Archive for August, 2006

on MDG 15 and Affordable Medicines

Posted on August 25, 2006. Filed under: Resources |

This MDG target talked about providing access to affordable essential drugs, but the report delved more about the prices going down 60.9% which was beyond the 50% target, through the GMA 50 program. While such effort is commendable and should be sustained further, the more relevant question to ask is whether the lower prices enabled more segments of the population to get access to drugs. The report noted only 66% of the country’s population had access to essential medicines, which is a 1999 figure – with the current period taken into account by the report, did that figure increase or decrease ? We do not know and the report preferred not to delve into it, perhaps the figures have shown a worsening trend towards lack of access.

The report discussed the conduct of parallel drug imports as a means to reduce drug prices, but did it say how much money was actually provided for this? As far as sources gathered by AGAP will show, the money for this program, which may reach up to P 500 million this year 2006, is not even enough to create a dent in a market which has a total market value of around Php 80-100 billion. Thus, the worry is that this program will not create even a ripple, and even the 800 Botika ng Barangays set up is a not even a drop in a bucket in a country with over 40,000 barangays, no matter how strategically located they may be in giving access to medicines to the ordinary hard-up citizen buffeted by spiraling costs not only of medicine but in all basic commodities resulting from the almost-weekly oil price increases which the government is not doing something about.

But aside from the magnitude or the lack thereof of this parallel import program, a way to make it sustainable has not been discussed by the report, which is through an amendment of the Intellectual Property Code of the Philippines (Republic Act 8293)  by way of removing the national exhaustion of patent rights principle in its sec. 72.1 and replacing it with an international exhaustion of patent rights principle such that groups who wish to buy branded medicines in countries where their comparative prices are lower, such as India and Pakistan, will not be stopped by the same patent holders in the Philippines claiming that their patent rights are not being respected. With this international exhaustion of patent rights principle in place, it means that the rights of the patent holder are already used up once the patented product is bought from elsewhere outside the Philippines.

The Philippines can very well adopt this principle as this is what is also provided by the Doha Declaration on TRIPS and Public Health which the Philippines also signed on to in Doha, Qatar in November 2001, during the 3rd  WTO Ministerial Conference held around that time.

One final point, as the Philippines seeks a partnership with the drug companies, it should make clear to these companies that the public health interest is paramount and the patent rights of these companies to their drugs are subject to the right of government to create exceptions to it during times of national emergency or circumstances of extreme urgency.
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AGAP’s comments on the Millenium Development Goal (MDG) Target 15: Provide access to affordable  essential drugs in cooperation with pharmaceutical companies

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A Just Cause: Quality Affordable Medicines for All

Posted on August 16, 2006. Filed under: Resources |

by Sen. Mar Roxas

In every nook and corner of our archipelago, Mr. President, we have sick citizens who are sick not because there is no cure for their ailment, not because they haven’t been able to see a doctor for diagnosis, they are sick because they cannot afford the medicine that has been prescribed for them and which will make them well.

Ginoong Pangulo, kung si Juan dela Cruz ay tumaas ang presyon ng dugo at kinailangan niyang bumili ng gamot na Norvasc, mabibili niya ito sa Mercury sa halagang P44.75.

Pero ang taga-India, na katulad ni Juan na may mataas na presyon, ay makakabili ng Norvasc, na walang pinagkaiba sa binebenta sa botika, sa halagang P5.00 lamang.

Norvasc, priced at P44.75 in the Philippines, sells for the equivalent of P5.00 in India.

Kung ang Misis ni Juan dela Cruz ay may impeksyon, tulad ng respiratory tract infection, upang gumaling, kailangan niyang bumili ng Bactrim 400 sa pharmacia sa presyong P17.75 per tablet. Samantala, ayon sa Philippine International Trade Corporation (PITC), isang ahensya ng gobyerno, ang bawat tableta ng Bactrim 400 ay nabibili sa Pakistan sa halagang piso, at sa India, sa halagang 69 centavos.

Bactrim 400, priced at P17.75 per tablet in the Philippines, sells for the equivalent of P1 in Pakistan, and P0.69 in India.

Kung ang anak naman ni Juan dela Cruz ay may hika at kailangan ng Ventolin inhaler para lumuwag ang paghinga, mabibili ito ng kanyang magulang sa Mercury Drug Store ng P406 per inhaler.

Samantala, kahit sinong bata na hinika sa Bangkok, ay maaaring maibili ng kanyang magulang ng Ventolin Inhaler sa halagang P231 lamang.

Ventolin, priced at P406 in the Philippines, sells for the equivalent of P231 in Thailand.

Mr. President, what is so special about Thailand, India, Pakistan and other countries across and beyond our region, that these affordable medicines are available to their citizens while we Filipinos have to pay many more times for the same medicines?

Mr. President, I wish government can simply decree lower prices and have it come about. Unfortunately, this is easier said than done. There is no magic cure, no magic wand, to wave or wish this problem away.

There have been numerous efforts to address this problem. I recall that Senators Pimentel and Angara, co-authored the Generics Drugs Act, while Senator Enrile voted for its passage in 1988. Senator Juan Flavier championed it before and while he was Health Secretary, and up to the present.

Part of the rationale for enacting the Retail Trade Liberalization Law was to open the door to greater competition among drug stores and pharmacies.

The idea underlying these efforts was to create a more competitive and creative environment, such that our people will have viable and affordable alternatives for accessing their medicines.

These prior efforts to address this problem have made much progress but sadly because of poor implementation, or inhospitable circumstances, or worse, venal collusion, there has not been enough success to make substantial headway against the problem.

Today, we make another attempt to address this problem and thus give life to the public health provisions of our Constitution, and assure our people that their welfare is uppermost in our minds.

Mr. President, I have been studying this problem for quite some time. I was first sensitized to it during the illness and death from liver cancer of my brother at 32.

During his illness, I came across so many of our kababayans in the hallways and waiting rooms of hospitals who need not have been there at all, had they better access to lower priced medicines. I remember, while visiting him in the hospital, walking through its corridors and seeing so many patients trying to cope with their illnesses and their families worried sick for them.

Doon po sa ospital may nakausap akong matandang babae. Tinanong ko siya kung ano ang kanyang karamdaman. Sinabi niya na nag-umpisa ang kanyang sakit sa simpleng trangkaso ngunit dahil wala siyang pambili ng gamot, ito ay lumala at napilitan siyang pumunta na sa ospital.

When someone you love dies, it’s not political or economic, it’s personal. But for the poorest of the poor – those who could have saved their loved one if they only had the money to do so – it goes beyond what is personal. It goes straight to the question of social justice.

Let me cite three major obstacles to our people’s access to affordable, quality medicines.

The first obstacle is the structure of the pharmaceutical industry.

The pharmaceutical industry in the Philippines sold around P85 Billion worth of products last year. Roughly translated, this means approximately P1,000 for every man, woman and child in the country.

But unlike other countries, the industry here is characterized by extreme concentration of market power, in short, controlled by a handful of players.

In technical terms, what we now have is what’s known as an uncontested market. Whatever these players charge, the market will bear, because of the relative absence of competition and alternatives.

Kung ang gamot ay tubig, ang pagdaloy nito ay nagmumula lamang sa iilang gripo at kontrolado din ng iilan lang ang hose.

Iisa ang manufacturer at contract manufacturer dito. Halos iisa lang ang major wholesale distributor, ang Zuellig Pharma. Pagkatapos, halos iisa rin lang ang malaking retailer dito, ang Mercury Drug. Kaya sa kakulangan ng kompetisyon, mananatiling mataas ang presyo ng gamot sa Pilipinas.

The second obstacle has to do with the behavioral orientation of our consumers, doctors, and public institutions.

There must be continuing education on the Generics Law. Our consumers have yet to fully appreciate the value for money offered by generic substitutes. Our doctors and public health institutions must not negate the spirit of this law by failing to live up to their duty to inform their patients, particularly the poor, about generic substitutes.

The third and perhaps, biggest obstacle to affordable, quality medicines, is rooted in the protectionist provisions of existing law.

Certain provisions of the Intellectual Property Code (IPC) have been misused over time such that profit trumps public interest.

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