30 November 2016 12:00 am
The maximum retail price is imposed on 48 medicines including medicines for diabetes, high blood pressure, cardio vascular diseases, asthma and arthritis. Health Minister Dr. Rajitha Senaratne took this initiative claiming he was following Prof. Senaka Bibile’s essential drugs policy, which has been hailed worldwide. However, certain groups say Dr. Senaratne’s claim was dubious as he had not followed the basics of Bibile’s policy, which is to make quality drugs available at affordable prices
“This report shows that the CIF price is non-verifiable and as a result we should not go down that road. Another publication by the WHO in 2015--which is a guideline for countries to regulate pharmaceutical pricing- -also states that the CIF model will not work well in low and middle income countries. “We decided not to follow this model after careful thought, going through reports by global experts and also with the experiences we have with pharmaceutical importing,” he said. He added that the Chamber of Pharmaceutical Industry and major colleges such as the Sri Lanka Medical Association (SLMA), College of Physicians, Pediatricians, Surgeons and Neurologists were consulted and that they had endorsed the move away from the CIF pricing.
“The NMRA Act was brought in last year. It looks at quality, efficacy, safety as well as the needs and cost. As for quality assurance we do have challenges. But there is a stringent process to follow. Whatever drug that is registered under the NMRA is quality assured.” Adding that Sri Lanka was not the only country that uses generics he said that thirty percent of medicines in Britain and upto 40 percent in the United States are generics. “A majority of them are supplied by India. But they go through a stringent quality assurance process. Some people say that the NMRA is inefficient because it takes around eight months to register a product. But this is because we go through a stringent process to assure quality. We also have our national medical quality assurance laboratory. One of our priorities is to strengthen this laboratory and we have also asked for a new laboratory to be set up. Then we will be even more confident about quality assurance.” He also said that the NMRA was implementing a procedure to restrict the number of brands of the same type of medicine being imported to the country. Stating that the NMRA was responsible for monitoring the pharmacies and pricing he said they had food and drug inspectors. “We have a hotline (828) in the Ministry of Health. The number of complaints has dropped dramatically in the last few days.
But even by August this year the prices of drugs had not been reduced or the imports restricted. Therefore he had invited Prof. Asita de Silva to take control of the NMRA and introduce a price reduction urgently. He says last month’s reduction of prices is only a first step and more price reduction will be announced soon, while China will help to set up a hi-tech quality assurance laboratory. Dr. Senaratne also says that from next year the Government hopes to sign agreements for about 25 publicprivate partnership companies so that 70 percent of the drugs now being imported could be produced locally with the prices being drastically reduced
“The drugs that are under this policy are drugs from Western countries, which are drugs that are not affordable to the average person or a poor person as they would choose the Indian brands instead. Because of their expensive nature the profit margin from these drugs, prior to
“People who would buy these drugs will find it difficult to cope as they would have to switch to the less effective counterparts. Switching brands does not have any drastic consequences, the only
The Government hospitals can get down drugs at a lower cost. But the Ministry of Health needs to maintain the quality and the standard of the drug. The type of brand a patient uses depends on the patient’s financial status. If low quality drugs are brought in then, due to their low effectiveness patients will be coming in to the hospital more frequently resulting in overcrowding of the wards. “The aim of a Government hospital is to get patients out of the hospital faster. Therefore, good quality drugs are necessary,” said a doctor who works at the General Hospital and did not want to be named.
They are not trained in Pharmacy. Therefore we see that they are not suitable people to go into the field of authorization of pricing formulas. So, first of all the Ministry should define who the authorized officers are and issue a Gazette notification. The new drug Act clearly mentions that they should Gazette the authorized officers and give the Director General powers over them,” he said. Referring to the lack of a reliable quality assurance laboratory he said that they had repeatedly asked the Ministry to establish one. “He has informed us that it would take around two years. They are currently discussing it with the Chinese government who will give aid to build a sophisticated lab. Quality laboratory assurance should be given priority because doctors depend on the quality of the product and not so much the price when prescribing drugs. If you have a drug which is cheaper but lacking in quality, ultimately patients suffer.” When asked if the Health Minister was following Prof. Senaka Bible’s policy he said they had doubts. “In Prof. Bibile’s concept it is clearly stated that we should first have an essential drug list and update it annually. It’s not necessary for a country to have 30 to 40 companies or brands importing hundreds of brands-a shortlist of five or ten brands essential to the country. “We hope to discuss with the Minister and try to help him succeed,” he added.
“However, there are no restrictions to brands in Dr. Senaratne’s policy. Some drugs are being imported under about 30 brand names. There are so many brands and the price range is wide. For example, the price of the SPC drug Acyclovir which is a generic drug for chicken pox is around Rs. 6.00. Zovirax which is a brand of the same drug sold at around Rs.140 for a 200 mg tablet,” he added. Reiterating the grievance of many doctors Dr. Bandara said that there was no quality assurance for drugs both in the public and the private sector. “We inquired from the Health Minister about this issue and he informed us the State laboratories were inadequate to provide quality assurances for most drugs,” said Dr. Bandara. “Prof. Bibile’s policy also focused on the availability of drugs in the Public Sector. Drugs should be available at all times in correct doses and in adequate amounts. However, in Dr. S e n a r a t n e ’s policy little is mentioned about the availability of a drug in the Public Sector. Drug availability in Sri Lanka is very poor at the moment,” he added. “Our aim is to reduce drug prices. But we have not achieved that target through this pricing method. People still suffer,” he said.