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[e-drug] Medicines Price and Availability Survey in Delhi, India

E-DRUG: Medicines Price and Availability Survey in Delhi, India
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Dear All, 

A detailed survey using standardized WHO/HAI methodology was conducted to 
measure medicine prices, availability, affordability and medicine price 
components in National Capital Territory, Delhi, India. The data was collected 
from July-October 2011. 

Findings of the survey will be useful for the policy makers as government of 
India is going in for Universal Health Coverage and planning to provide free 
medicines to all through public sector facilities. Data and report is available 
on HAI website: 
http://www.haiweb.org/medicineprices/surveys/201107IND/sdocs/ReportFinal_Delhi%20Medicine%20Price%20Survey_KotwaniA_Web.pdf
[please fix URL in browser if broken]

The survey was conducted in both public and private sector facilities covering 
all eight districts of NCT, Delhi. Three predominant public health providers, 
Government of NCT, Delhi (GNCT, Delhi), Municipal Corporation of Delhi (MCD), 
and Central Government (federal government) were included for the survey. 
Private sector sites included traditional private retail pharmacies and retail 
chain pharmacies of one particular corporate house. This is the first survey in 
India where all the major public healthcare providers of one state were 
included and retail chain pharmacies were also surveyed.

Findings have given evidence and insight to the procurement prices of various 
agencies and have shown that procurement price of medicines purchased by 
tertiary care facilities was higher than the procurement price of central 
agencies. Availability of surveyed essential medicines was poor in public 
facilities under all three public sectors. Availability of certain pediatric 
preparations, asthma inhalation medicines, hypolipidemic and antipsychotic 
medicines was very poor; zinc dispersible tablets were not available in any of 
the facilities. 

Availability of medicines in the private retail pharmacies was consistently 
higher than public sector pharmacies. The mean availability of originator brand 
(OB), highest-priced generic (HPG), and lowest-priced generic (LPG) was 29.3%, 
34.6%, and 68.8%. Similar to the public sector, zinc sulphate dispersible 
tablets were not available in private sector. The range for median medicine 
price ratio compared to international reference price (MPR) for medicines was 
0.56 - 16.51. Surprisingly, off-patent medicines like diazepam, diclofenac, and 
doxycycline had the highest MPRs, indicating that these medicines were very 
expensive as compared to international reference price. Findings at chain 
pharmacies for availability and prices of medicines were similar to retail 
pharmacies shops.

A detailed price component survey was conducted in the private sector. The 
survey revealed trade schemes between manufacturer, wholesaler and retailer: 
these schemes chiefly benefit the manufacturer and the retailer; savings are 
not passed on to patients. Also, the manufacturer reaped a majority of the 
profit for 'branded' medicines and the retailer made a similar profit in case 
of branded-generic (generic) medicines. Therefore, the main profit is for the 
actor who is pushing and responsible for promoting the sale of medicine.

Policy options are suggested to improve access to essential medicines in public 
sector and private sector which required good governance and transparency in 
the system. Some of the findings are cited in the following two papers: 
1. Kotwani A. Psychiatric medicines in India: why public healthcare facilities 
and a thriving generics industry cannot assure access and affordability. 
International Psychiatry 2012;9: 34-36.
2.A paper on medicine price components was presented during Asia Pacific 
Conference on National Medicines Policy (APNMP 2012) held in Sydney; Abstract: 
Kotwani A. Medicine supply chain price tracking identifies who benefits from 
the free market in India. Abstract book of Asia Pacific Conference on National 
Medicines Policies, Sydney, Australia, May 2012


 Dr. Anita Kotwani
Associate Professor
Department of Pharmacology
V. P. Chest Institute
University of Delhi
Delhi 110007
India
anitakotwani@yahoo.com
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