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Paying the PricePaying the Price

Margaret EwenMargaret EwenHealth Action International Europe

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Public sector Procurement price

Public sectorPatient price

Originator Generic Originator Generic

captopril 25mg tab

Kenya (2001) 12 4.17

Morocco (2004) 37.65 12.80 free free

Indonesia (2004) - 1.35 21.80 1.69

Mongolia (2004) - 1.58 - 2.89

phenytoin 100mg cap

Indonesia (2004) - 2.19 - 21.46

glibenclamide 5mg tab

Chad (2004) - 1.29 - 4.49

Median price ratios, public sectorMedian price ratios, public sector

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Median price ratios, atenolol 50mg tab,Median price ratios, atenolol 50mg tab, private retail pharmaciesprivate retail pharmacies

0 20 40 60 80

Uganda (2004)

Kuwait (2004)

Lebanon (2004)

India/Chennai (2004)

Indonesia (2004)

Median Price Ratio

Lowest Priced Generic

Originator Brand

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Public sector Private sector

Originator Generic Originator Generic

Chad (2004) 4% 0% 18% 0%

Maharashtra (2005) 0% 0% 0% 10%

Mongolia (2004) 0% 0% 0% 4%

Philippines (2002) 15% 0% 9% 1%

Indonesia (2004) 0% 0% 2% 0%

Morocco (2004) 25% 65% 5% 50%

Availability: beclometasone inhaler 50mcg/doseAvailability: beclometasone inhaler 50mcg/dose

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0 10 20 30 40 50 60

Uganda

Peru

Jordan

Indonesia

China: Shandong

Armenia

Number of Days' Wages

Lowest Priced Generic

Originator Brand

Affordability: fluoxetine 40mg tab/day Affordability: fluoxetine 40mg tab/day 30 days treatment, private retail pharmacies30 days treatment, private retail pharmacies

96»

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EML

AvailabilityPublic sector

facilities

Originator Generic

Uganda (2004) yes 0% 0%

Mali (2004) yes 0% 0%

Indonesia (2004) no 13% 0%

AffordabilityPrivate retail pharmacies

Originator Generic

5.6 days 2.0 days

4.2 days 2.7 days

4.1 days -

salbutamol inhaler 0.1mg/dose: salbutamol inhaler 0.1mg/dose: availability vs affordability availability vs affordability

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Taxes on MedicinesTaxes on Medicines

Tajikistan (private sector, imported medicine)

VAT 20% Customs duty 5% Tax 1-5%+ transport charges, wholesale & retail mark-ups

Eliminate taxes: cumulative mark-up 123% → 74%

Peru (private sector, imported medicine)

VAT 12%, IGV 19%, Municipal promotion tax 2%+ insurance, import, wholesale & retail mark-ups

Eliminate taxes: cumulative mark-up 238% → 149%

IndonesiaVAT 10% - charged twice

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Public sector component costsPublic sector component costs

Chad (official rates for generics)• Statistics tax 2%• Central Medical Store mark-up 16%• Regional Medical Store mark-up 25%• Health facility mark-up 30%Cumulative mark-up: 92%

Peru• VAT 12%, IGV 19%, Municipal promotion tax 2%• Insurance 2%• Importers mark-up 20%• Health facility mark-up 25%Cumulative mark-up: 108% (some medicines/programmes 40%)

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Generic (patient price: 24 RM)

4: Retail 50%

3: Wholesale 3%

2: Landed 7%

1: MSP, CIF 40%

Originator (patient price: 72 RM)

1: MSP, CIF 56%

2: Landed 11%

3: Wholesale 13%

4: Retail 20%

Malaysia: atenolol 50mg tab Malaysia: atenolol 50mg tab private retail pharmaciesprivate retail pharmacies

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4: Doctor 44%

3: Distributor 6%

2: Landed 7%

1: MSP, CIF43%

Malaysia: atenolol 50mg tab Malaysia: atenolol 50mg tab dispensing doctorsdispensing doctors

1: MSP,CIF 30%

2: Landed 5%

3: Distributor 5%

4: Doctor 60%

Generic (patient price 32 RM)

Originator (patient price 94.29 RM)

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