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Centralization in the purchase of medicines,
a mechanism that strengthens the health system


Angela Perez
Researcher in public health policies

One of the critical aspects of health systems has to do with access to medicines; quite difficult subject due to variables such as prices, quality, availability and affordability of the same. When access to medicines is difficult due to inequity, this fact can be read as a symptom that the Health System has problems and can even be a clear sign of a government failure (1).

Low- and middle-income countries face a challenge associated with financing health care, derived from epidemiological changes, fluctuations in morbidity rates, the rise in universal coverage, the needs and expectations of the population. , as well as the appearance of new health technologies, with higher costs (2).


On this basis, several governments have incorporated a critical evaluation of these technologies, as a result of which the necessary information is obtained to decide what to finance and how much to pay. In addition, methodologies have been incorporated to determine the price and make decisions related to coverage and the effective allocation of resources.


High-income countries have adopted mechanisms to control and regulate drug prices. Latin America has joined this trend and has developed policies focused on the effective regulation of drug prices, either through direct regulation or through purchase or acquisition mechanisms. Some experiments, such as in Mexico, show significant savings in public costs based on drug price regulations. Likewise, there are other mechanisms that allow the efficient use of resources, when it comes to the actors of the system, directly associated with the aforementioned strategies, for example, the development and use of guidelines for clinical practice and care routes integral. These combined strategies are a mechanism to solve complex problems that focus on improving the results of the health care system from the perspective of resource efficiency, quality of service, and the impact of this service on people's health. and populations (3).


Centralized purchasing of the health system in Colombia


Currently, the General System of Social Security and Health in Colombia has sectoral policies that focus on improving access, the efficiency of the system and having a healthier population. An example of this policy is the incorporation of the need to define a Comprehensive Health Care Policy (PAIS) and its operational framework, as well as a Comprehensive Health Care policy (MIAS), and a centralized drug purchase strategy in the National Development Plan. The aforementioned, considering the enactment of the Health Law that establishes health care as a fundamental and autonomous right, offers guarantees for its granting, and establishes its protection mechanisms. Derived from current legislation, the health system has developed and is applying the PAIS and MIAS and, in the same way, made the first centralized purchase of drugs for the treatment of chronic hepatitis C and the development of a broad trajectory clinic, and a clinical practice guide for people with this condition.


The high cost is one of the main limitations of the new drugs for the treatment of hepatitis C (HCV). As an immediate response, the World Health Organization has already included direct-acting antivirals on national essential drug lists to obtain global, fast-track approvals that make it easier for the government to negotiate prices with pharmaceutical companies. Urgent action is needed by a wide range of stakeholders to facilitate access to HCV treatment so that millions of people with this disease can effectively access lifesaving treatments (4,5 ) (6)


In Colombia, estimates of the prevalence of HCV in the general population are limited. However, the Center for Disease Analysis estimates a prevalence of active infections at 0.66%, which would represent around 325,000 people (6). However, the country data vary significantly depending on the source; for example, the Social Protection Information System (SISPRO), the National Public Health Surveillance System (SIVIGILA), the drug prescription system (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.


In any case, it was clear that the Colombian health system had a barrier to access medicines for the treatment of hepatitis C because the prices were higher compared to prices in other countries in the region (Brazil, Argentina) ( 7). New technologies for treatments have an efficacy close to 95%, and a better safety profile compared to previous treatments, these factors were the main arguments to improve access to medicines for the population with hepatitis C. For this reason, the Ministry of Health decided to make a centralized purchase.


The mechanism to make this purchase was through the Strategic Fund of the Pan American Health Organization (PAHO). With this mechanism, the Colombian health system achieved significant reductions in drug prices (up to 80% in some cases) (6).


The centralized purchasing system is a comprehensive strategy because negotiation prices, delivery, logistics chain, clinical and economic monitoring and evaluation were taken into account.


Regarding this strategy, the evidence is clear when it comes to the conclusion that implementing a single mechanism is not enough to permanently reduce drug prices and improve access to them (1), but the Colombian health system implemented a comprehensive and innovative 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 and make use of other strategies to improve access to medicines, the quality of health services and the results obtained to treat other diseases. for example, cancer and orphan diseases.


1. Abdel Rida N, Mohamed Ibrahim MI, Babar ZUD, Owusu Y. A systematic review of pharmaceutical pricing policies in developing countries. J Pharm Heal Serv Res [Internet]. 2017; 8 (4): 213–26. Available from: http://doi.wiley.com/10.1111/jphs.12191 Bigdeli M, Peters DH, Wagner AK. Medicines in Health Systems.

2. Chalkey M, Malcolmson J. Government Purchasing of Health Services. Handbook of health economics. AJ Culyer JP Newhouse [Internet]. 2000; 1. Available from: papers3: // publication / uuid / 8A790FC4-20F2-408B-8D21-47AE57573EB0

3. Health G, Strategy S, Ending T, Hepatitis V. WHO: Viral Hepatitis 2016-2021. 2016; (June).

4. Walsh N, Durier N, Khwairakpam G, Sohn AH, Lo YR. The hepatitis C treatment revolution: how to avoid Asia missing out. J virus Erad. 2015; 1 (4): 272–5.

5. 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.

6. Castro Jaramillo HE. SOCIALIZATION OF GUIDELINES FOR THE IMPLEMENTATION OF RESOLUTION 1692 OF 2017 [Internet]. 2017. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/MET/lineamientos-resolucion-medicamentos-hepatitisc-2017.pdf

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