What are essential medicines and who should pay for them, especially in lower-income countries?
Those questions and others were studied by The Lancet’s Commission on Essential Medicines Policies and explored in a series of articles published recently in the London-based medical journal. Findings from the Global Burden of Disease (GBD) served as a vital resource in the commission members’ discussion, debates, and deliberations, especially regarding estimating cost.
“In estimating the cost of providing a basic package of essential medicines in low-income and middle-income countries, we used a combination of disease prevalence, current or projected consumption, or both to estimate drug demand,” said Commissioner Prashant Yadav, a Senior Fellow at the William Davidson Institute at the University of Michigan and Visiting Scholar at Harvard Medical School. “The data for disease prevalence we used was primarily from GBD and played a critical role in developing the costing model.”
Indeed, that costing model ranges from $13 to $25 per person per year for the so-called basic package of 201 essential medicines for people in low- and middle-income countries. This equates to global price tag of $77.4 to $151.9 billion annually.
Regrettably, the Commission’s report notes that, “in 2010, the majority of low-income countries and 13 out of 47 middle-income countries, spent less than $13 per capita on pharmaceuticals. Thus, the Commission confirmed that many people worldwide do not have access to even a limited basket of essential medicines.”
To help address such disparities, the Commission recommends the following:
- Governments and national health systems must provide adequate financing to ensure inclusion of essential medicines in the benefit packages provided by the public sector and all health insurance schemes.
- Governments and national health systems must implement policies that reduce the amount of out-of-pocket spending on medicines.
- The international community must fulfill its human rights obligations to support governments of low-income countries in financing a basic package of essential medicines for all, if they are unable to do so domestically.
- Governments and national health systems must invest in the capacity to accurately track expenditure on medicines, especially essential medicines, in both the public and private sectors, disaggregated between prepaid and out-of-pocket expenditure, and among key populations.
That issue of tracking costs and expenditures on medicines is also a concern of Dr. Yadav, a researcher, educator, and policy advisor in the area of health care supply chains.
“There is very limited data to track medicines expenditure in low-income and middle-income countries,” he said. “At best we know gross aggregate figures on total pharmaceutical expenditure, but without clearly understanding pharmaceutical expenditure by sector and payment method, it is challenging to identify best levers for improving access and efficiency. Similarly, data on prices paid by patients or payers is only available through one-off surveys and there is no systematic collection of such data.”
In addition to financing medications, there are four other policy recommendations the Commission makes for countries to address to help ensure “equitable access to affordable, quality-assured essential medicines is to be achieved.” Those four are making medicines affordable, ensuring quality and safety, promoting quality use, and developing missing essential medicines. Also, throughout the report, there are three cross-cutting themes: equity of access, strengthening institutions, and promoting accountability.
In a comment accompanying the article on the Commission’s findings, Lancet Editor Richard Horton and Senior Editor Pamela Das contend:
“Publication of this Commission comes at what we hope will be an opportune moment – the beginning of an era of sustainable development. Sustainable Development Goal 3.8 calls for universal health coveragex7UN. Sustainable Development Goals. https://www.un.org/sustainabledevelopment/sustainable-development-goals/; 2015. ((accessed Oct 19, 2016).)
See all References7 and this report provides a roadmap to assist countries in achieving that important objective. A next step will be to bring together all those with an interest in essential medicines, and to move beyond historical and organisational differences with pragmatism and transparency. Now is the right moment to find timely solutions to ensure equitable access to affordable, quality-assured essential medicines.”
For more information, see the Commission’s report and other related articles at http://www.thelancet.com/commissions/essential-medicines.
