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Medicines prices and Malaysia--untangling the medicines web

Hill S

PLoS Med, 2007 Mar 27;4(3):e149.
PMID: 17388686
Matched MeSH terms: Drugs, Essential/economics
Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia

Babar ZU, Ibrahim MI, Singh H, Bukahri NI, Creese A

PLoS Med, 2007 Mar 27;4(3):e82.
PMID: 17388660

Malaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components.

Matched MeSH terms: Drugs, Essential/economics
Are essential medicines in Malaysia accessible, affordable and available?

Saleh K, Ibrahim MI

Pharm World Sci, 2005 Dec;27(6):442-6.
PMID: 16341951 DOI: 10.1007/s11096-005-1318-8

OBJECTIVE: To assess the pharmaceutical sector to know whether people have access to essential medicines.

SETTING: The study was conducted in 20 public health clinics, five public district drug stores and 20 private retail pharmacies selected randomly in five different areas randomly selected (four states and a federal territory).

METHOD: The methodology used was adopted from the World Health Organization study protocol. The degree of attainment of the strategic pharmaceutical objectives of improved access is measured by a list of tested indicators. Access is measured in terms of the availability and affordability of essential medicines, especially to the poor and in the public sector. The first survey in the public health clinics and public district drug stores gathered information about current availability of essential medicines, prevalence of stock-outs and affordability of treatment (except drug stores). The second survey assessed affordability of treatment in public health clinics and private retail pharmacies.

MAIN OUTCOME MEASURE: Availability, stock-out duration, percent of medicines dispensed, accessibility and affordability of key medicines.

RESULTS: The average availability of key medicines in the public health clinics for the country was 95.4%. The average stock-out duration of key medicines was 6.5 days. However, average availability of key medicines in the public district drug stores was 89.2%; with an average stock-out duration of 32.4 days. Medicines prescribed were 100% dispensed to the patients. Average affordability for public health clinics was 1.5 weeks salary and for the private pharmacies, 3.7 weeks salary.

CONCLUSIONS: The present pharmaceutical situation in the context of essential medicines list implementation reflected that the majority of the population in Malaysia had access to affordable essential medicines. If medicines need to be obtained from the private sector, they are hardly affordable. Although the average availability of essential medicines in Malaysia was high being more than 95.0%, in certain areas in Sabah availability was less than 80.0% and still a problem.

Matched MeSH terms: Drugs, Essential/economics
Fulltext The right to health as the basis for universal health coverage: A cross-national analysis of national medicines policies of 71 countries

Perehudoff SK, Alexandrov NV, Hogerzeil HV

PLoS One, 2019;14(6):e0215577.
PMID: 31251737 DOI: 10.1371/journal.pone.0215577

Persistent barriers to universal access to medicines are limited social protection in the event of illness, inadequate financing for essential medicines, frequent stock-outs in the public sector, and high prices in the private sector. We argue that greater coherence between human rights law, national medicines policies, and universal health coverage schemes can address these barriers. We present a cross-national content analysis of national medicines policies from 71 countries published between 1990-2016. The World Health Organization's (WHO) 2001 guidelines for developing and implementing a national medicines policy and all 71 national medicines policies were assessed on 12 principles, linking a health systems approach to essential medicines with international human rights law for medicines affordability and financing for vulnerable groups. National medicines policies most frequently contain measures for medicines selection and efficient spending/cost-effectiveness. Four principles (legal right to health; government financing; efficient spending; and financial protection of vulnerable populations) are significantly stronger in national medicines policies published after 2004 than before. Six principles have remained weak or absent: pooling user contributions, international cooperation, and four principles for good governance. Overall, South Africa (1996), Indonesia and South Sudan (2006), Philippines (2011-2016), Malaysia (2012), Somalia (2013), Afghanistan (2014), and Uganda (2015) include the most relevant texts and can be used as models for other settings. We conclude that WHO's 2001 guidelines have guided the content and language of many subsequent national medicines policies. WHO and national policy makers can use these principles and the practical examples identified in our study to further align national medicines policies with human rights law and with Target 3.8 for universal access to essential medicines in the Sustainable Development Goals.

Matched MeSH terms: Drugs, Essential/economics*
Fulltext Policies and programs to facilitate access to targeted cancer therapies in Thailand

Sruamsiri R, Ross-Degnan D, Lu CY, Chaiyakunapruk N, Wagner AK

PLoS One, 2015;10(3):e0119945.
PMID: 25798948 DOI: 10.1371/journal.pone.0119945

BACKGROUND: Increasing access to clinically beneficial targeted cancer medicines is a challenge in every country due to their high cost. We describe the interplay of innovative policies and programs involving multiple stakeholders to facilitate access to these medicines in Thailand, as well as the utilization of selected targeted therapies over time.
METHODS: We selected two medicines on the 2013 Thai national list of essential medicines (NLEM) [letrozole and imatinib] and three unlisted medicines for the same indications [trastuzumab, nilotinib and dasatinib]. We created timelines of access policies and programs for these products based on scientific and grey literature. Using IMS Health sales data, we described the trajectories of sales volumes of the study medicines between January 2001 and December 2012. We compared estimated average numbers of patients treated before and after the implementation of policies and programs for each product.
RESULTS: Different stakeholders implemented multiple interventions to increase access to the study medicines for different patient populations. During 2007-2009, the Thai Government created a special NLEM category with different coverage requirements for payers and issued compulsory licenses; payers negotiated prices with manufacturers and engaged in pooled procurement; pharmaceutical companies expanded patient assistance programs and lowered prices in different ways. Compared to before the interventions, estimated numbers of patients treated with each medicine increased significantly afterwards: for letrozole from 645 (95% CI 366-923) to 3683 (95% CI 2,748-4,618); for imatinib from 103 (95% CI 72-174) to 350 (95% CI 307-398); and for trastuzumab from 68 (95% CI 45-118) to 412 (95% CI 344-563).
CONCLUSIONS: Government, payers, and manufacturers implemented multi-pronged approaches to facilitate access to targeted cancer therapies for the Thai population, which differed by medicine. Routine monitoring is needed to assess clinical and economic impacts of these strategies in the health system.

Matched MeSH terms: Drugs, Essential/economics*
Effect of privatization of the drug distribution system on drug prices in Malaysia

Babar ZD, Izham MI

Public Health, 2009 Aug;123(8):523-33.
PMID: 19665741 DOI: 10.1016/j.puhe.2009.06.011

Previous studies on anti-infective and cardiovascular drugs have shown extraordinary price increases following privatization of the Malaysian drug distribution system. Therefore, it was felt that there was a need to undertake a full-scale study to evaluate the effect of privatization of the Malaysian drug distribution system on drug prices.

Matched MeSH terms: Drugs, Essential/economics