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% % 100 75 Pub-IB Pub-LPG 50 Pri-IB Pri-LPG 25 0 Salbutamol Amitriptyline Cephalexin 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 I IB LPG LPG B 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 Price of Cumulative % charge dispensed mark-up quantity 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 Customs Importer Pharmacy Cumulat. Insurance Clearance Markup Markup 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 on 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 Lebanon, 2004
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