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Essential Medicines 36.4 days income to buy originator branded fluoxetine Ulcer: One months treatment with lowest priced generic omeprazole 2.9 days income in Sudan and 7.7 days income in Jordan; with originator brand 10.6 days income in Morocco and 23.7 days income in PakistanNumber of days income a lowest paid government servant has to spend to buy pre-selected treatment regimes for 9 common diseases in the private sector Essential Medicines & Pharmaceutical PoliciesDHS/EMROAffordabilityNo. of days wages to purchase treatments from the private sectorDIABETES OB LPGMetformin 1.9 1.6Glibenclamide 1.4 0.9ARTHRITISDiclofenac 4.5 1.7PEPTIC ULCEROmeprazole 23.7 4.8Ranitidine 8.5 6.5DEPRESSIONAmitriptyline 1.4 -Fluoxetine 36.4 7.7RESPIRATORY TRACT INFECTION (adult)Amoxicillin 1.0 1.0Ciprofloxacin 11.3 3.0Essential Medicines & Pharmaceutical PoliciesDHS/EMROAffordability & PovertyEssential Medicines & Pharmaceutical PoliciesDHS/EMROAffordability of Atenolol: 50mg/day LPG in private sector: at the cost of USD 0.04/daynot affordable for the poorest 80% of the population at the 2.5% income threshold.CATASTROPHIC APPROACHEssential Medicines & Pharmaceutical PoliciesDHS/EMROAffordability of 4 selected medicinesProportion of population becoming impoverished because of medicine procurementIMPOVERISHMENT APPROACHEssential Medicines & Pharmaceutical PoliciesDHS/EMROThe PresentationPART 1: WHO Perspective on access to medicinesPART 2: Medicine prices and affordability in EMR & in PakistanPART 3: Medicine Pricing Policy considerationsPART 4: Conclusions & RecommendationsEssential Medicines & Pharmaceutical PoliciesDHS/EMROMedicine Pricing Policies Pricing Policies for New Chemical Entities (NME) Patent protection & access to medicines TRIPS and public health safeguards Data protection Differential pricing Cost-effectiveness analysis Pricing Policies of GenericsEssential Medicines & Pharmaceutical PoliciesDHS/EMROPricing Policies for GenericsGeneral Considerations Lifeline of local pharmaceutical industry in developing countries. Expiry of patents and introduction of generics is known to bring prices down in first year up to 40%. Pricing policies need to be developed within the context of each country. Essential Medicines & Pharmaceutical PoliciesDHS/EMROParadox of Pharmaceutical Industrial Development in Developing Countries The Case of India Claims to be the 4th largest producer of medicines in the world Exports to almost every country in the world 70% of medicines in Africa are exported from India And yet 50 to 80% of people within India do not have reliable access to needed medicines Proportion of out-of-pocket expenditure on health is highest in the world i.e. 84% A World Bank study suggests OOP medical costs alone may push 2.2% of the population below the poverty line in one year.Essential Medicines & Pharmaceutical PoliciesDHS/EMROEssential Medicines & Pharmaceutical PoliciesDHS/EMROContextual Factors Guiding Pricing Policies for Generics National vision Level of public health care coverage Level of social protection Existence and capacity of local pharmaceutical industry Regulatory capacity and effectivenessAccess to MedicinesNational Medicine PolicyMedicine PricesNational Health PolicyNational Development ObjectivesNational ConstitutionGlobalizationEssential Medicines & Pharmaceutical PoliciesDHS/EMROFive sets of policy tools for Generics for better availability, improved quality & affordable prices Policies aimed at early introduction of generics. Encouraging gene