Centralized Procurement of Drugs in Colombia
Por: Diana González-Bravo
Do you know what centralized procurement of drugs is? Do you know where the resources come from to finance it? The centralized procurement of drugs has been adapted in Colombia initially for Hepatitis C. This first attempt opened a multisectorial controversy all around the country. Also, it served as an example for other latinamerican countries to take the same route.
What is it?
A centralized procurement of drugs is an economic mechanism in which several units of purchase negotiation, associated services and contracts in common. The Ministry of Health and Social Protection of Colombia will be responsible for the centralized negotiation and purchase of medicines (Article 88, Law 1438 of 2011), in order to guarantee the access to medicines for the Colombian population and does not ruin the financial sustainability of the health system.
The Pan American Health Organization (PAHO) developed a strategic economic fund to finance high-cost medicines (PAHO revolving Fund). In response to this demand, PAHO has incorporated into this fund the most modern and effective therapeutic alternatives for treat high prevalence diseases (e.g. Hepatitis C), with more accessible prices (OPS.org).
What’s the reason for centralized procurement of drugs?
Hepatitis C is a costly disease, which currently constitutes a challenge for health systems in the world. The Colombian ministry of health estimates that 400,000 Colombians have the virus and that 60,000 of these people will require specific treatment between 2017 and 2030*. In July 2017, the ministry of health incorporated the centralized procurement mechanism of the PAHO for the treatment of Hepatitis C. In this new scenario, the combined treatment of daklinza + sovaldi will decrease by 137.2 million to 29 million COP per person. For the treatment with harvoni, the cost per person will reduce from 114.3 million to 23.5 million COP*.
The centralized procurement will benefit a thousand Colombians and will generate a saving of 292,000 million COP for the health system in its first year of operation, which means a reduction of more than 90% with respect to the previous price. With a different mechanism for purchasing drugs, treating these patients would have required an investment of 7.8 trillion pesos in the next 14 years*.
*Information taken from: 07/24/2017 Press release No 098 of 2017, Ministry of Health and social Protection (MINSALUD). Available at: https://www.minsalud.gov.co/Paginas/Medicamentos-contra-hepatitis-C-ahora-80-mas-baratos.aspx
Resolution 1692 of 2017, which establishes the criteria for the centralized procurement, distribution and supply of medicines for Hepatitis C and the follow-up of patients diagnosed with said pathology and dictates other provisions.
How is it done? – Hepatitis C
The criteria for considering the centralized procurement of medicines for Hepatitis C not covered by the health benefits plan by the UPC are listed below (resolution 1692 of 2017):
1) Epidemiological and demographic information related to chronic Hepatitis C.
2) The recognition of services and technologies not covered by the benefit plan charged to the UPC.
3) The available scientific evidence on the effectiveness and safety of treatments.
4) The expected impact of the treatment supply.
5) The availability of resources.
Where does the money come from?
According to the article 5 of the resolution 1692 of 2017 “the centralized purchase of medicines will be carried out with charge to the resources of the sub-account of FOSYGA (Compensation of the Solidarity and Guarantee Fund) or the entity that makes its time, destined to the financing of the recoveries of services and technologies not covered by the health benefits plan that is charged to the UPC and the resources that the territorial entities have or authorize for such purpose, in accordance with the contributive or subsidized regimes”.
How are these medications prescribed, distributed and delivered?- Hepatitis C example
Once the diagnosis of Hepatitis C has been confirmed, including genotyping, the doctor will prescribe the full doses of the drugs not covered in the Health Benefits Plan charged to the UPC for treatment, in accordance with the prescription guidelines established in the Clinical Practice Guideline defined by the Colombian Ministry of health (Mipres).
See the instructive Colombian Ministry of health: Prescription of medicines for hepatitis C through Mipres
The distribution of medicines purchased by the Ministry of Health and Social Protection to members of the health system will be made through their logistics operator. The delivery to the Health Promoting Entities (EPS) will be carried out according to the cases notified and confirmed through the Public Health Surveillance System -SIVIGILA (resolution 1692 of 2017).
Whose responsibility is it?
The EPS will be responsible for: provision of health services and supervised supply of the medication, guarantee delivery and supervised daily intake by the health personnel responsible for the care, monitoring and follow-up of the patient through the IPS.
The Colombian high cost account will be responsible for consolidating, analyzing and delivering the information to the Ministry of Health and Social Protection.
Do not miss the pros and cons of centralized purchasing within 8 days.
For more information about the latest legislation in Colombia and pharmacoeconomics:
Republic of Colombia. Ministry of Health and Social Protection. Resolution 1692 of 2017.
07/24/2017 Press Release No 098 of 2017, MINSALUD. Available at:https://www.minsalud.gov.co/Paginas/Medicamentos-contra-hepatitis-C-ahora-80-mas-baratos.aspx
Ministry of Health and Social Protection. Government of Colombia. Available in: https://www.minsalud.gov.co/salud/MT/Paginas/negociacion-y-compra-centralizada-de-medicamentos.aspx
Washington, DC, February 28, 2017. (PAHO / WHO). The PAHO Strategic Fund incorporates high-cost drugs for the treatment of Hepatitis C. Available at: http://www.paho.org/hq/index.php?option=com_content&view=article&id=13001%3Apaho-strategic-fund-hepatitis-c-2017&catid=4669%3Aannouncements-hss&Itemid=39594&lang=es