The South East Asian FIP-WHO Forum of Pharmaceutical Associations (SEARPharm Forum) will soon undertake a realistic review of the drug pricing mechanisms in SEA region. The forum would initiate discussions on the national policies, pricing mechanism and control systems aimed at improving the understanding of the systems prevailing in the countries of SEA region on drug price control and monitoring. The entire exercise would be based on "Medicine Prices a new approach to measurement", the manual brought out jointly by World Health Organisation (WHO) and Health Action International (HAI).

The forum would attempt to identify the pricing structures, process for determining prices and outcome using examples of real life cases of core list of medicine prices in different set-up within a country. The forum, in association with the Maharashtra State Branch Trust and Industrial Pharmacy Division of Indian Pharmaceutical Association (IPA) is organizing a workshop in this regard, P D Sheth, professional secretary, SEARPharm Forum informed Pharmabiz.

The member countries participating in the discussions would try to understand the existing pricing structures, the common denominator - generic, branded generic, tender supplies, pack variation, company variation, etc and would tabulate the information and cases for comparison and reporting.

Information on policy, legislative/regulatory framework, patent laws situation, pricing processes and practices, outcomes in terms of pricing pattern within comparable drug/product, comparison denominators, cases of price variation of a few key drugs to address high priority morbidity areas, factors affecting price variations, like industry approaches to pricing where no regulatory framework exists, fiscal policies - taxes, duties, etc, quality standards and rational use of drugs and their impact on drug prices are all to be analyzed by the experts, he said.

"Each participating country representative will share respective country situation and information about current drug pricing. The shared information will focus on core list of medicines covering the spectrum of the disease burden. The data will relate to relative prices of innovator brand medicines and their generic equivalents, prices in different parts of the same country, relationship between procurement prices and final prices to patients, affordability of treatment for ordinary people and international differences in prices for the same medicines", he explained.

The core list includes medicines like Acyclovir tab 200 mg, Amitriptyline tab 25 mg, Amoxicillin caps/ tab 250 mg, Artesunate tab 100 mg, Atenolol tab 50 mg, Beclomettasone inhaler 50 mcg/ dose, Captopril tab 25 mg, Carbamazepine tab 200 mg, Ceftriaxone inj 1 g powder, Ciprofloxacin tab 500 mg, Co- trimoxazole paed suspension (8+ 40) mg/ mL, Diazepam tab 5 mg, Diclofenac tab 25 mg, Fluconazole caps/ tab 200 mg, Fluoxetine caps/ tab 20 mg, Fluphenazine decanoate inj 25 mg/mL, Glibenclamide tab 5 mg, Hydrochlorothiazide tab 25 mg, Indinavir caps 400 mg, Losartan tab 50 mg, Lovastatin tab 20 mg, Metformin tab 500 mg, Nevirapine tab 200 mg, Nifedipine Retard tab 20 mg, Omeprazole caps 20 mg, Phenytoin caps/ tab 100 mg, Pyrimethamine with sulfadoxine tab ( 25+ 500) mg, Ranitidine tab 150 mg, Salbutamol inhaler 0.1 mg per dose and Zidovudine caps 100 mg.

The core list, prepared by WHO-HAI, covers the most common medicines needed for diseases that affect the developing world.

In developing countries, most medicines are paid out-of-pocket by individual patients. High prices are a major barrier to the use of medicines in the region. Too little is known about prices that people pay for medicines. There are big gaps between the prices of branded generics and their generic versions. Prices vary in different parts of the same country. There are numerous factors, which influence the medicine price. For example in Nepal, albendazole 400 mg chewable tablet sells at Rs. 9 - 16 per tablet. The price of the same in the tender procurement is Rs.0.70.

In case of pharmaceuticals, in countries where no clear pricing framework exists, industries are free to set any price they are able to sell medicines. For prescription drugs, physicians are the consumers where for OTC products retailers are decision makers who decide the selection of the products on behalf-of the patients.

"Often to improve the outreach, a national government puts in place system, which decides the prices people have to pay for medicines in retail pharmacies and other medicine outlets. We have seen over the years that this concept has not fully worked. Even today, almost 60 - 70 per cent of patients have no access to Essential Medicines in the region". Sheth said.

Representatives from Indonesia, Thailand, Sri Lanka, Nepal, Maldives, Bangladesh and Bhutan are to be a part of the programme.