The reality of drug prices in Latin America

Valentina Jaramillo

Investigacion Clinica Latam

Valentina Jaramillo addresses the problem of increased drug costs in Colombia and the resultant problem of reduced patient access to medication.

Latin America consists of several different countries in which market price drug regulations differ significantly from one to another. In this article, I will discuss the situation in Colombia, since it’s one of the countries where medications are the most expensive. Other countries will be used as examples with which to compare Colombia’s situation and try to understand how the situation is to be solved without extreme damage to the pharma companies.

In Colombia, access to medication is extremely difficult due to high prices. For example a study compared the price of Plavix® in Colombia with Venezuela and it was seen that for fourteen tablets of Plavix® 75mg, a patient is charged US$ 90 in Colombia, while the same box costs a patient in Venezuela US$ 29. This is a really big difference and it gets worse when we consider that the generic for Plavix®, Clopidogrel, is only US$ 5 dollar. This is a reasonable price but most doctors in these areas do not prescribe generics and most people do not know they exist.

This situation has being going on for a long time already and it’s becoming worse every day. Like Plavix®, there are many other examples and as a result, of every 10 people who go to a pharmacy to get their prescription, seven leave empty handed because they cannot afford their prescription.

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“…for fourteen tablets of Plavix® 75mg, a patient is charged US$ 90 in Colombia, while the same box costs a patient in Venezuela US$ 29.”

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In November 2010, the Ministry of Social Protection set out an order in council # 4474 / 2010 to try and set maximum prices for all medications not listed in National Therapeutic Form. This did not solve the conflict and presented a huge problem for the pharma industry, which kept arguing that the reason the prices are high is because it’s the only way to recover costs from research and development. The tension between Government and pharmas increased.

The problem became a big political issue that called for extreme measures. The whole National Pharmaceutical Policy needed to be revised in order to reach a solution. Last 23rd of April Colombia’s Ministry of Health and Social Protection sent out a draft of the national Pharmaceutical Policy showing the real and crude truth about the problems of the pharma industry, it examined the different price and quality models of medications and most importantly it stated several strategies to help overcome the problem.

The big surprise is that this draft document shows a huge increase in Colombia’s public health expenditure, it has grown 45% between 2006 and 2010, and yet still more people are not being able to access their medications. The project is trying to find out why, even though the Government is giving the resources and the market is continuing to grow, a large percentage of patients don’t have access to their prescriptions.

What seems to increase the problem is the way the healthcare system works. Private healthcare companies are supposed to make the drug available at a lower cost to their affiliates and then get reimbursed by the Government. At the moment, there are several of these companies and Government employees and ex Government employees being investigated for lack of transparency in the reimbursement procedure.

Now that the Ministry of Health has a clear diagnosis of the problem it can start working on possible strategies to make the whole healthcare system work better by including a serious and well-developed Pharmaceutical Policy that can help modify the complete healthcare system in order to give better opportunities and treatments to the Colombian population.

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“…of every 10 people who go to a pharmacy to get their prescription, seven leave empty handed because they cannot afford their prescription.”

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It looks really simple but the real controversy is going to be with the pharmaceutical industry in the price regulation. Once the new policy is approved the drugs under a pharma monopoly are going to be strictly monitored, both nationally and internationally, and whenever the Government finds public health reasons it will be able to do centralized negotiations or even adjust the prices.

As we can see this is a public problem, which needs the involvement of all different actors in the healthcare system in order to reach a solution to meet the needs of the patients whilst also allowing pharma to continue their business. In conclusion, it’s clear that a great challenge lies ahead for Colombia, which started with high prices for medications that went on to expose problems in the overall healthcare system. The strategy that Colombia chooses definitively needs to include a serious Pharmaceutical Policy which protects both patients and pharma companies at the same time. The first step has been achieved with the draft document and now the pharma industry needs to do their share to remember that they are not the only ones who need to benefit but we need to reach a win-win situation for patients as well.

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About the author:

Valentina Jaramillo DVM is co-founder of Investigacion Clinica Latam. She is also founder and moderator of the twitter hashtag #hcsmla. She can be contacted at vale.jaramillo@gmail.com.

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