Access to Medicines: downstream initiatives
Rachelle Harris, July 2013

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Poverty reduction in poorest countries
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MDGs
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.7% GDP commitment by 2013
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Approach to health development assistance is aimed at systems strengthening as well as targeted results.
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 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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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA

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1/3 people / c 2 billion do not have regular access to essential medicines
Supports multiple MDG goals (4,5,6 and 8)
Consistent with systems strengthening approach
Improve effectiveness of existing spending (reduce costs, improve rational use, increase impacts)
Supports responses to diseases
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 Active at all points of the medicines value chain
 Activities are led by a number of
DFID teams and regional and country office programmes.
Strengthening Health Systems
Enabling International Environment
Build markets, increase supply, drive down price
Global Health Innovation System
• Medicines Transparency Alliance
(MeTA), SARPAM
• Bilateral Country Programmes
• Market shaping: CHAI, UNITAID
• Large investments in GF, GAVI
• Patent Pools (MPP)
•Strengthening Regulatory Systems
•International Financing Architecture
•Pharmaceutical Industry Good
Practice ATM Index
• Supply security: Emerging
Powers
• Direct investment in R&D
• 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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 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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 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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 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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selected examples
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• 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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• Innovative IP:
• MPP – 2 originator, many generics companies
• NEVLs
• GSK DCMAU – sales volume rather than revenue
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• 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
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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
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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
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Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA
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 Rachelle-harris@dfid.gov.uk
1 Palace Street, London SW1E 5HE
Abercrombie House, Eaglesham Road, East Kilbride, Glasgow G75 8EA