undertaken by Dr Rita Karam, Ministry of Health Marg Ewen (on - - PowerPoint PPT Presentation

Lebanon, 2004

Medicine price survey in Lebanon, 2004

undertaken by Dr Rita Karam, Ministry of Health

Marg Ewen (on behalf of Dr Karam)

WHO/HAI post-medicine price survey regional workshop, Cairo 7-9 January 2007

Lebanon, 2004

Country background

 Population in millions: 4 (excluding foreign residents & refugees)  % of rural population: 85 %  Total adult literacy rate: 88 %  GDP per capita: 5611 US $  Total health expenditure: 10.4 % of GDP  Government health expenditure 29.3% of total health

expenditure

 Public sector – medicines supplied by MoH (free) and NSSF

(75-80% of patient price reimbursed)

Lebanon, 2004

Methodology

• Number of medicines surveyed: 32

Core 26 Supplementary 6

• Year of MSH reference price used: 2002
• Number of regions surveyed: 4
• Total number of facilities sampled:

Sector (patient prices) Number Public

20

Private retail pharmacies

40

Other

NS

Lebanon, 2004

Availability

Public Private IB LPG IB LPG Median availability 0% 0% 95% 84%

25 50 75 100

Salbutamol Amitriptyline Cephalexin

%

Pub-IB Pub-LPG Pri-IB Pri-LPG

Lebanon, 2004

Prices: summary MPRs and examples

Procurement Public Private IB LPG IB LPG IB LPG Median MPR 5.9 1.2 free 12.9 6.1 ciprofloxacin 104 29.3 metronidazole 4.7 42 31.7 beclometasone 0.6 3.3 1.4

IB = innovator brand LPG = lowest priced generic

Lebanon, 2004

Affordability (No. of days’ wages)

Daily wage (US$) Public Private = $6.60

IB LPG I B IB LPG

Amoxicillin 500mg tabs, 21 free 1.4 0.5 Captopril 25mg tab, 90 3 1.2 Ranitidine 150mg tabs, 60 8.2 1.2

Lebanon, 2004

Price components

Official figures: imported medicine

Type of charge Charge basis Amount of charge Price of dispensed quantity Cumulative % mark-up FOB 2000 0% Shipping/insurance percent 7.5% 2150 7.5% Customs/clearance percent 11.5% 2397 19.86% Importers mark-up percent 10% 2637 31.85% Pharmacy mark-up percent 30% 3428 71.4%

Official figures: locally manufactured medicine

Manufacturer’s selling price 1000 0% Distributor’s mark-up percent 10% 1100 10% Pharmacy mark-up percent 30% 1430 43%

Lebanon, 2004

Main Findings

 Public sector procurement prices vary from

acceptable to high

 Availability of medicines in the public sector is

extremely poor

 Availability of medicines in private retail

pharmacies is good

 Prices are very high for both generics and

innovator brands in the private sector

Lebanon, 2004

Recommendations

 Develop a National Drug Policy  Annual budget allocation for essential medicines

in the public sector

 Unify public sector procurement, use tenders  Streamline the public sector supply system  Review the pricing scheme in order to lower

prices

 Permit and encourage generic substitution

Lebanon, 2004

Follow-up activities

2004:

 Committee of 4 pharmacists compared

FOB prices of about 2200 imported medicines with prices paid by Saudi Arabia & Jordan. Outcome: 1100 meds (25% of all registered medicines) had FOB price reduced by 20-30%

 Budget increased for cancer, HIV & other

specialised medicines from $14M per annum to $40M

Lebanon, 2004

2005: Implemented a new pricing structure for all imported medicines, estimated to reduce patient prices by 3-15%

FOB $ Shipping Insurance Customs Clearance Importer Markup Pharmacy Markup Cumulat. Markup 0- $10 6% 10% 10% 30% 66% $10 - $50 4.5% 8.5% 10% 30% 62% $50 - $100 3.5% 7.5% 9% 27% 54% > $100 2.5% 6.5% 8% 24% 46%

Lebanon, 2004

2006: Information on patient prices & pharmacy margin included

• n MoH website. Updated every 2 weeks.

2007:

 First Lebanese National Formulary to be distributed in

April to all doctors & pharmacists. Comparative information on brand/generic products registered in Lebanon, strength/dosage form, country of origin, price and coverage by NSSF. To be updated annually.

 Project to review price structure of locally manufactured

medicines (700, generics, prices quite low) 2008/2009: Implementing a re-pricing scheme for all medicines – reducing the FOB price