Dadsih G€rnral Trading d[ Sana'a), PT. Carung Indah Abad, - hethl ndicine industryl jarrujam.en (dengan agsmp AFMa?br phanna dli Sana'a). PT. Dragon Pnma Farna dan PT. Deirya Varia yang saat ini sedang melakukan peniaiakan lapangan. Tidak rnenutlp falde d hpangan betrua ada jugn obat-obdan/ farmasi produk Indonesia yang masr* melalui jalurli@k resni
12. Obat-obatm/ farrnasi yeng umumnya dipakai di Yaman untuk rnengobatil mengatasi
penyakit hipcrtcrld, infiuenza, bsiut dan jed+ienis pernfalcit lainnya yarug bersitat epiderilc Selain obetdaten/ fannasi yang nerniliki potensi pasar, alat kesehatan fainnya seperti iarum strntik, det-alat kontrascpi, debsftop, alat tcni darah (baik yang konvensbnal maupun dbttal), tetqDet lidr pasien, kursi tpda, alel penyangga lraki, tangan dan kaki palsu juga mempunyai proqpek yang cerah.
dengm pcrusahaan importir fernasi di Yaman. kualitas obatobatan/ farmasi Indonesia dnilairm cukrp bagus (brmasuk iuga kuafitas dan bentuk kernasannya). namun rnasih sedakil letih mahd daripada obat-obatan/ farmasi yang diimpor dad negara-nagara Asb lainny?.
13. Saat bertemu
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14. Terlampir
disanpaikan ddar pcrulaltaart ifTrpoftr famrai
d Yaman dan artikel dari Nes,
,ifclcfrforfiarcn Wn mcr4rcnai q(cnpn: ttledieirc avaih ffifty, atrorlaltifity and prtn @marlnellls'-
WF|O
&sfem
Demikian disanpaikan, alas pcrfidan rhn
brfr$rnanya diucapbn tedma kasih. Sana'a. 0E Maret 2009
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Pharmaceudcals, Healtlrcare and He6al Producti 1.
NationalTrading Company Ltd. Natco, Yemen Head Office: Djibouti Str., ln front of Pol- Seorrity BuiHing; Sana'a Tel/Fax: (967-t@l5@; Fax: {96i1-1H4.754115-274L18-274r69, P,O. Box: 1182 1105, 1108 We b site: www- natco-ye me n.corn; e-ma il: natbnal@ natco.ciom.ye
Arraafah Corporatbn, Yemen Leading Yemeni lmport€r and Agent of several leadi,ng mmpanies in medical field Head Otticn: Ali Abdulmughni Street, Behind Taj Sheba ll'otel, Sana'a - Yemen Tef : ( 957-1) 27 3W-273988; Fax: 1962 -L127 23U, P.O. Box : 109O Web site: urwtry.arraafah.bir; e-mail:
[email protected] 3.
Ala'bed Medical suppliesCo. Ltd., Yernen Leading Yemeni Company Specialized in lmport and Marketing
of
Pharmaceuticals and
medicines. Head Office: Sana'a - Yemen. (967-1) 47 287 5 I 617 ; Fax: (967-1)47 287 4, rc Box: 8286 We bs ite : unrrvu.a la bedpha rma.com; e- ma il: info@a labed pharma.co m
Te t :
AFFurqan Trading, Yemen Leading Yemeni Corporation Specialized in lmport and Marketing medicines. Head Office: Sana'a -Yemen. Tef : (957-1)47 2883| a I 5; Fax: (967- 1)47 28t82, Po Box : 8285 E-mail: info@atfu rqanpharma.com
of
Pharmaceuti,cals and
Al-Ghazali For Trade & Medicines , Yemen Head Office;22nd May Str., Sana'a. TellFax (967-11675280/81; Fax: (967-1167s277, P.o. Box: 2069 Web Site: wvnn.ghazalipharma.com; e-mail:
[email protected] MIASS Trading Center for Medicines & Generaf Agencies , Yemen Head Office: 45 St, in front of Af-(ohali Tower, Sana'a - Yemen Tef; (96-l-1l6l440t; Fax; (967-1f 6t4d,ffi, PO Box :2O299
E-mail:
[email protected]; miassphanna@yahoo-com
Td:
tnffii ffsassy etutW, fujMr, bfu( 79mtH&,fuPb'Ycrrwr qZZ2tZ;
(571) A721AQ7211; htt: (67-4
E;mil:
tu
6at
@/.,reLF
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7.
A'alam Al-Dawa Co. ttd., Yemen Head Office: Al-Shera'ee Str, Behird C.enbral Bank of Yemen Building, Sana'a. Tef/Fax (967-U271831; Far (967-11272635, P.O. Bor 4242 Web Site: wnnr-aal-dawa.com; e-maih
[email protected];
[email protected]
8.
Amir Aldin Co. For Trading & Agencbs Ltd., Yemen Pharmaceuticals and medirzl appliances Head Offrce: Altahreer-Saif ben thi yaaen stree$ Sana'a Te : ( s67 - I l n 1ffi3/ 27 5395; Far: l96t -r127?t330, P. o. Box : 843 2 Website: wmry.amiraldinco.com; e-mail:
[email protected] |
9.
Al-Marwan Medical Corporation, Yemen Head Office: Al{aser Str, Behind Taj Sheba Hotel, Sana'a - Yemen Te l/Fax: (%f -tl29Tn1; Mobile: {967Vn LLT 6L7, P.O. Box: 43 23 E-ma il: ma
[email protected]
10. ARJA'A TRADING, Yemen Head Office: Taiz Str., Sana'a - Yemen. Tef : (967-1)633677 - Fax: {96'7-l)633674, P.O. Box: 2685 We b s ite : www.arjaagrou p.co m; e -mail: aria a @ye rne n.net.ye 11. Al-Razi Pharmaeutical Center, Yemen
& markeUlg company with long experiences, import & distribute products pharmaceutical & Medlcal appliances , Baby Food and Veterinary medicine in Yemen market. Head Offrce: Seiun, Hadramout - Yemen. Tel: (95-f-5)4O3803; Fax: (967-11403336, P.O-Bor 9il)2 ALRAZI is an importing
E-mail: ZUBAIDI €!Y.NET.YE
12. Bilquis Drugstores, Yemen Bilquis Drugstores are a private company importlng pharmaceuticals, foodstuff and baby mifk and fmd to Yemen market for more than 30 years. The company represents many
world companies that produce rnucft rnercftandise. Head Office: Eehind Central Bank of Yerneo Sanab - Yenren. Tel: (967-1)272274 -278136 - Fax: {95-l-1l27$tq P.O.Bor 305 Website: www.bilguis-ye.com; e-mail: Bilquis.d.s@y,netye
lndonedan Embrcy
Td:
eift W, hjAffir, h tu l*tft t& *Be - feaw,
(%7-t) 427214427211; hx: (fi7-l) 427214 Eraril: inM@t'.ne.re
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&Srx**ctm* grrie*s, sv**taxLt*ttuy. mff*r'c$mh* *it.v erl# pri*;*
*sr}tf3{}ffi#nts jiil
S,:
ei i ;r.
i
;t,".: ;:'.: i f:
13
:" i'li"tt if *
T;rliie i.. i.".::',.
f
Rapidly rising costs of hcalth care and high medicine prices arc a grorving conc€rn *'orldwlle, especiallv in d*<{oping counritl w'hr:re patierrts oftcn havc ro pa;, rhe 6rll price of medicincs. This bricf rcport about mudicine prkes and availzbiliqv in l'etnen is onc of a seritx of papcrs strrnmariring the tcsults nf national mcdicine pricc and arailabilitv suncys carried our around the globc using a standard survry m.thodology devdogd hy the $9orld Hr>alth Organization {\fHO) and H
.
Availabilrty
-
ri
V
i:i.u:r..'i-' fijltr
iii:.r
l
In prirate pharmacies, the prices of originator brand
genczal hcalth sen'icet (either public or prirat€) ere mainly found
products rverc gencrally ver.v higlr wherras prices of generk cquivalents varied from vcry cheap to high.
in major cities, ddrou$r primary trealth .are centres/units and polyclinics are scattered throughout the w'holc countrv, including $ome nlral areas, Putrlk hcalth sen'ice.s arc not fuc; the paticnt pap a precription ftr and the (a-store cost of mcdicincs with a I()Yo mark-up (trcept for cenain sub,$idibd mrdicines which are given for free) and thc cost ofany diagnostic tests, as n.rdcd. The local pharmac
of mcdicines in the public srxtor outlets was
Trtattnents with lr*v pric
nati,rnal rncdicinrs policies alrd
efrrtire pricing polici<*.
ir,:i:fliir? r:riif{i.if,iirls} x}ri::# ,*fxi aii,i}ii*i}ii!t-v ${{{\i€:.vYemen has a population of approx. I 9.7 million inhabltants, 7196 of rvhom livc in rural arrrs. The illite,racy rate is high and reachs about 55.79.r. ltmcrr is a lor+'-incomc countr;v with per cagira
F WI
r'
vcry l,:w
Generelly, across the WHO Fascern llltditerrantln Rr.gion, a sinrilar picrurc crncrgr:: rcasonebly cffic,icnt public c,xtor procuremcnt, people having to pay for their own tncdicincs in thc prirate i(€tor; ofren at high and froquentlv unafiondablc' priax; and thc need firr str<,ngct governmcnt action to intrtrdtre or imprcvc
L
ifi".:i:
'::rjit-l.ij
domcrk product (CDP) of US$ (r59. Yemcn sprcnt 5.5olo of irs GDP on hahh in 2003 with a roral hcalth txpendirure pcr capis,rf US$ 32. Private c'xpenditure on health as a percetrtEl",r[ toml expcnditurc on hcalth rvas <stimaced to bc 5996 in 2003. ln
Thc, availabiligv
.
ilr
Price
';'f',
grosr
rFidrin l'emen:
.
Procurefitsrt
-i
(-rncs, Ar'.rth\|. fFm hnpr//*lnthdwb.o€,/
io/tl.tl. M
\forld tteelrh Orsuttarion,
7Oo3.
to m636s6mgnr"
ln&li.ineprii'e5 t \ilHOiH.f. llc&drc pnrs, atuibbrtry ajfui&rk1' dtd prie .e,ipo4ftt. i rylw r d{ n2dittnt 2ttzc xttr4 radatt*at i* nhacl twilrta ol d:c Wi,li ''ariAa lh.alth Qrytwrt* fnlaa M&tolvnan Rtla*, (ldru, Vorlil I lcrhh Orgrni arion Frsiond Ofhcc lbr rhr lxwn Medimnm, ?ff)3 (in pre)-
y+*
OftiGG
f
i:' ri i: r.? i * f* F":: Et'; i* li survey rnethodologv prcscnts
-ctteti $ !'i'*"
prics
as median
pricc ratios (MPR). Thc MPR is cdculatod bv dividing thc l rcal prke b.7 dre intcrnationd rcfercne price {convcrtxl into krcal crrrrr'ncy). An MPR of I mans rhe local price is cquivalcnt to thc rcfenrncc price, whercas an MPR of2 m.:ans the lmal pricc is twicc the refergrrr prke. The inrcrnatio.ml refcrcncc prkrs used 6r this
HAI
@)H,tlg#:ftL* Rcgbnrl
l*
lb€ WHO/HAI
fof thr E5rlrn fqfttcrr.ncrn
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suft-cy,*cre takcn from the 2005 Man4lement Sciencr= for Hcalth (I4SH) Inrcrnational Dng Price Indicator Guidc (nrdian prkr: of high quality multi-source medicines offercd to dcve.loping countri$ by different suppliets). Use o[ referencc prics facilitatcs intemationat comparisons. i i1{.,* v
l.:rti:'t;rf ir: i'+ i: f, fi trciirrgl*
Corrntrt sprrilir facrors, ruch as pncing polkicrn nla*.a si'ts, competition, national economic and othcr facrors. ma)'inflrrncc priccs. Rrr the purposcs of thetc sun-eys in a low-incr>me
les rhan r:r cqr.url to I for public procurcm€nt pric6 and public $ertor pattent prkcs is considcred trr iodicate a-ceptahlc (not scrssivc) prices. dcvcloping countrif an MPR of
s*tor
vi-i;i i.itl ii;ir Affordabilitv is calculetcd ss the numbcr ot&p tlre lornst paid unrkillcd gaveutmxnt worker would hare ro work to pay for a tRatmcnt coursc for en acuc condition or one mDntht tteatmcnt f,lr a chronic condition. At the time of thc surtc''. the lowct paid Ycmeni government wo*er carncd 555 Yemcni riyele fYER) (US$ 2.81) per da.v. Owing to the limited availability of the medicincs sur-gvcd, it rxas possible ro calculatc affordabilir'' in the prrblic sector for onlv thre conditionr, witt dl three medicirxs costing le$s than half a dat's.,r.agc. .4.1"itt
O'-crall
in tlre private rctail plurmacies a Ycmeni workcr, if
purclrasing l,>w<st priced gencrics, would gencrally necd less then ,,ncdayt wagefor rhesandard tnatmentsanalped foraffordabilitv, cxccpt for anritripqvline (deprcssion), ceptopril (hvpertcnsion), mctforn'rin (diabettx) and carbamanr:pinc (epilepsy) wherc 1.8, 1 .4, 1.4 and days wagcs arc rcquirct, rc'spcttivd,v Figurc l).
LI
Thc r-ost o[ standard treatmeo$ wirb originaror brands were 2 to I 2 tinres greatcr than the cost when usingi lowesr priccd gcnrric cquivalents. Treatmc-nts r+'ith originator brandc thendore geoo"elly cost more than 3 dayi wages. The most e{rcnsirrc trcatm€nts r+'l'rcn usiug originator bralds included thc trcatmc'nt rrf peptk cdctr rcith ranitidinc, 5.8 deyt' wages; tftirtfilcnt ,rf hyperuension
13
*i:ii*: s':.jtt!t- pricsJii
The data on public scrdor procuremenr priccs wcre lirnitcd as tcndcr price information was available for only six medicincs (all generics). Due to the low availability of medicincs in thc public sctor, therc was litde dae 6rr calculating ptice ratios for prices tbar paticnts pry in ptrblic sctor health facilities, On avr.ra€le, generic oredicitrcs werc purchasd b-v the National Prograrn fnr }ledi
l.{PR l-09 for lowcst pricttl
gcrericr). Howtlcr, orling to poor mcdicinc arzilability. data for onl,v sir medkines could te includd in thc analvsis (Table ?) and ir was not possiblc ro ass6s tbe diference hct*een public sector
procurrmrntpricts and paticntprks (i.e. puhlk scctor mark-up). Pr.:l>i ir: sri{:i{:}i *t.+i!;ihi$iir The results shc,t'cd overdl public scctor median arailability ,rf only 5% flable l). Only 6 of thc 35 survcrrcd rncdicines rvcre frxrnd in at leart four of the survcycd oudcts.
For individual medkints, a completc abcence of more than 459o of the targetcd mcdicinesrvas obscn'ed (16 out of 35) which are ussd t<, ar€.a irnpofianr disr:ases srch as h.tpertencion, epilcpsy (plrcnltoiu), d'rat'ctes(metformin),thyroiddirordcn (levorhvroxini) and asrhna (salbutamol and beclometasone inhalers). Only tw
chloroquine phosphatc (70,q6 3veihhiliq)- Cltarh, mosr Paiicnts h:ve to purdrase medicineo hom private rcail pharnracic.
'lt';i:i* t. '.:,1':,,:.,':-, liir.:', ";r.r:ll','.::i
r:i.1
:.:;':','ii,,' ::i-'..
rvith captopril, 5.4 de,v's wages; and trrathrent of anhriris with dicloftnac, 5 dalr' rvagcs.
G
F. ;3-l ozl
1:
i
ffi&fu.fi
Pelic ukt aitEln r
tta*ota
m€tto.dn
Hypctt**n c+loFrl
?gi-it,r,:.:i .:: ::: :.:1, tr::;r ,.' :,il rr- ::,1
..,:'1.
:..::, :ii.:11:i,': r J li.
Drpcssiffi
rrtriltyfE
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f prieas
Thc median retail price of originator brands in the privctc sector in Yemc,n u.as about l8 times higher than intematianal refcrcnce price (Thble d). The prico of there odginator brands varicd
;1,
bcru'.r:n 2 and 130 rime* morc, with 75% of rhe.m costingg at k:st 7 tinrc.r morr than the interrrarional rfercncc pricc. For lorcst pricc generic
lqd.
0
Crdlo(sn Brconaztt Glbrn[hfiiJe
thc results shos' tfnt:
.
IIPRs of some low<st priccd gencrics werr mrrh less rhan thc refcrcnce prices, srch as risperidom (0.2O. This ma,v be attr ibutcd to rgistercd chcaper sources Fmm south md south-crst,&ia, such as lrrdia, Pakistan.
.
The difen:nces betrvtrn priccs oforiginator brands and thcir lo*'est priced gcneric cquivalcnts wene often vcry high. For insrance, originator brand ciproflox.xin was 24 tims highcr prked than thc lowcsr priced gcncric txluir2Ln.. Origirrattir hrands of fluconaz-ole, omcprazrle aod ralritirCinc wcrc a
lirtle over
I
I
;m;:t*"."
l&fltu&
c
>.
At the individual medicines
S
tinres morc than their lowcst priced gcneric
equivalents.
[n somc casts, br>th tlre originatrrr brand and dre lorxtrt priced gcncric cqtrivalent wcre cxcc'ssivcly cpcnsire Figrrc 2 illurtrat<x *arnples of high priced nrcdicines (both originator brands and lon'est priced generks) with MPRs rn-er 5.
liii*r;: *.
t/bbehdszde
!j::i.::''rr.;,;
i0r 50
T
i
: 1
R',
g.-i a D
{1
M
ii Ettr
x'+bfFEbFltFi.trd Dicbtctcililirtrbild Glimc$ti$dv gffit hild
Acmss rhc privatc pharmacics, thcrc wrre considerable prke rariations for
sr>mc
lowsr
priced generk medkines and
originrtor
brand prodtts, As shown in Figure 3, dr irrerquartih .-g. for originator brand glibenclamide nas z0.n Q5& F €.mile) - 56.24 C/5th percentilc), wi& tlrc m.dirn MPR of 5t.92. For originator brand diloferrrc drcrc wzs lers veriability; thc intcr,qurtile rangs rrs 43.4 - 52.09 (median lvtPR 44.62).
fi,gi:l:: :-..'r
'r 'i,'r,
3.- :l:..; r, , r. ' : ^
i.
Slei;ri Bytli?iiir{?}s i* ti:s pr-iv;it* riectrJr For the 24 nredicines available in private pharmacies as both the, originator brand and lmvcst priccd gencric equivalenr, th€ leriation in price {mcdian brand premium) was 26Vo, i.c. on everagc the cost of the lowest priced gcnerk equivalent vvas a quarrcr of that of tlre origioator brand produrt- Ttre interguanile range was l59o
-38%-
of medhines {domcstic, Arab countriei, soudr-cast ,fuian countries and Eurog:an producers)
Akhough rhe rarious sources
may txplain thc largc price rnariations of l
x,txt priccd or bnnded
it is very dificult to givg 3 feasible explanation
or inrerpretation for originator brand prodrrrs unltxr somc of the significantly'lower ccxt originator brand prodrrts wete imported from a suhtsidi"rd fact
generics,
f3
ri.;aett: * t;,tii.i :. d$!, A ii?s flilr ti:
Thc rncdian availability ofthc survg'ed mcdicincs nas vcr.v high for' generics. 9096, in priv-ate rctail pherm*l=. The mcdian arailabilitl' for originator bnnds rras 5096 {Tabb 5).
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a:: r:ii:r,i:!i-
S
Fletd oan{-up 1b-*
i-:?a-l
ttft&iale d.lr.,Jo 8t
orts c14rs
No products, cither originator bran& or gcnerics, were frxrnd in thc privare retail pharmacies survr:vod for thn:e medioncs:
Tgg4Y gqzgE
rrcr'irapine, lcrr,astatin and hydrochlorothiaz)de. i
;:
*1+;
1'5q'41q,;
tii *rl$lil.*f i s€'irt
Cudmr
i::' j'{i:'.:: i:;i: t:ririr_-}It*, tt.* The .rfficial curnulative mark-up in tlrc privais *.,.r supply drain is 5?.449(,, whethcr thc nredkinc is imgoned or locallv pnduced. gcncric or originator btand. This includcs a rvhole'sale matk-up of l0qi' and a pharmacv mark-up of Ltt%. This rcpreseots 379i' of the total paticnt price in the casc of E:neric aciclovir, with thc manufacturcrls price contributing 63% of rhe find pdient prk€ (Figurc 4),
,'"t"r"nent
data
we obniml
di
tEnsfo.rdril 3\
The overall price pcoplc pay for kru,cs priccd pgnc'rics in the privarc sector was twic€ the patient price in drc Aublic sectoc end tcn timcs rhe gol€rnmeoa procrrcrnent pt'rc. Howerer, Iow pubiic sector availabiliw makcs it difficult to nrake sound cross,scctor conclusions except the possibility that ccftriaone inicctior had lxen purchased from thc locd prirate nrar{<e nrhich would eccount for the similarity in price across the scctors (privatdpublic ratio L l8). This contrasts wirh a t6-fold &f,er.nce in ttre pricc of gcrreric raniridinc.
,).lj:
1%
t-mr olicial nums end mr
d'Jq
tt4r8 $EDo.t
F:iL.-iis.
4.
3* ftd 13 8n* !hl3E
Co6l" in$rarce. frer8hr {cFi 6J9c 1%
i.lj :,.1,:,:::- i,:ri: : ii:1'
a'ri! ri
Carbamare€tne -LB,Va i.:,+ioiirliitil#+*qg Glib€ndamde 393.8% liiiiri;ttiii*. s
ilq
i:i
Srritzerland
lil;,+rtr
i:i
i.:i:r.
E$rpt
:it: ri
'''':,.:I.r:
r"elk{ared
I.1ii:
Tir see if the official c.umulative mark-up of 5?.44% is appl-kd, paticnt pric6 of originatot brands in the privatr soctor were compared to rcgisercd CIF pricas. lf an ofFer of t1096 of the official cumulative marL-up is applid, only fl of 26 originator
!-1{}11*1u.*i*B*
r
brand products bclong to this category Table 5 shou's s.rmc oFthe wide variations in mark-ups, basad ch< di{fcrcncc .rf rcgiscrcd "n CIF price and observcd petirnt price.
There r:right be sr+'eral nasons for such *'ide variabilitv in cumulative mark-up*: . .rf6ciallvset retail nrarginsare violatrrd by rvhoksalcrsandl ,rr rsailcrs to incrca.sc profits; . registcrcd CIF pricrx are incornrt or manipular.-l te d*reasc liabilirks (thc t % impons;jon fe for thc cosr r,f each pro-forna invoicc and the 596 custonrs fte for the cost of each shipmcnt); . dre oficial margin af 57.441m is not feasiblc and considercd to bc unfair bv mcdicines treders.
limited puhlic procurement data and very low evailabilitv of rnost nredicinc in public hr:lth faciliries ir is di6nrlt ro make a rcund;udgemenr abour prrblic lxdth s
.
Overall the availahiliq'of gcncrics in private t
.
ln conrpa,rison with intcrnational reierence ptices, thc pliccs of lowest pricerl branded-grlerk I gencric rncdrcinr:s in r:bc prirrate scctor varied from verv chcag to considerablv high priced- Mosr originator brands werc considcrablv higher
pricrd rhan rhe refcrence prics (?5'/ohsd an MPR>7).
10t12 BB.OsO/SANAA FBM-06394.max
.
Almost hglfofthc priccs of 1 5 originator brands lcrte higher in l'cmen compared to three Arab crxrntries with mtrh highcr GDP per capita, namcly. Jordan, kbanon and Kuwait.
.
ccensive usc of pharmaco-economic tools and fir€asurcm€ots, including coat-benefit analvsis' costcffectiveness and,vsic, cost-minimization anabsis and crxt-{rtil iqv tnd}'s is.
.
In comparison with thc registered CIF pricec of medicins' thc cumulative marlaups varied wrddy- Some vrcrcles than thc officially allowod ma*-up {t7.44Vo) or tr-cn n€atiye (providing ev-idencc of exagg
r
srrioeconomic sittntion an lysis of the countEv as wdl tbe affordabiligv of treatments for poor Patients.
i,r* #f 'r't It3# a'} r3:* f it ri s Bascd on the findings of thc strdy, nrommcndations made by rhe invtstigators to thc Govrernment of Yenren irK{udrd t}E tt"
following.
4. Ch6k and revise
as
rcgistcrcd CIF prico on a fair, rcliable and
regular besis, given that prkcs of raw materids are dccrcrsing anoudly fur origlnator braods with the iutroducti.rn ,rf
numeror$ gencric/ btandcd-gencric quivdcnts5. Encourage drc prescribing of mcdicincs bv the gencric rame; information diss€minated in thc media and through htalth ryndicater/ prolessionel associations could play an importanr role in rhi:r'ing this goal,
l. Enhance *re role ofthe public sector to ensurc the anilabiliqv ofall mcdicines on the national ctsentinl list, after rerrising and uprlating the lint to arcommodate ncnt thcrapeutic catcgorits and emerging illncsses. 2. Find alternative sources offinancing for thc purchasing oF medicines and implementing suiublc mechanisms to retionalize expenditure thc National Health Accounts nrethodolog.v might be rlscful in this reg;and. 3. Adopt a pricing system that takes into considcration: . rvhether medicines are locally produced or imponed; odginator brands or genericsi branded-gcnerics; life saring
or otherwise;
o
comparing priceri across a well-chosen range of countri.x which use cost-efiectiveness anatyris, taking into account diffcrcnces in thcir wealdr to that ofYemcnl
t
applying regressivc mark-ups that is, sening ups for more expensive rn6ll.1not
.
tlre price of theraperrticdly equivrlent products with thc same risk-bencfi t tradc-offs;
.
using thc registration of ncw medicincx t.r reduce the prices of older brands prodrred by the.same pharmaccuticd company;
.
compariot pricrx cornpilod by non-pro6t orgahizdion$/ institutions strch as Manag9ment Scicncer for Hcalth, Australian Pharmaccutkds Beneft Scheme and othcr
lorrrrer
mark-
sourc€s;
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Furf
ir*r
irrfr:rs: rai ian
Dr Yasccn Ahmod Al-Qgbati Dircctor of Planning and Statistical Depanment Suprane Board of Dnrgs and \'ledicat Appliancrx Ministr.v of Health Email: [email protected] Essential Mcdicincs and Pharmrceuticd Policies Unit Regional Ofice for tlr Eastern Mediterranean
\forld Hcalth Organization,
AMul RazzakAl Sanhouri Strc*, PO.Box 7608 Nasr Cky, Cairo, F- mail :
Eg1ryt
[email protected]. int
Thc fi.rll survry rcport end data can be found at httpJ/www.haiweb,org/modicincprices/survess
Document no- VHO-EM/EDB/090/E
@\0orld Health Organization 2008
12112
BB.OsO/SANAA FBM-06394.max
