Access to essential
medicines for NCDs
WHO EMP and NVI Departments
1|
Essential Medicines Technical Briefing Seminar
Access to NCD essential medicines
on the global agenda
 Access to chronic disease medicines is required for the
fulfilment of MDG8
– Governments, in collaboration with the private sector, should give greater
priority to treating chronic diseases and improving the accessibility of
medicines to treat them (MDG Report 2009)
 Political declaration at the UN General Assembly, Sept 2011
(A/66.1, 45l)
 WHA 2013:Endorsement of a Global Action Plan for the
Prevention and Control of Non-communicable Diseases
(NCDs) focusing on cardiovascular diseases, diabetes,
CRDs and cancer including palliative care
2|
Essential Medicines Technical Briefing Seminar
Global Action Plan and Monitoring Framework
3|
Essential Medicines Technical Briefing Seminar
Target 9
 80% availability of basic health technologies and essential medicines
including generics required to treat major NCDs in both public and
private facilities
 Achieved in many LMICs for vaccines, TB and malaria medicines,
ARVs
 In 40 LMICs, availability of generic essential medicines in public and
private sector (Cameron et al, 2011)
– For treatment of acute communicable diseases: 53.5% public, 66.2% private
– For chronic diseases: 36% public, 54.7% private facilities
 Costs of chronic medicine treatment can incur catastrophic health
expenditure, pushing the family below the poverty line… however
many of the commonly used medicines are out of patent and relatively
cheap
4|
Essential Medicines Technical Briefing Seminar
What do NCD medicines cost without tariffs,
taxes and mark-ups?
Product
Units per
month
Median Unit
Cost
Monthly cost
Source
Glibenclamide 5mg tab
30
$ 0.0034
$ 0.102
MSH 2010
Metformin 500mg tab
60
$ 0.0105
$ 0.630
MSH 2010
Insulin NPH 100IU/ml 10ml
1
$ 4.20
$ 4.20
MSH 2010 (Buy)
Salbutamol inh 100mcg
200 doses
1
$ 1.08
$ 1.08
ADF 2011
Beclometasone inh
100mcg 200 doses
1
$ 1.28
$ 1.28
ADF 2011
Aspirin (ASA) 100mg tab
30
$ 0.0019
$ 0.0057
MSH 2010
Simvastatin 20mg tab
30
$ 0.0286
$ 0.858
MSH 2010
Hydrochlorothiazide 25mg
tab
30
$ 0.0037
$ 0.111
MSH 2010
Atenolol 50mg tab
30
$ 0.095
$ 0.285
MSH 2010
Tamoxifen 20MG tab
30
$ 0.0732
$ 2.196
MSH 2010
Main sources: MSH International Drug Price Indicator Guide 2010 and ADF Catalogue 2011
5|
Essential Medicines Technical Briefing Seminar
Challenges with NCD medicines
 Oral medicines available as generic multisource products (Metformin,
Aspirin, Hydrochlorothiazide, Tamoxifen) – cheap on the international market
but not always available where patients need them, quality problems
 Inhalers for asthma/COPD and insulin – available but more expensive and
more sophisticated to produce and to use. For insulin, limited number of
manufacturers, domination of the market by few pharmaceutical companies
and specific conditions for distribution.
 Some products still under patent and only accessible through large access
programs from pharmaceutical companies, variable access for population.
 Opioid analgesics: efficacious and at affordable costs, necessary for
palliative care, not largely available due to legislative/regulatory barriers.
93,8% of all licit morphine consumption by 21,8% of the world population
(INCB 2010, Data for 2009)
6|
Essential Medicines Technical Briefing Seminar
Availability of asthma inhalers
Babar ZU, Lessing C, Mace C, Bissell K. The availability, pricing and
affordability of three essential asthma medicines in 52 low- and middle income
countries. Pharmacoeconomics. 2013;31(11):1063-82.
7|
Essential Medicines Technical Briefing Seminar
Prices of insulin per 10ml 100 IU vial
Beran D, Yudkin JS. Looking beyond the issue of access to insulin: what is needed for proper diabetes care in resource poor settings. Diabetes Res Clin Pract.
2010;88(3):217-21
8|
Essential Medicines Technical Briefing Seminar
Affordability and availability of insulin
in the public sector to the individual
HI = Health Insurance 40% of interviewees had health insurance
IfL = Insulin for Life – supplies two of the three main paediatric hospitals in Vietnam
Beran D, Yudkin JS. Looking beyond the issue of access to insulin: what is needed for proper diabetes care in resource poor settings. Diabetes Res Clin Pract.
2010;88(3):217-21
9|
Essential Medicines Technical Briefing Seminar
Access to essential medicines
A Framework for action
1. Rational
selection
3. UHC and Sustainable
financing
ACCESS
2. Affordable
prices
10 |
Essential Medicines Technical Briefing Seminar
4. Reliable
health and
supply
systems
Options to improve the situation
 Rational selection
– Standard Therapeutic Guidelines including evidence-based selection of
medicines (NEML based on recommendations from WHO Expert
Committee on Selection and Rational Use and PEN guidelines)
– Alignment of NEML and STGs as a basis for procurement, reimbursement
and training of staff
– Promotion of the use of STGs and NEML by health care professionals
and proper training of staff on STGs
 Financing and Universal Health Coverage
– Increase government budget to ensure widespread access to a reduced
number of NCD essential medicines
– Expand coverage/health insurance and ensure NCD essential medicines
are part of the essential package covered
11 |
Essential Medicines Technical Briefing Seminar
Options to improve the situation
 Price
– Competition, promotion of generics, transparent procurement procedures,
substitution, reduce duties/taxes and mark-ups, monitoring prices
– For single source products or under patent, apply WTO/TRIPS flexibilities
and use available differential pricing
 Reliable Supply systems
– Supply quality-assured products: reinforce NRAs and limit SSFFC
products in the supply chain, increase confidence of prescribers in
generic products
– Improve quantification of needs and forecasting using good information
systems
– Reinforce private and public supply chains
12 |
Essential Medicines Technical Briefing Seminar
Perspective and Role for WHO/EMP
 Sensitize countries and partners to the barriers for access to essential
medicines and health technologies for NCDs
 Develop and promote monitoring tools to document the situation, to
identify priority interventions and measure improvements in access over
time
 Update WHO Model List of Essential Medicines to address NCD issues
(e.g. cancer section)
 Update and promote use of National Standard Therapeutic guidelines
 Continue the country support to strengthen NRAs and supply systems
and develop relevant policies (including pricing policies)
 Support global and regional initiatives for information sharing on
medicines prices and availability
13 |
Essential Medicines Technical Briefing Seminar
Recent Global Initiatives
 Global Coordination Mechanism – Working Groups on
NCDs
– Active private sector participation
– Innovative financing for NCDs
 UN Inter Agency Task Force on NCDs
– 42 working teams – access to essential medicines for NCDs
being one of them
 WHO working plan – Discussion Paper
– Action points for WHO and Member States on NCD medicines
– To be peer-reviewed and posted on website for public
comments before the end of the year
14 |
Essential Medicines Technical Briefing Seminar
THANK YOU