Health professionals’ perception of pharmaceuticals procurement performance in public health facilities in Southwestern Ethiopia

Background Pharmaceutical’s procurement is a core component of logistics management, and has a significant influence on product availability, and total supply chain costs. In Ethiopia, there are few studies on this topic where almost all of them were from suppliers’ perspectives and entirely quantitative. This study, therefore, aimed to assess health professionals’ perceptions about pharmaceuticals procurement performance in public health facilities in southwest Ethiopia. Methods A facility-based cross-sectional study complemented with a qualitative method was conducted from March 20 and April 30, 2019. We collected the quantitative data through self-administered structured questionnaires from pharmacy staff and document review using checklists. EpiData version 3.1 and SPSS version 20 were used for data entry and analysis, respectively. Descriptive statistics were done for quantitative data. Qualitative data were gathered through face-to-face in-depth interviews and analyzed using thematic analysis technique. Results Regarding respondents’ perception of accountability in pharmaceutical procurement, 110 (57.9%) agreed or strongly agreed that their facilities adopt and use standard treatment guidelines and facility-specific medicine lists. Concerning competitiveness, 139 (62.6%) of the participants either disagreed or strongly disagreed that their facilities used formal suppliers’ qualifications based on service reliability and financial capacity. Regarding efficiency, 146 (76.8%) disagreed or strongly disagreed that their facilities develop a mechanism for prompt, reliable payment to lower medicine prices. The qualitative analysis identified staff workforce and competency, budget shortages, suppliers’ uncertainty, and pharmaceutical non-availability as challenges for procurement management performance. Conclusion The results indicated that participants perceived procurement performance of their facilities as poor. Therefore, staff development, fundraising options, monitoring and evaluation, coordination and collaboration can improve procurement practice and performance.

Strategies to improve pharmaceutical supply chain resilience under politico-economic sanctions: the case of Iran

Background Given the impact of politico-economic sanctions on the pharmaceutical supply chain, this study aims to identify practical strategies to improve the resilience of the Iranian supply chain in pharmaceutical procurement under politico-economic sanctions. Methods This is a qualitative content analysis study conducted in 2018. Semi-structured interviews were conducted using snowball sampling, and saturation was achieved after 18 interviews. Guba and Lincoln's criteria, namely credibility, confirmability, transferability, and dependability, were considered to ensure the validity and transparency of the study. A five-step framework analysis was applied to analyze the data using MAX QDA10. Results The results led to the identification of nine main themes and 26 subthemes as strategies to improve the resilience of the pharmaceutical chain. According to the thematic map, some of these strategies have an extra-sectoral character: ‘insurance organizations’, ‘strengthening relations with other countries’, ‘mechanization of the distribution system’, and ‘suppliers and manufacturers’. At the same time, some inter-sectoral strategies can help the pharmaceutical chain maintain its resilience: ‘healthcare management and policy’, ‘exploiting local potential’, ‘pricing’, and ‘integrated health information systems.’ As a strategy, ‘Medical community and consumers’ also plays a crucial role in this regard. According to the subthemes, revisions of health management, more supervision, privatization, clinical policies, strategic purchasing, improvement of the referral system, inter-sectoral cooperation, support of indigenous medicines, rational pricing, insurance system, improvement of medical coverage, and development of electronic prescription should be considered by health systems. Sufficient support for indigenous medication and supervision of the distribution system should be considered by the pharmaceutical industry, taking into account the cooperation between consumers and patients. Conclusions Integration of the pharmaceutical supply chain and modern technologies, more attention to business complexity, economic development, intense competition, rapid changes in customer needs, and appropriate relationship between manufacturers, distributors, prescribers, and insurance organizations as purchasers should be considered by policymakers to improve supply chain resilience.

Pharmaceutical procurement among public sector procurers in CARICOM

Objective. To examine multiple aspects of the medicines in CARICOM procurement markets, including manufacturer headquarters location, regulatory history, and type (innovator versus generic); the proportion of World Health Organization (WHO) essential medicines; and the most expensive medicines procured. Method. An analysis of procurement information from selected CARICOM procurers. Four public sector procurement lists were obtained based on public availability or sharing of data from public sector procurers. Analyses were based on parameters available or deduced from these data. Results. The majority of products come from manufacturers headquartered in North America and Europe (63%–67%). The percentage of medicines procured from generic companies is 60%–87%; and 25%–50% of medicines procured are on the WHO Essential Medicines List. Wide price variations exist in the most expensive medicines purchased. Conclusions. The analysis identifies vulnerabilities and opportunities in the procurement situation of CARICOM states, particularly related to quality and rational use of medicines. This analysis represents a baseline that governments and other stakeholders can use in the future.

Drug shortages in a state-owned academic hospital during the COVID-19 pandemic in Ecuador

Background During a pandemic, medical supplies are at increased risk of being depleted rapidly. The COVID-19 sanitary emergency has generated global shortages in critical supplies, like personal protective equipment and medicines. This study aimed to describe the pharmaceutical procurement challenges to overcome medicine shortages in a state-owned academic hospital during the COVID-19 pandemic in Ecuador. Methods We conducted a cross-sectional study using secondary administrative data of documented public tenders for medicines and drug prescriptions for the critical care unit at Hospital Pablo Arturo Suárez in Quito, Ecuador. The occurrence of shortages, their frequency, and the procurement mechanisms used to overcome them were documented by the pharmacy service between January 1st and July 31th, 2020. The units purchased and unitary price of pharmaceuticals procured by the hospital was also documented and compared to data from 2019. Results From 38 medicines analyzed from 12 ATC groups, there were 84 shortages during the sanitary emergency period covered by the study, and 25 medicines had one or more shortages. Norepinephrine and midazolam shortages were most frequent. Retail or emergency direct purchase and loan-stock from other public hospitals were the main procurement methods to overcome the shortages. The purchase mechanism directly influenced the price. Drugs purchased in small tenders via retail or emergency direct purchase had the most significant price increase (up to 819%), while medicines acquired via the electronic catalog managed by the public procurement service experienced no price changes. Conclusion Monitoring and responding to drug shortages during a pandemic can be challenging, and governments must adapt quickly, providing specific guidance on how to deal with shortages.

Pharmaceutical procurement practice aspects

Procurement is the most important part of the pharmaceutical logistic cycle. It is the process of acquiring supplies after a properly selected list of products. The procurement system or model depends on the type of organization weather it is governmental or private, centralized or decentralized, autonomous or semiautonomous. The objectives of procurement system is to make available the right drug in an appropriate quantities of adequate quality from a reliable supplier at the right time with the lowest possible prices through an ethical and legal procedures. Prequalification of suppliers is the successful quality assurance activity. Needs and funds can be reconciled and a rational cut can be done by using ABC- VAN matrix technique. Purchasing should be by transparent competition through open tender, restrictive tender, restricted competition or in certain cases by direct negotiation by transparent committee leading to transparent contract. One of the most important procurement practice for the system to succeed is the reliable payment and efficient financial management and monitoring the supplier performance. The system should have an efficient quality assurance program with annual auditing and regular reports.

6.F. Round table: What is the evidence for and against price transparency in pharmaceutical pricing and procurement?

Although the potential for price transparency in pharmaceutical systems has been widely debated, there has been less discussion of the empirical basis to inform policymaking in this area. The lack of price transparency is viewed as one of the biggest barriers to joint pharmaceutical procurement, an initiative that has the potential to drive down pharmaceutical prices by pooling the purchasing power of smaller populations and thus improve the affordability of medicines. However, critics of the call for increased transparency in pharmaceutical pricing argue that such policies would lead to price inflation, particularly for countries with lower ability to pay or limited negotiating power. Given the widespread use of negotiated confidential discounts granted to different payers by manufacturers and the pervasiveness of international reference pricing as a policy mechanism for determining pharmaceutical prices, transparency policies would not only affect countries directly implementing them. As a result, policy-makers are often reluctant and unsure about how to proceed; this became readily apparent in the discussions around the Transparency Resolution at the World Health Assembly in May 2019. A concise overview of the evidence on the consequences of transparency policies is lacking. This panel draws on a wide-ranging literature review that sought to answer the following key research questions: Is there empirical evidence that examines the effect of price transparency on price development (within countries implementing the policy as well as other countries) In the area of pharmaceuticals? Regarding other types of healthcare goods and services? Regarding products from other industries? What insights can we learn from the available evidence and how transferrable is evidence from other healthcare dimensions or other industries to the issue of price transparency for pharmaceuticals? In this workshop we will bring together researchers to discuss the type of evidence available the extent to which it is empirically grounded. The workshop aims to address this issue and highlight evidence gaps for and against price transparency policies. Each panellist will talk for a maximum of 10 minutes presenting insights from their work; audience members will be actively invited to share their insights and reflections. Key messages The debate on price transparency in pharmaceutical systems needs to advance by looking at the full range of evidence available. Highlighting evidence gaps can endorse real world experiments to test theoretical arguments.

Latin American health cooperation shows limited gains

Subject Pharmaceutical procurement and pricing. Significance For over a decade, Latin American countries have engaged in efforts to reduce the price of high-cost medications, whether through joint price negotiations or pooled procurement at the regional and, in some cases, national level. In public health emergencies such as the current COVID-19 pandemic, the Pan American Health Organization (PAHO)'s Strategic Fund is also often utilised to make emergency public sector acquisitions of medications and strategic health supplies, as they do not have to have the cash on hand, but can get what amounts to a short-term, interest-free loan. Impacts Difficulties in regional cooperation may further complicate the fight against COVID-19. The USMCA may strengthen pushback on pharmaceutical costs. Healthcare costs will continue to drive frictions in countries such as Chile.

How well does Malaysia achieve value for money in public sector purchasing of medicines? Evidence from medicines procurement prices from 2010 to 2014

Background Malaysia’s public healthcare sector provides a greater volume of medicines at lower overall cost, indicating its importance in providing access to medicines for Malaysians. However, the Ministry of Health (MOH), as the main healthcare provider, has concerns about the continuous increase in the public sector medicines budget, and achieving efficiencies in medicines procurement is an important goal. The objectives of this study were to assess the overall trend in public sector pharmaceutical procurement efficiency from 2010 to 2014, and determine if the three different ways in which MOH procures medicines influences efficiency.Methods We matched medicines from the public sector procurement report by medicine formulation to medicines with a Management Sciences for Health (MSH) International Reference Price (IRP) for each year. Price ratios were calculated, and utilizing the information on quantity and expenditure for each product, summary measures of procurement efficiency were reported as quantity- and expenditure-weighted average price ratios (WAPRs) for each year. Utilizing MOH procurement data to obtain information on procurement type, a multiple regression analysis, controlling for a number of factors that can influence prices, assessed whether procured efficiency (relative to IRPs) differed by MOH procurement type.Results Malaysia’s public sector purchased medicines at two to three times the IRP throughout the study period. However, procurement prices were relatively stable in terms of WAPRs each year (2.2 and 3.2 in 2010 to 1.9 and 2.9 in 2014 for quantity and expenditure WAPRs, respectively). Procurement efficiency did not vary between the three different methods of MOH procurement. Procurement efficiency of both imported innovators and imported generics were significantly lower ( P <0.001 and P <0.01) than local generic products, and medicine source and category influenced the procurement efficiency of each MOH procurement mechanism.Conclusion The design of different medicines procurement mechanisms, along with the balance of interests that Malaysia has sought to achieve in its public procurement procedures, have not been able to achieve lower public sector medicines procurement prices (relative to IRP). Introducing pooled procurement options along with continuous monitoring of procurement efficiency and exploring ways to improve price competition among local and foreign suppliers is recommended.