By:Angela Perez
Epidemiologist
Researcher in public policy in health
One of the critical aspects in the Health Systems is off the access to drugs, but this topic is hindered by many reasons including drug prices, quality, availability, and affordability. When the drugs access is inequity maybe is a symptom that the Health System has problems and can be a signal of a governmental failure (1).
Countries with low and mid-level incomes are faced with a challenge related to the budgets and financing of health care, derived from the epidemiological changes, fluctuations in morbidity rates, the uprising of universal coverage, necessities and expectations of the population, as well as the emergence of new health care technology, with higher costs (2)
Based on this, various governments have incorporated a critical evaluation of these technologies, the result of which information is needed to decide what to finance and how much to pay. Besides that, methodologies to determine the price and make decisions related to coverage and effective allocation of resources have been incorporated.
Countries with high incomes have adopted mechanisms to control and regulate pricing. South America has followed this tendency and policies focused on effective regulation of pharmaceutical pricing have been developed, be it through direct regulation or buying or acquisition mechanisms. Some experiments like in Mexico show significant savings on public costs based on drug pricing regulation. Likewise, there are other mechanisms that allow (more) effective use of resources, when it comes to stakeholders in the system, directly related to the mentioned strategies, for example, the development and use of guides for clinical practice and integral assistance routes. These strategies combined are a mechanism to resolve complex problems which focus on improving the results of the health care system from a perspective of resource efficiency, the quality of service and the impact of this service on the health of the people and populations (3)
Centralized purchasing in Colombia Health System
Currently, the Colombian General System of Social Security and Health has sector-based policies focused on improving access, system efficiency and a healthier population. An example of such policies is the incorporation of the need to define a PAIS and its operational framework, the Integral Health Care Policy (MIAS), and the centralized buying of medication strategy in the National Development Plan, considering the Enacting Health Law that consecrates health care as a fundamental autonomous right, guarantees its provision, regulates it and establishes its protection mechanisms. Derived from the current laws, the Health System developed and currently implementing the PAIS and the MIAS, and in the same way, did the first centralized purchase of medications for the treatment of chronical hepatitis C, and the development of a comprehensive clinical pathway and a clinical practice guideline for people with this condition.
The high cost is one of the main limitations of new drugs for the treatment of hepatitis C virus (HCV). As a key immediate response, the World Health Organization has already included direct-acting antivirals in domestic essential medicines lists for globally, and fast-tracking domestic drug approvals to facilitate government-level price negotiations with pharmaceutical companies. Urgent action by a broad range of stakeholders is needed to facilitate access to HCV treatment to ensure that the millions of people living with this disease may effectively access to life-saving treatments(4,5)(6)
In Colombia, estimates of the prevalence of HCV in the overall population are limited. However, the Center for Disease Analysis estimated a prevalence of active infections between 0.66%, which would correspond around 325.000 people (6). Nevertheless, the country data varies significantly between different sources, for instance, the Colombian National Health Information for Social Protection (SISPRO for its acronym in Spanish), Epidemiological Surveillance (SIVIGILA), drugs prescriptions (Mipres) and Health Financing data. (6). Due to the above, the country is aware of the lack of information that limits the reliability and scope of the available data.
Nevertheless it was clear that the Colombian Health System had a barrier to drug access for the treatment for Hep C because the price in Colombia was higher compared to the prices in the region countries (Brasil, Argentina) (7). Nested to the high costs, the new treatment technologies have an effectiveness near 95%, and better safety profile compared to the available treatment; these factors were the main arguments to improve drug access in the population with Hep C. For that reason, the Ministry of Health decided to initiate a centralized purchasing.
The mechanism to do this purchasing were through the Strategic Fund of the Pan American Health Organization (PAHO). Whit this mechanism the Colombia Health System got significant reductions in drug prices (up to 80% in some cases)(6).
Centralized purchasing is an comprehensive strategy because it considered the prices negotiation, delivery, logistics chain, monitoring, and clinical and economic assessment.
Regarding this strategy, the evidence is clear to a conclusion that implementation of only one mechanism is not enough to reduce permanently the drug prices and improve drug access (1), but Colombian Health System implemented an innovative and comprehensive strategy to try to solve a public health problem. It is important and represents a challenge for the Health System to take advantage of this type of strategies, expand them and make use of others to improve access to medicines, quality in health and health outcomes in other diseases, for example, orphan diseases and cancer.
1. Abdel Rida N, Mohamed Ibrahim MI, Babar Z-U-D, Owusu Y. A systematic review of pharmaceutical pricing policies in developing countries. J Pharm Heal Serv Res . 2017;8(4):213–26. Available from: http://doi.wiley.com/10.1111/jphs.12191
2. Bigdeli M, Peters DH, Wagner AK. Medicines in Health Systems.
3. Chalkey M, Malcolmson J. Government Purchasing of Health Services. Handbook of health economics. AJ Culyer JP Newhouse . 2000;1. Available from: papers3://publication/uuid/8A790FC4-20F2-408B-8D21-47AE57573EB0
4. Health G, Strategy S, Ending T, Hepatitis V. WHO: Viral Hepatitis 2016-2021. 2016;(June).
5. Walsh N, Durier N, Khwairakpam G, Sohn AH, Lo Y-R. The hepatitis C treatment revolution: how to avoid Asia missing out. J virus Erad. 2015;1(4):272–5.
6. Juan Carlos Rivillas; Ornella Moreno-Mattar; Hector Eduardo Castro; Angela Viviana Pérez; Carlos Mario Ramirez; Alejandro Gaviria Uribe. Strategic purchasing in the medicines to Hepatitis C in Colombia: equity and health financing innovations. Porter No. 33. World Hepatitis Summit. 2017. Brazil.; 2017.
7. Castro Jaramillo HE. SOCIALIZACIÓN DE LINEAMIENTOS PARA LA IMPLEMENTACIÓN DE LA RESOLUCIÓN 1692 DE 2017 . 2017. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/MET/lineamientos-resolucion-medicamentos-hepatitisc-2017.pdf
