Alexandra Cameron et al


Medicine availability and prices in both public and private sectors are key indicators of access to treatment. Surveys of medicine prices and availability, conducted using a standard methodology, have shown that poor medicine availability, particularly in the public sector, is a key barrier to access to medicines. Public sector availability of generic medicines is less than 60% across WHO regions, ranging from 32% in the Eastern Mediterranean Region to 58% in the European Region. Private sector availability of generic medicines is higher than in the public sector in all regions. However, availability is still less than 60% in the Western Pacific, South-East Asia and Africa Regions. In countries where patients pay for medicines in the public sector, average prices of generic medicines range from 1.9 to 3.5 times international reference prices (IRPs) in the Eastern Mediterranean and Western Pacific Regions, respectively. While public sector availability of originator brand medicines is low, when these medicines were sold to patients their average costs ranged from 5.3 times IRPs in the Eastern Mediterranean Region to 20.5 times IRPs in the European Region.

Due to low availability of medicines in the public sector, patients are often forced to purchase medicines in the private sector. In this sector, patient prices for lowest-priced generic products ranged from 2.6 times IRPs in South-East Asia to 9.5 times IRPs in the Americas. For originator brand products, private sector prices were at least 10 times higher than international reference prices in all WHO regions. When originator brands are prescribed and dispensed for products that are also available in generic form, patients are paying four times more, on average, to purchase the brand.

High medicine prices increase the cost of treatment. For example, treatment of an adult respiratory infection with a 7-day course of treatment with ciprofloxacin would cost the lowest-paid government worker over a day’s wage in most countries. Costs escalate when originator brands are used: the same treatment would cost the lowest-paid unskilled government worker over 10 days’ wages in the majority of the countries studied; in Armenia and Kenya, over a month’s salary would be needed to purchase this treatment. Additional problems of affordability face people living with chronic diseases due to the lifelong nature of treatment and the frequent need for combination therapy.

Countries should intensify efforts to measure and regularly monitor medicine prices and availability, and adopt policy measures to address the issues identified. A range of policy options are available to address issues of high prices and low availability of medicines. Low public sector availability can be addressed through improved procurement efficiency, and adequate, equitable and sustainable financing. Medicine prices can be reduced by eliminating duties and taxes on medicines and promoting the use of quality-assured generic medicines. Mark-ups can also be regulated to avoid excessive add-on costs in the supply chain. The most appropriate actions to follow depend on a country’s individual survey results and their underlying determinants, as well as local factors including existing pharmaceutical policies and market situations.