Evaluating Drug Prices, Availability, Affordability, and Price Components: Implications for Access to Drugs in Malaysia

BackgroundMalaysia's stable health care system is facing challenges with increasing medicine costs. To investigate these issues a survey was carried out to evaluate medicine prices, availability, affordability, and the structure of price components. Methods and FindingsThe methodology developed by the World Health Organization (WHO) and Health Action International (HAI) was used. Price and availability data for 48 medicines was collected from 20 public sector facilities, 32 private sector retail pharmacies and 20 dispensing doctors in four geographical regions of West Malaysia. Medicine prices were compared with international reference prices (IRPs) to obtain a median price ratio. The daily wage of the lowest paid unskilled government worker was used to gauge the affordability of medicines. Price component data were collected throughout the supply chain, and markups, taxes, and other distribution costs were identified. In private pharmacies, innovator brand (IB) prices were 16 times higher than the IRPs, while generics were 6.6 times higher. In dispensing doctor clinics, the figures were 15 times higher for innovator brands and 7.5 for generics. Dispensing doctors applied high markups of 50%�C76% for IBs, and up to 316% for generics. Retail pharmacy markups were also high��25%�C38% and 100%�C140% for IBs and generics, respectively. In the public sector, where medicines are free, availability was low even for medicines on the National Essential Drugs List. For a month's treatment for peptic ulcer disease and hypertension people have to pay about a week's wages in the private sector. ConclusionsThe free market by definition does not control medicine prices, necessitating price monitoring and control mechanisms. Markups for generic products are greater than for IBs. Reducing the base price without controlling markups may increase profits for retailers and dispensing doctors without reducing the price paid by end users. To increase access and affordability, promotion of generic medicines and improved availability of medicines in the public sector are required.背景：马来西亚稳定的医疗保健体系正面临医药成本持续攀升的挑战。为探究此类问题，本研究开展了一项调查，以评估药品价格、可及性、可负担性及价格构成结构。 方法与结果：本研究采用了世界卫生组织（World Health Organization，WHO）与国际健康行动组织（Health Action International，HAI）开发的研究方法。研究人员从马来西亚西部四个地理区域的20家公立医疗机构、32家私营零售药店以及20家配药诊所收集了48种药品的价格与可及性数据。将药品价格与国际参考价格（international reference prices，IRPs）进行对比，以计算中位价格比值。本研究采用最低工资的非技术政府雇员的日薪来衡量药品的可负担性。在整条供应链中收集价格构成数据，并明确了加价幅度、税费及其他分销成本。 在私营药店中，原研品牌（innovator brand，IB）药品的价格为国际参考价格的16倍，仿制药则为6.6倍；在配药诊所中，原研品牌药品的价格为国际参考价格的15倍，仿制药为7.5倍。配药诊所对原研品牌药品的加价幅度达50%~76%，仿制药加价幅度最高可达316%。零售药店的加价幅度同样较高：原研品牌药品的加价幅度为25%~38%，仿制药则为100%~140%。在公立医疗机构中，尽管药品免费，但即使是国家基本药物目录（National Essential Drugs List）内的药品，其可及性也较低。在私营部门，患者接受为期一个月的消化性溃疡病与高血压治疗，需支付约相当于一周薪资的费用。 结论：顾名思义，自由市场无法对药品价格进行有效管控，因此有必要建立价格监测与调控机制。仿制药的加价幅度高于原研品牌药品。若仅降低基础价格而不管控加价幅度，可能只会增加零售商与配药诊所的利润，而无法降低终端用户的实际支付价格。为提升药品可及性与可负担性，需推广仿制药并改善公立医疗机构的药品供应情况。