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The controversial centralized purchase of medicines

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By: Diana González-Bravo
MD, Epidemiologist
MBE researcher
Neuroeconomix

In Colombia, a mechanism was incorporated for the purchase of medicines called centralized purchasing. This means that, from now on, at least for Hepatitis C, the purchase of medicines for the treatment of this disease will be in charge of the Ministry of Health, and will be executed through the revolving fund of PAHO (Pan American Organization of health). Like any innovative measure, it is accompanied by benefits and difficulties in its development and implementation, which generate controversy among the different actors of the health system.

In Colombia there are approximately 400 thousand people they could have hepatitis C. With treatment, this disease can achieve cure rates higher than 95% (Hepatitis C, WHO, 2017). Between 2017 and 2030, according to figures from the Ministry of Health, 60,000 people will require treatment for this disease. In our country, the treatment for daklinza + sovaldi cost $137 million and harvoni was worth $119 million pesos. With the centralized purchasing mechanism, you could save $296,000 million in just one year *.

* Information taken from: 07/24/2017 Press Bulletin No 098 of 2017, MINSALUD. Available in: https://www.minsalud.gov.co/Paginas/Medicamentos-contra-hepatitis-C-ahora-80-mas-baratos.aspx

 

 Some advantages are mentioned below:

  • This mechanism will serve as “pilot test”For other drugs or medical devices, drugs for orphan diseases and vaccines
  • The silver The centralized purchase of medicines will be made at the expense of FOSYGA or the entity that takes its place (currently the Administrator of Resources of the General System of Social Security in Health - ADRES), through the revolving fund of PAHO (See 03 / 08/2017, Press Bulletin No. 105 of 2017, MINSALUD; Decree 1429 of 2016)
  • Drug prices will decline, improving the access of patients to this treatment, complying with the coverage SGSSS health
  • I know will reduce investment in the purchase of high-cost drugs, thereby optimizing the capital available for new purchases
  • Homogeneous and uniform purchasing processes, thereby control spending made in the purchase of medicines
  • The responsibility of the purchase process rests on a sole actor (Ministry of health and social protection)

 

As not everything is rosy, the difficulties of this methodology are seen globally in terms of little flexibility and centralization decision making. AFIDRO, which is the Association of Pharmaceutical Research and Development Laboratories, generated a document with opinion, perspective and doubts about this measure, among which the following needs that are to be met, clarified, included or executed are highlighted:

  • Medical autonomy, as long as the doctor can make decisions about the diagnosis and treatment of the patient, framed in medical ethics (article 17, resolution 1751 of 2015)
  • Equity between regimes (contributory and subsidized), in terms of access to resources for centralized purchasing, in order to reduce the gap between them in terms of coverage and financing
  • Is required expand regulations, in order to include other high cost molecules for the system
  • The prioritization methodology of medicines to be acquired through centralized purchasing. This point is linked to the expansion of the legal regulations of this mechanism.

 

These difficulties lead to improvement as soon as the centralized purchasing process is adopted, there is a multisector feedback and changes, inclusions and modifications are made in favor of the sustainability of the SGSSS.

 

Good, bad, regular? Judge 

compra centralizada 3

Not everything that shines is gold. Centralized purchasing is an effort by the government to demonstrate its interest in the coverage of treatment to the population where indicated and to save or control the expenditure of economic resources, for the sustainability of the SGSSS. It is worth noting that this mechanism has been in force for approximately 6 months, which requires improvement in its content and its provisions.

This represents an economic and financial challenge for the SGSSS and the government, however, the pilot test has worked relatively well. You have to take advantage of the fact that the door was opened.

Next week: interview with an expert in centralized purchasing.

Don't miss our next post!

References

Hepatitis C. Descriptive note, October 2017. World Health Organization- WHO. Available in: http://www.who.int/mediacentre/factsheets/fs164/es/

Republic of Colombia. Ministry of Health and Social Protection. Resolution 1692 of 2017

08/03/2017, Press Bulletin No. 105 of 2017, MINSALUD. From the first of August ADRES assumed activities of the FOSYGA. Available in: https://www.minsalud.gov.co/Paginas/Desde-el-primero-de-agosto-ADRES-asumio-actividades-del-FOSYGA.aspx

07/24/2017 Press Bulletin No 098 of 2017, MINSALUD. Available in: https://www.minsalud.gov.co/Paginas/Medicamentos-contra-hepatitis-C-ahora-80-mas-baratos.aspx

Comments AFIDRO- Centralized Purchase. January 02, 2018. https://www.afidro.org

Administrator of the Resources of the General System of Social Security in Health.  https://www.adres.gov.co/

Republic of Colombia. Ministry of Health and Social Protection. ADRES structure: Decree 1429 of 2016

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6 Comments
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Angelica Fula
3 years ago

In this case of centralized purchasing, it is clear in the regulations who is responsible for the pharmacovigilance of the drugs? If there are issues that require recall, who takes care of it?

Andres Acevedo
3 years ago

Very informative article, thank you very much!

One concern that arises to me is why PAHO functions in this case as an intermediary or rather a seller of the medicine. What is its role really and why is it able to offer the drugs at a lower cost instead of the national government doing it directly with a multinational laboratory?

juana quevedo
3 years ago

Hi !

I wanted to ask you a question on the subject: does this include the purchase of drugs for orphan diseases? or has not yet been evaluated
with this, something would change in the current legislation

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