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Pharmacology and therapeutics
Original research
Impact of National Drug Pricing Policy 2018 on access to medicines in Lahore division, Pakistan: a pre-post survey study using WHO/HAI methodology
  1. Amna Saeed1,2,3,
  2. Hamid Saeed4,
  3. Zikria Saleem5,
  4. Caijun Yang1,2,3,
  5. Minghuan Jiang1,2,3,
  6. Mingyue Zhao1,2,3,
  7. Wenjing Ji1,2,3,
  8. Muhammad Majid Aziz1,2,3,
  9. Faiz Ullah Khan1,2,3,
  10. Ali Hassan Gillani1,2,3,
  11. Naveel Atif1,2,3,
  12. Yu Fang1,2,3,
  13. Zaheer Ud Din Babar6
  1. 1Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Shaanxi, China
  2. 2Center for Drug Safety and Policy Research, Xian Jiaotong University, Shaanxi, China
  3. 3Shaanxi Centre for Health Reform and Development Research, Shaanxi, China
  4. 4Department of Pharmaceutics, University of the Punjab, Lahore, Pakistan
  5. 5Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
  6. 6Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, West Yorkshire, UK
  1. Correspondence to Dr Yu Fang; yufang{at}mail.xjtu.edu.cn

Abstract

Objective To evaluate the impact of new National Drug Pricing Policy (NDPP) 2018 on access to medicines in terms of prices, availability and affordability.

Design Two cross-sectional surveys were undertaken before and after the launch of NDPP 2018, using a modified WHO/Health Action International (WHO/HAI) methodology.

Setting Four districts of Lahore division, Pakistan.

Participants 16 public sector hospitals and 16 private sector retail pharmacies.

Measures The pre and post survey data on prices and availability of lowest price generics (LPGs) and originator brands (OBs) of 50 medicines were obtained by visiting the same public and private sector health facilities (n=32). Out of 50, 46 surveyed medicines were from the National Essential Medicines List. Inflation-adjusted median unit prices (MUPs) and median price ratios (MPRs) from 2019 were used for price comparison. Affordability was calculated in terms of number of days’ wages required to get a standard treatment by the lowest paid unskilled government worker.

Results The overall mean percent availabilities remained poor in both years, that is, far less than 80%. In the public sector, the mean percent availability of OBs improved from 6.8% to 33.1%, whereas, in the case of LPGs, it was reduced from 35.1% to 9%. In the private sector, the mean percent availability of both OBs and LPGs demonstrated slight improvements in 2019, that is, 55.0%–58.3% and 20.3%–32.3%. The adjusted MUPs and MPRs of OBs significantly increased by a median of 4.29% (Wilcoxon test p=0.001, p=0.0001), whereas the adjusted MUPs and MPRs of LPGs increased by a median of 15.7% (p=0.002, p=0.0002). Overall, the affordability of many medicines for common ailments was reduced significantly in 2019.

Conclusions The availability of medicines slightly improved, except in the case of LPGs, which was reduced in the public sector. The implementation of NDPP 2018 led to increase in drug prices, making the standard treatment for some of the most prevalent ailments unaffordable. So verily, the drug pricing policy must be reviewed to ensure access to essential medicines.

  • health economics
  • health policy
  • pharmacology
  • health services administration & management
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2019-034720

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    Footnotes

    • Contributors AS, ZUDB and YF conceptualised the study. ZS, HS, AS and ZUDB designed the methodology. ZS, HS and AS trained the data collectors and obtained the data. YF provided resources and supervised the project. ZS worked as survey area manager. MMA, AHG, NA, FUK and MZ did data cleaning, validation and entry. AS, HS, CY and MJ analysed the data. AS and HS wrote the original draft. YF, ZUDB, ZS, CY, MJ and WJ reviewed and edited the manuscript.

    • Funding This work was funded by the ‘Young Talent Support Plan’, ‘High Achiever Plan’ of Health Science Center, Xi’an Jiaotong University and the Central University Basic Research Fund (2015qngz05).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval Ethics approval was obtained from the Medical Ethics Committee of Xi’an Jiaotong University under study ID 2019-067.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. Extra data can be accessed via the Dryad data repository at http://datadryad.org/ with the doi:10.5061/dryad.tqjq2bvwq.