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Access to essential medicines for NCDs Access to essential medicines for NCDs

Access to essential medicines for NCDs - PowerPoint Presentation

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Access to essential medicines for NCDs - PPT Presentation

WHO EMP and NVI Departments 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 acces ID: 731526

access medicines health essential medicines access essential health 2010 insulin ncd public availability global ncds private supply diseases products

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Slide1

Access to essential medicines for NCDs

WHO EMP and NVI DepartmentsSlide2

Access to NCD essential medicines on the global agendaAccess to chronic disease medicines is required for the fulfilment of MDG8Governments, 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 careSlide3

Global Action Plan and Monitoring FrameworkSlide4

Target 980% 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, ARVsIn 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% privateFor chronic diseases: 36% public, 54.7% private facilitiesCosts 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 Slide5

What do NCD medicines cost without tariffs, taxes and mark-ups?

ProductUnits per monthMedian Unit Cost

Monthly costSourceGlibenclamide 5mg tab30$ 0.0034$ 0.102

MSH 2010

Metformin

500mg tab

60

$ 0.0105

$ 0.630

MSH

2010

Insulin

NPH 100IU/ml 10ml1$ 4.20$ 4.20MSH 2010 (Buy)Salbutamol inh 100mcg 200 doses1$ 1.08$ 1.08ADF 2011Beclometasone inh 100mcg 200 doses1$ 1.28$ 1.28ADF 2011Aspirin (ASA) 100mg tab30$ 0.0019$ 0.0057MSH 2010Simvastatin 20mg tab 30$ 0.0286$ 0.858MSH 2010Hydrochlorothiazide 25mg tab 30$ 0.0037$ 0.111MSH 2010Atenolol 50mg tab30$ 0.095$ 0.285MSH 2010Tamoxifen 20MG tab30$ 0.0732$ 2.196MSH 2010

Main sources: MSH International Drug Price Indicator Guide 2010 and ADF Catalogue 2011Slide6

Challenges with NCD medicinesOral 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)Slide7

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.Slide8

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):217-21Slide9

Affordability and availability of insulin in the public sector to the individual

HI = Health Insurance 40% of interviewees had health insuranceIfL = 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):217-21Slide10

Access to essential medicines A Framework for action

1. Rational

selection

4. Reliable

health and

supply

systems

2. Affordable

prices

3. UHC and Sustainable

financing

ACCESSSlide11

Options to improve the situationRational selectionStandard 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 STGsFinancing and Universal Health CoverageIncrease government budget to ensure widespread access to a reduced number of NCD essential medicinesExpand coverage/health insurance and ensure NCD essential medicines are part of the essential package covered Slide12

Options to improve the situationPriceCompetition, promotion of generics, transparent procurement procedures, substitution, reduce duties/taxes and mark-ups, monitoring pricesFor single source products or under patent, apply WTO/TRIPS flexibilities and use available differential pricing

Reliable Supply systemsSupply quality-assured products: reinforce NRAs and limit SSFFC products in the supply chain, increase confidence of prescribers in generic productsImprove quantification of needs and forecasting using good information systemsReinforce private and public supply chainsSlide13

Perspective and Role for WHO/EMPSensitize countries and partners to the barriers for access to essential medicines and health technologies for NCDsDevelop and promote monitoring tools to document the situation, to identify priority interventions and measure improvements in access over timeUpdate WHO Model List of Essential Medicines to address NCD issues (

e.g. cancer section)Update and promote use of National Standard Therapeutic guidelinesContinue 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 availabilitySlide14

Global Coordination Mechanism – Working Groups on NCDsActive private sector participationInnovative financing for NCDs UN Inter Agency Task Force on NCDs 42 working teams – access to essential medicines for NCDs being one of themWHO working plan – Discussion PaperAction 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 Recent Global InitiativesSlide15

THANK YOU