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[e-drug] Drug Pricing in South Africa

E-DRUG: Drug Pricing in South Africa
[crossposted from DRUGINFO with thanks. For the non-south
Africans: the Health System Trust issues a report on the
health situation in South Africa. This year drug prices
are analyzed in one of its chapters. Well done, Andy! WB]

Hi all

Today the Health Systems Trust's annual publication, the South 
African Health Review 2000, was launched in Johannesburg. This 
year I contributed, together with my colleague Thulani Matsebula 
from the Wits Centre for Health Policy, a chapter on Drug Pricing. 

An html version can be viewed at: 

In addition, it is available as a .pdf file (276kB) at 
ftp://ftp.hst.org.za/pubs/Sahr/2000/chapter9.pdf,  with the 
references as a separate file 
(http://www.hst.org.za/sahr/2000/refs.htm#Chapter 9)

A summary brief issued at the launch is also available at:

The abstracts reads as follows: "Improving access to necessary 
drugs requires attention to all four component parts of the access 
equation ? ensuring rational selection, providing sustainable 
financing and efficient systems to distribute and use the drugs but 
also making sure that prices are affordable. However, comparing 
drugs prices across countries and health systems is not always 
easy. Methodological pitfalls abound, and have in the past 
ensnared the South African Ministry of Health. The National Drug 
Policy contains a variety of proposed strategies to reduce the price 
of medicines in South Africa. This chapter considers the complex 
issue of drug pricing, the policy options outlined and available, and 
provides recommendations on steps that will advance the 
implementation of such policies".

The chapter calls for :
"* More detailed data on price trends in both the private and public 
* More analysis of the impacts of policy decisions, with emphasis 
on indicators of equity, affordability and availability
* Finality on those policy choices which seem to hold clear 
advantages (such as fixed professional fees and non-discriminatory 
exit pricing based on volume)
* Finality on the legal struggle to introduce generic substitution, to 
regulate marketing practices and to exploit the safeguards provided 
by the TRIPS Agreement
* Consideration of regional options, including bulk purchasing 
across the SADC region".

It concludes that: "Crucial to the success of these options will be 
strengthening of the national departments responsible, the 
Directorate: Pharmaceutical Programmes and Planning (and in 
particular the sub-directorate of Medical Stores and Systems, 
which provides the secretariat to COMED) and the Directorate: 
Medicines Administration (the secretariat to the Medicines Control 
Council). Significant strengthening of the inspectorate functions of 
the MCC will also be necessary if the potential pitfalls of parallel 
trade and compulsory licensing are to be avoided. Strengthening 
the entire system will ensure that the populace is not exposed to 
counterfeit and sub-standard medicines and will demonstrate that 
such exposure is not an inevitable consequence of the policy 
choices outlined in this chapter. In this regard, South Africa 
remains a test case, one watched closely by the international 

I would welcome any comments on the chapter from list 
participants, or any updates on what is by now a document 4 
months out of date!

Andy Gray
Discipline Chair: Pharmacy Practice
School of Pharmacy and Pharmacology
University of Durban-Westville
email: andy@healthlink.org.za
Tel: +27 31 2044358 Fax: +27 31 2044792
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