Consumers' Knowledge, Attitudes, and Practices Toward Medicine Price Transparency at Private Healthcare Setting in Malaysia

Background: Medicine price transparency refers to the practice of making prices available to consumers for them to identify, compare, and select the medicine that provides the desired value. This study aimed to evaluate consumer knowledge, attitudes, and practices regarding Malaysia's medicine price transparency initiative, as well as factors that may influence related good consumer practices in private healthcare settings.Methods: A cross-sectional, self-administered survey was conducted between May and July 2019 among consumers attending private healthcare institutions in Malaysia. The self-developed and validated survey consisted of four sections on the following: respondents' demographics, and 28 close-ended and graded Likert scale answer options on knowledge, attitudes, and practices toward medicine price transparency. Factors influencing good consumer practices toward the transparency initiative were modeled using binary logistic regression.Results: A total of 679 respondents were part of the study. The mean age of respondents was 38 ± 13.3, with the majority (n = 420, 61.9%) being female. The respondents' mean score of knowledge and attitudes toward the price transparency initiative was 5.6 ± 1.5 of the total score of 8 and 31.9 ± 4.0 of the total score of 40, respectively. The respondents had the lowest score in the practice of price transparency, with a mean score of 31.5 ± 5.6 of the total score of 60. Male gender, Chinese ethnicity, high score on knowledge and attitudes, and high expenses on medicines influenced respondents' good practices of medicine price transparency.Conclusion: Respondents had good knowledge and attitudes, but their usage and implementation of the medicine price transparency initiative was still inadequate. A number of factors influence this inadequacy, including gender, race, consumers' out-of-pocket spending on medication, and knowledge of and attitudes toward price transparency practices. Consumer-driven market price control would be impossible to achieve without the good consumer practices of medicine price transparency.

Encouraging and Advancing the Reconversion of Rubber Plantations: Developing Incentives Using a Combined Market and Government Payment System

In various regions in Southeast Asia, over the past decades, natural tropical forests have rapidly been converted into monoculture plantations of rubber (Hevea brasiliensis), a consequence of the rubber boom. With the goal of slowing the ecologically and environmentally detrimental conversion of forests to rubber plantations and to encourage the reconversion of rubber plantations back to close-to-nature rainforests, we developed a theoretical combined market and government payment system. To evaluate the potential impacts of such system, we carried out a simulation study plus sensitivity analyses, using the latest land-use data from Xishuangbanna, Southwest China. The results of this simulation suggest that the payment system may make the annual reconversion rate develop from 9,009 ha to 4,610 ha over the modeled period from 2021 to 2050, so that the total reconversion area by 2050 would sum up to 197,902 ha. The total net present value (NPV) of compensatory payments for the whole period, in this case, would sum up to US$3.19 billion. The total carbon sequestration benefit resulting from the replacement of rubber plantations would be 11.37 million tons of carbon (tC) over the modelled period, translating into a cost of US$280.44 per tC. Sensitivity analyses revealed that higher variations in rubber prices cause more difficulty in determining compensatory payment. Of course, changes in a number of factors may lead to a reduction of the total NPV of compensatory payments, including increases in the carbon price or traditional medicine price, increases in the discount rate, and decreases to the rubber price and the targeted final reconversion rate. The area-specific compensatory payments ($11,154–$16,106/ha) and area-specific carbon sequestration (46.39–57.45 tC/ha) would then increase linearly as the targeted final reconversion rate increases. This new integrated payment system has the potential to contribute to restoring rainforest in rubber monoculture-dominated landscape.

COVID-19: unprecedented challenges for Indian pharmaceutical industry and pharma emerging markets

<p class="abstract">WHO has declared the present outbreak of a new corona virus disease (COVID-19) as a global pandemic. The impact of novel COVID-19 epidemic is uncertain and unpredictable, which is also a challenging phase for the pharmaceutical industry across the globe. The rationale of this article is to compile existing research and published data and identify the various challenges among the pharmaceutical sector in India and other developing countries. To overcome from present epidemic effects such as increase in medicine price, disruption in the pharmaceutical supply chain, balancing between IPR and access to innovation and regulation on counterfeit medicine in developing countries, the certain possible strategies and solutions are discussed. The present article also emphasized the solidarity and global cooperation among developing countries to strengthen the pharmaceutical operations across India and other developing countries to meet the current demand during COVID-19 pandemic.</p>

WHO key access antibiotics price, availability and affordability in private sector pharmacies in Pakistan

Background Poor availability and unaffordability of key access antibiotics may increase antimicrobial resistance in the community by promoting inappropriate antibiotic selection and abridged therapy compliance. Objective To check the prices, availability, and affordability of the World Health Organization (WHO) key access antibiotics in private sector pharmacies of Lahore, Pakistan. Methodology A survey of WHO key access antibiotics from WHO essential medicine list 2017 was conducted in private sector pharmacies of 4 different regions of Lahore employing adapted WHO/HAI methodology. The comparison of prices and availability between originator brands (OB) and lowest price generics (LPG) were conducted followed by the effect of medicine price differences on patient’s affordability. The data were analyzed using a preprogrammed WHO Microsoft excel workbook. Results The mean availability of OB products was 45.20% and the availability of LPGs was 40.40%. The OBs of co-amoxiclav, clarithromycin and metronidazole and LPGs of azithromycin and ciprofloxacin were easily available (100%) in all private sector pharmacies. Whereas, antibiotics like chloramphenicol, cloxacillin, nitrofurantoin, spectinomycin, and cefazolin were totally unavailable in all the surveyed pharmacies. The OBs and LPGs with high MPRs were ceftriaxone (OB; 15.31, LPG; 6.38) and ciprofloxacin (OB; 12.42, LPG; 5.77). The median of brand premium obtained was 38.7%, which varied between the lowest brand premium of 3.97% for metronidazole and highest for ceftriaxone i.e. 140%. The cost of standard treatment was 0.5 day’s wage (median) if using OB and 0.4 day’s wage (median) for LPG, for a lowest paid unskilled government worker. Treatment with OB and LPG was unaffordable for ciprofloxacin (OB; 2.4, LPG; 1.1) & cefotaxime (OB; 12.7, LPG; 8.1). Conclusion There is dire need to properly implement price control policies to better regulate fragile antibiotic supply system so that the availability of both OB and LPG of key access antibiotics should be increased. The prices could be reduced by improving purchasing efficiency, excluding taxes and regulating mark-ups. This could increase the affordability of patients to complete their antibiotic therapy with subsequent reduction in antimicrobial resistance.

Access to Essential Cardiovascular Medicines in Pakistan: A National Survey on the Availability, Price, and Affordability, Using WHO/HAI Methodology

Objective: This national survey was aimed at measuring the access to cardiovascular disease (CVD) medicines in terms of their availability, price, and affordability in Pakistan. This was done by using the standard WHO/Health Action International (HAI) methodology.Methods: The price and availability data for 18 CVD medicines were collected from public sector hospitals (n = 40) and private sector retail pharmacies (n = 40) in eight cities of Pakistan. The outcome measures were availability (calculated as percentage of health facilities stocked with listed medicines), medicine price to the international reference price ratio (i.e., median price ratio (MPR)), and affordability (calculated as number of days’ wages (NDWs) of the lowest paid unskilled government worker required to afford one-month treatment of a chronic disease). The affordability of standard treatment in Pakistan with four CVD drugs was compared with data from six other low and middle income countries (LMICs) using HAI database.Findings: The mean percent availability of CVD medicines was significantly low (p &lt; 0.001) in the public sector as compared to the private sector, that is, 25.5% vs. 54.6% for originator brands (OBs) and 30.4% vs. 34.9% for lowest price generics (LPGs), respectively. For all OBs and LPGs, the inflation-adjusted mean MPR was 2.72 and 1, respectively. CVD medicines were found to be unaffordable with average NDWs of 6.4 and 2.2 for OBs and LPGs, respectively, that is, NDWs of more than 1. In international comparison with countries such as Sudan, Lebanon, Egypt, India, Afghanistan, and China, the affordability of standard treatment with selected CVD medicines (atenolol, amlodipine, captopril, and simvastatin) in Pakistan was found to be low. Overall, all four OBs and three out of four LPGs of selected CVD drugs were found unaffordable in Pakistan.Conclusion: This data indicated that the availability of selected CVD medicines was low in both public and private sector medicine outlets. Both OBs and LPGs were found unaffordable in the private sector, necessitating the redressal of pricing policies, structuring, and their implementation.

Evaluating Price and Availability of Essential Medicines in China: A Mixed Cross-Sectional and Longitudinal Study

Objectives: To evaluate the price and availability of medicines in China.Methods: A standard methodology developed by WHO and Health Action International was used to collect medicine price and availability data. We obtained cross-sectional data for 48 medicines from 519 facilities (280 public hospitals and 239 private retail pharmacies) in five provinces in China in 2018. We also collected longitudinal data for 31 medicines in Shaanxi Province in 2010, 2012, 2014, and 2018. Medicine price was compared with the international reference price to obtain a median price ratio (MPR). The availability and price in five provinces were compared in matched sets. We used general estimating equations to calculate differences in availability and median prices from 2010 to 2018.Findings: Mean availability of surveyed medicines in five provinces was low in both public (4.29–32.87%) and private sectors (13.50–43.75%). The MPR for lowest priced generics (LPGs) was acceptable (1.80–3.02) and for originator brands (OBs) was much higher (9.14–12.65). The variation was significant for both availability and price of medicines across provinces. In Shaanxi Province, the availability of medicines decreased between 2010 and 2018, but this was not significant in the public or private sector. Compared with 2010, the median adjusted patient price was significantly lower in 2018 for nine OBs (difference −22.4%; p = 0.005) and 20 LPGs (−20.5%; p = 0.046) in the public sector and 10 OBs (−10.2%; p = 0.047) in the private sector.Conclusion: Access to medicines was found to be poor and unequal across China in 2018. Future interventions are needed, and possible strategies include effective and efficient procurement, promoting the development of retail pharmacies and increasing medicine price transparency.

Impact of changes in the methodology of external price referencing on medicine prices: discrete-event simulation

Background Several governments apply the policy of external price referencing (EPR), which considers the prices of a medicine in one or more other countries for the purpose of setting the price in the own country. Different methodological choices can be taken to design EPR. The study aimed to analyse whether, or not, and how changes in the methodology of EPR can impact medicine prices. Methods The real-life EPR methodology as of Q1/2015 was surveyed in all European Union Member States (where applicable), Iceland, Norway and Switzerland through a questionnaire responded by national pricing authorities. Different scenarios were developed related to the parameters of the EPR methodology. Discrete-event simulations of fictitious prices in the 28 countries of the study that had EPR were run over 10 years. The continuation of the real-life EPR methodology in the countries as surveyed in 2015, without any change, served as base case. Results In most scenarios, after 10 years, medicine prices in all or most surveyed countries were—sometimes considerably—lower than in the base case scenario. But in a few scenarios medicine prices increased in some countries. Consideration of discounts (an assumed 20% discount in five large economies and the mandatory discount in Germany, Greece and Ireland) and determining the reference price based on the lowest price in the country basket would result in higher price reductions (on average − 47.2% and − 34.2% compared to the base case). An adjustment of medicine price data of the reference countries by purchasing power parities would lead to higher prices in some more affluent countries (e.g. Switzerland, Norway) and lower prices in lower-income economies (Bulgaria, Romania, Hungary, Poland). Regular price revisions and changes in the basket of reference countries would also impact medicine prices, however to a lesser extent. Conclusions EPR has some potential for cost-containment. Medicine prices could be decreased if certain parameters of the EPR methodology were changed. If public payers aim to apply EPR to keep medicine prices at more affordable levels, they are encouraged to explore the cost-containment potential of this policy by taking appropriate methodological choices in the EPR design.

Impact of changes in the methodology of external price referencing on medicine prices: discrete-event simulation

Background: Several governments apply the policy of external price referencing (EPR), which considers the prices of a medicine in one or more other countries for the purpose of setting the price in the own country. Different methodological choices can be taken to design EPR. The study aimed to analyse whether, or not, and how changes in the methodology of EPR can impact medicine prices.Methods: The real-life EPR methodology as of Q1/2015 was surveyed in all European Union Member States (where applicable), Iceland, Norway and Switzerland through a questionnaire responded by national pricing authorities. Different scenarios were developed related to the parameters of the EPR methodology. Discrete-event simulations of fictitious prices in the 28 countries of the study that had EPR were run over 10 years. The continuation of the real-life EPR methodology in the countries as surveyed in 2015, without any change, served as base case.Results: In most scenarios, after ten years, medicine prices in all or most surveyed countries were – sometimes considerably – lower than in the base case scenario. But in a few scenarios medicine prices increased in some countries. Consideration of discounts (an assumed 20% discount in five large economies and the mandatory discount in Germany, Greece and Ireland) and determining the reference price based on the lowest price in the country basket would result in higher price reductions (on average -47.2% and -34.2% compared to the base case). An adjustment of medicine price data of the reference countries by purchasing power parities would lead to higher prices in some more affluent countries (e.g. Switzerland, Norway) and lower prices in lower-income economies (Bulgaria, Romania, Hungary, Poland). Regular price revisions and changes in the basket of reference countries would also impact medicine prices, however to a lesser extent.Conclusions: EPR has some potential for cost-containment. Medicine prices could be decreased if certain parameters of the EPR methodology were changed. If public payers aim to apply EPR to keep medicine prices at more affordable levels, they are encouraged to explore the cost-containment potential of this policy by taking appropriate methodological choices in the EPR design.

Patients’ expectations on medicines information

Background Medicines information is important for patients as it assists them in achieving more safe and effective use of pharmaceuticals. Many patients seek information from community pharmacies' staff. The objectives of this study were to identify specific topics of medicines information which patients expect to receive at community pharmacies. Methods Face-to-face interviews were conducted with 1059 visitors of community pharmacies in Armenia. Previously developed questionnaire was used for interviewing patients. Data were analysed with the SPSS statistical software. Results Most of participants acknowledged importance of receiving from community pharmacies' staff information on therapeutic indications of medicines (91.1%), dosage and method of administration (90.8%), the duration of treatment (86.3%), expiry date (85.7%), adverse reactions (85.0%), contraindications (84.6%), storage conditions (77.5%) and type of activity (76.0%). Importance of receiving information on some specific topics depends on patients' age. Participants' acknowledgement of information on interaction with other medicines, certain categories of users, and potential effects on the ability to drive is decreasing with patients' age increasing (p &lt; 0.001). The opposite trend was observed with attitude to receiving information on medicine price that was mostly valued by elderly patients (p = 0.046). The number of patients who trust the information provided was higher among those who more often received comprehensive responses from pharmacists and pharmacy assistants (p &lt; 0.001). Conclusions Receiving medicines information from the staff of community pharmacies is important for patients, and the majority of them trust to information received. Patients are mainly provided with comprehensive responses to their questions about medicines, and there was dependence between a frequency of receiving comprehensive responses and a level of patients' trust the information provided by pharmacy staff. Key messages Increasing patients’ awareness on their right to get medicines information can be beneficial. Comprehensive responses increase patients trust medicines information provided by pharmacists.