Senaka Bibile dies again - EDITORIAL

ealth Minister Rajitha Senaratne, speaking at the Senaka Bibile Commemoration meeting last Friday,proclaimed that after some 40 years the spirit of Bibile had come alive with the decision to slash the prices of 47 drugs.   
The National Medicines Regulatory Authority’s (NMRA) new Chairman Asita de Silva whose appointment has been challenged by some Bibile policy movements, also spoke at Friday’s event to explain the price reduction formula. Over the weekend the media gave wide publicity to the announcement and most people were happy about the minister’s claim that they would be able to reduce their medical expenses by about 50 per cent a month.   
The Daily Mirror spoke to pharmacologists, medical specialists and veteran working-pharmacists who have worked hard to revive the Bibile policy. They say that though the Minister announced that prices of 47 drugs will be slashed by about 50 per cent, it would not be a real price reduction but a determination of maximum retail prices (MRPs) for these drugs.   
They say that according to Prof. Asita, the brands of a particular drug with a market share of more than 2% were selected and the median price of these were taken as the MRP of that particular drug. He mentioned few examples. Losartan 50 mg has 23 brands in the market and when these prices are listed in ascending order, the 12th one has the median price, which is Rs.10.30. This will be the MRP for Losartan 50 mg. Similarly, Atorvastatin 20 mg. has 18 brands and the median price of those is Rs.17.63. Therefore, this will be its MRP. 
That means 11 Losartan brands with prices below the MRP of Rs.10.30 will not have any price reduction. Similarly, nine atorvastatin brands below the MRP will not have any price reduction.  
What is important is to see what impact this price determination will have on the people and how scientific this method is. Is it going to actually benefit patients or is it only a political gimmick?   
Prof. Asita showed an example, a prescription with six drugs and put maximum prices for those. The cost for a month was around Rs.4,785. Then he put the MRP for those drugs and the cost came down close to Rs.2,371.50. A 50% reduction indeed but is this going to be true for any prescription. No. Prof. Asita forgot or deliberately did not tell the people that this is true only if all the drugs are bought at higher prices in the market. If patients are now buying these at a price less than the MRP there will not be any reduction.  
Prof. Priyadarshini Galappaththi, Professor of Pharmacology at the Faculty of Medicine in Colombo delivered the Senaka Bibile oration at this function. That was before the talks by Prof. Asita and the minister. She presented the findings of a countrywide study on pharmaceuticals. According to these findings, the median price of losartan is Rs.9.54 and not Rs.10.30 as mentioned by Prof. Asita. But other findings of this study are more important. Prof. Priyadarshini showed the example of Losartan. The most commonly prescribed brand of Losartan was Losarcar which was Rs.3.75. The most widely available brand of Losartan is Zaart and the price was Rs.9.54. With the MRP proposed by Prof. Asita, neither the price of the most widely prescribed brand of Losartan nor the price of the most widely available brand of Losartan will come down. In other words, a majority of patients on Losartan will not have any benefit from the price reduction.   
We urge President Maithripala Sirisena, who as Minister of Health from 2010 to 2015 worked hard to implement the Bibile policy to look into what appears to be another attempt to kill Prof. Bibile in terms of his policy. For the reductions, the prices considered were the present market prices which were decided by importers without a scientific basis. The prices are highly inflated. Unlike other importers, drug importers are getting huge profits due to this. If the price determination was based on the rational prices of available brands, the method would have been more scientific.