Medicine Prices Survey in Abu Dhabi

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Medicine Prices Survey in Abu Dhabi

• Mohammed Abuelkhair, Pharm.D.
• Drug Consultant, GAHS
• Asst. Professor of Clinical Pharmacy
• The Ohio State University

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Acknowledgments
To Sahar Abu-Omar Khawla Almahri Rasha
Abu-Ali Najwa Elbhissy For their support and
contribution in completing the survey for General
Authority for Health Services for the Emirate of
Abu Dhabi
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Table of Content
Introduction
General Information
Planning
Method
Result
Discussion
Recommendation
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Introduction

• What price do people pay for key medicines?
• Do the prices and availability of the same
  medicines vary in
• different sectors public health facilities,
  private retail pharmacies
• and other medicine outlets?
• Do prices of the same medicines vary in
  different parts of a
• country?
• What is the difference in prices of innovator
  brands and generically
• equivalent medicines?
• How do procurement prices compare with
  international reference
• prices and with local retail prices?
• What taxes and duties are levied on medicines
  and what is the level of
• various mark-ups, which contribute to their
  retail prices?
• How affordable are medicines for ordinary people?

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Introduction

• Mandate from the GAHS chairman to make Medicine
  prices affordable
• New Approach of studying Medicine prices in
  collaboration with the
• WHO and Health Action International
• Standard list of medicines for comparison
• Systematic sampling process
• Use of international reference prices
• Comparison of innovator brand and generically
  equivalent medicine
• Comparisons Affordability
• Identification of the components making up the
  final price .

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General Information

• Population of The Emirate of Abu-Dhabi is about
  1 million
• Average annual salary 44 thousand dirham (120
  Dhs daily)
• Public Pharmacies are in Public hospitals and
  PHC centers
• Formulary list is available for Public hospitals
• Medicines is procured through bids, price
  agreement contracts or
• through regional GCC contracts.
• There are 53 Registered Drug distributors in
  Abu-Dhabi
• There are 300 registered Private pharmacies in
  Abu-Dhabi and Al-Ain
• and Western Region

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Overview
Text
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Overview

• Dates Survey was conducted between August to
  December of 2004
• Place of Survey Abu-Dhabi Public hospitals,
  private pharmacies
• Sample of Survey
• List contains 29 major drugs approved in the
  government and available in the private
  pharmacies.
• The list is compared with the international list.
• For each drug we compared prices of
• Brand innovative product
• Most Sold Generic
• Lowest Price Generic

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Survey Data
The international major drug list did not match
Abu Dhabi major drug list, accordingly we had to
add either equivalent drugs or different
strength. The added drugs are mentioned below
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Drug Price Lists
The following price lists were Collected
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Data Collection

• Average Drug Prices in the private sector
• Median Price Ratio (MPR) was calculated according
  to the following formula
• MPR Price in UAE / International Medicine
  Reference price
• Identifying the drug price components
• Comparing the drug price with the capability of
  worker (limited income) to purchase the drug
• Identifying the cumulative mark-ups, which is
  added to the manufacturer price and appears in
  the final selling price
• Availability of drugs in the Government central
  store and the private pharmacy store.

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Survey Results Prices
The average drug prices in private sector By
reviewing the private sector drug list, which
included around 6500 drug types. The list was
analyzed and sorted in the following table
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Survey Results Prices

• Most drugs which are available for consumers and
  costs less than 50 Dhs are not commonly
  prescribed by the physicians and least consumed
  by the patients.

• Drugs used in chronic diseases such as diabetes,
  hypertension, asthma, cholesterol are considered
  expensive to consumers with limited incomes.
• For example diabetic patient with hypertension
  and prostate need the following drugs

• Avandia for diabetes costs 200 Dhs/month
• Norvasc for hypertension costs 120 Dhs/month
• Omnic for prostate enlargement costs 155
  Dhs/month
• Total 475 Dhs/month which equals 28.5 working
  days for non-qualified worker

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Survey Results Prices
Emphasizing on the drugs reviewed in the survey,
it was found that the summary MPR of 29 medicines
in the main medicine list are
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Survey Results Prices
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Results Public Prices
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Survey Results Prices

• Average drug prices in the governmental sector
• The overall ratio for brand innovative product
  is 4.97 times the international reference price
• In the governmental sector, most sold generic
  overall ratio is 0.76 compared to International
  Reference Price
• lowest price generic is 0.68 i.e. less by 24-32
  from the free on board price.

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MPR Public vs Private

• Comparing the dug price ratios between
  governmental and private sectors
• The average price ratio of the governmental
  sector compared to the private sector was as the
  following
• Brand innovative product ratio in the
  governmental sector 4.97 whereas in the private
  sector it was 17.6, accordingly the governmental
  sector is less expensive by 354.
• Most sold generic ratio in the governmental
  sector 0.67 whereas in the private sector it was
  12.55, accordingly the governmental sector is
  less expensive by 1866.
• Lowest price generic ratio in the governmental
  sector 0.63 whereas in the private sector it was
  7.85, accordingly the governmental sector is less
  expensive by 1243.92.

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MPR Public vs Private
Diabetic Glibenclamide
Rheumatoid Arthritis Diclofenac

• The differences between the average ratios in
  brands innovative products is high (approx.
  double)
• Most sold generic and Lowest price generic ratios
  differences in the private sector is 30-40 times
  the governmental sector

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MPR Public vs Private
Comparing the actual prices in dirhams for every
100 unit from each product
Rheumatoid Arthritis Diclofenac
Diabetic Glibenclamide
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Availability of medicines

• The average availability of a random sample in
  the governmental sector was 75. In the private
  sector the average availability of the random
  sample was 72.
• It was noticed that the brand product has the
  highest market share. The lowest price generic
  market share was low, in spite of its
  availability in the pharmacies participating in
  the survey (pharmacies chosen are the biggest and
  works 24 hrs / 7 days

Drug market share from the 3 types in local market
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Treatment Affordability
The consumer is a worker with no qualifications,
his salary reaches 500 Dhs monthly i.e 16.67 Dhs
daily. Treatment cost for an illness
Brand innovative product equals 1.6 workers
salary/day in the governmental sector and 5.6
workers salary/day in the private sector. Most
sold generic and lowest price generic equals 0.4
workers salary/day in the governmental sector,
moreover they equal 3.4 and 3.6 (respectively) in
the private sector.
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Cumulative Mark-Ups
The cumulative mark-ups have been measured in the
private sector for the imported and local drugs.
This was done to measure the differences in the
cumulative mark-ups and to evaluate the effect of
different fees on the consumer. The following
table compares the imported drug in the private
market versus the local drug in governmental
price agreements.

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Local prices from international point of view

• A cost comparison was done for the drug
  Ranitidine 150mg (brand generic) in Abu Dhabi
  versus Ranitidine 150mg (brand generic) in USA.
  From the table below
• Brand innovative product in USA costs 2 time more
  than Abu Dhabi
• Generic products in Abu Dhabi cost 4-7 time more
  than USA

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Prices of Different Strengths for a Drug

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Conclusion

• The governmental sector prices are more cost
  effective.
• The private sector prices are very expensive and
  not affordable for low
• income workers.
• Brand Innovative products have high market
  share, although it is more
• expensive (high Profit). High expenses for
  consumer.
• Brand Innovative price is 20 more expensive
  than generics, and
• does not encourage consumer to use less
  expensive generic.
• Generics varies in their costs and generally the
  least expensive is the
• least sold.
• Lowest price generics are not always available
  in the pharmacy
• forcing the patient to purchase more
  expensive drugs.
• The current drug pricing formula encourage the
  pharmacist to sell the more expensive products to
  maximize his gain

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Conclusion

• Prices of the drugs manufactured locally are
  closest to the brand innovative prices, which
  discourage consumer to purchase it.
• In the private market the increase in strength
  leads to increase in
• price.
• The generic in private sector cost 500 more
  than in the
• governmental sector.
• In regard to health insurance companies, it is
  noticed that prescribing patterns are not
  different for insured and non insured patients
  with brand innovative medicines being the most
  prescribed for.

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Policy Option Line of Action

• General Authority for Health Services for the
  Emirate of Abu Dhabi has to
• Follow the policy of preferring generics
  prescribing
• Educate consumer to accept generics
• Provide incentive for pharmacies that recommend
  generics
• The availability of drugs in the governmental
  sector has to be improved slightly in-order that
  consumer will not purchase from the private
  sector which is more expensive.
• The government has to decrease the profit and
  fees, which is implemented in the private sector
  as described below.

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Recommendations
Policy Option Line of Action

• Decrease port receiving price by 7
• Review the drug prices annually and decrease the
  CIF price by 1 after every year of the drug
  registration date example drug registered for 10
  years, CIF price has to decrease 10.
• Decrease the prices of over the counter drugs
  (OTC) by 50 from the current price.
• Assistance program for low income elderly to pay
  12 or
• 15 to receive a month supply of Avandia,
  Lipitor or Symbicort.
• Stabilize currency conversion ratio by taking
  the average over 3 years before making any
  changes.
• Promote Pharmacist Academic Detailing

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Recommendations
Policy Option Line of Action

• Transfer the central store to the private sector
  to supply major drugs as a wholesaler.
• Impose 16 rebates for drugs which are patent
  drugs. Rebates can be used to provide drugs at
  minimum fee to Consumer with low income
• Develop a central computer network for private
  pharmacies to watch brand drug dispensing and
  controlling it.

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Recommendations
Policy Option Line of Action

• Require physician to write the generic name not
  the trade name in the prescription with providing
  the choice of the brand product.
• Generalize policies and logistics on drugs in
  government and private sectors example
  Clopidogrel Criteria and Cox2 Inhibitor Criteria
• The average selling price in Abu Dhabi must not
  exceed the average selling price in the Gulf
  Countries.
• Pharmacist has to inform the patient on the
  availability of different generics even if it was
  not available in his pharmacy.

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Recommendations
Policy Option Line of Action

• Educate consumers to accept generics by
  advertising campaigns and
• recommend insurance company to set policies
  and regulation to generic
• drugs.
• Develop a drug information center working 24
  hours to provide advice
• to patients by building internet website and
  free telephone services.
• This survey, which used main indicators can not
  provide the whole
• picture for pharmaceutical services in Abu
  Dhabi. But we look forward
• to taking in consideration the results and
  recommendation to improve
• medicines providing and affordability to all
  consumers.

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International Drug Price List
International drug price list
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Unit Drug Comparison Data Base
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