Access to Medicines: downstream initiatives
Rachelle Harris, July 2013
Context
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Poverty reduction in poorest countries
MDGs
.7% GDP commitment by 2013
Approach to health development assistance is aimed at systems strengthening
as well as targeted results.
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
2
Priorities & Ways of Working
Value for money (rate of return, cost-benefit)
Results (line of sight)
Linking inputs to outcomes and impact
Tracking resource flows/ accountability
Creating and using performance frameworks
Innovation and improved use of technology
Building demand, creating options, widening
choice in service delivery
 Accountability to UK tax payer
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1 Palace Street, London SW1E 5HE
Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
Why DFID works on ATM
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1/3 people / c 2 billion do not have regular access to essential medicines
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Supports multiple MDG goals (4,5,6 and 8)
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Consistent with systems strengthening approach
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Improve effectiveness of existing spending (reduce costs, improve rational
use, increase impacts)
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Supports responses to diseases
1 Palace Street, London SW1E 5HE
Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
4
Strengthening Health Systems
 Active at all
points of the
medicines
value chain
• Bilateral Country Programmes
Enabling International Environment
•Market shaping: CHAI, UNITAID
•Large investments in GF, GAVI
Build markets, increase supply,
drive down price
•Patent Pools (MPP)
•Strengthening Regulatory Systems
 Activities are
led by a
number of
DFID teams
and regional
and country
office
programmes.
• Medicines Transparency Alliance
(MeTA), SARPAM
•International Financing Architecture
•Pharmaceutical Industry Good
Practice - ATM Index
•Supply security: Emerging
Powers
• Direct investment in R&D
Global Health Innovation System
• Pull Mechanisms - AMCs
• Donor coordination/multilateral approaches
• Policy collaboration
Improving the Evidence Base
• Access to Medicines Research Network
• DFID Research Strategy
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
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New era of NCDs and
Universal Health Coverage
 c. 10-40% of health budgets goes to
medicines
The proportion spent on medicines is higher in low per capita income
countries. On average 24.9 % of THE is spent on medicines*
 Will need to obtain better VfM from
medicines to stretch health budget
reach
*(WHO World Medicines Report, 2011)
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
6
Requires multiple interventions
 Health insurance coverage
 Reduced prices
 Discounts by pharma/negotiations with payers
 Volume guarantees and bulk procurement (GF,
GAVI)
 NEVL
 Donations
 Limiting mark-ups, tariffs
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
7
Other interventions
 Technology (e.g. apps) to control for
budget overruns, help negotiations,
rational use
 Better supply security – (e.g. emerging
powers)
 Quality control and assurance
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
Recent Initiatives
Pricing, Regulation, Quality
selected examples
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
Pricing: new business models
• Intra country tiered pricing: 7/20 companies*
• Inter country tiered pricing: increases across the
board (e.g. Pfizer from zero to whole portfolio)*
BUT STILL NOT ENOUGH due to perceived barriers
 Therefore: IGFAM research projects, AAWG pilots,
more comprehensive approach by payers….
* ATM Index 2012
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
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Pricing: new business models
• Innovative IP:
• MPP – 2 originator, many generics companies
• NEVLs
• GSK DCMAU – sales volume rather than revenue
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
Pricing & supply control:
knowledge is power
• Shift in balance of power: payer decisions
• Value-based/need for improved function
• Increasing need for data and analytical expertise
• NICE International
• Transparency: MeTA Peru –data is being used
to inform policy, but is also being used by the
Ministry of Health and others to improve
medicines practice
• Apps for demand forecasting, supply control and
price negotiation
1 Palace Street, London SW1E 5HE
Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
But pricing strategies need to be accompanied
by health systems improvements and better
pharmaceutical policies
 Price alone is not enough: hospital
readmissions need to decline
 Supply chain mark up and tariffs must be
addressed
 Cautions about protracted negotiations
which can drive prices upwards
 More rational approaches to pricing by
decision makers
1 Palace Street, London SW1E 5HE
Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
Contentious events and policy implications
• Quality Control / Ranbaxy scandal
• Challenge: unknown sources in supply chain
• Need for:
– ongoing strengthening of WHO PQ surveillance
– better controls on supply and demand sides
– evidence of scale of problem to generate political will
• Solutions:
– World Bank: Regulatory Harmonisation;
– Capacity bulding & testing: QUAMED and WHO PQ
– Technologies
1 Palace Street, London SW1E 5HE
Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
14
Thank you
 [email protected]
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA