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Medicine Pricing - Coggle Diagram

- - - - the DOH medicine access programs (MAPs) refer to government programs that guarantee access to certain medicines to a particular group or segment of the population
        
        breast cancer medicine access program
        
        complete treatment pack program
        
        medicine access program for mental health
- - - - This can be done without a framework agreement but without this agreement, the supplier can only get their payment once all materials have been delivered to the government
  - - - Let's say we have a 1 year agreement, 5000 tablets were requested. The purchase request states that we will request for delivery of a certain amount depending on the need later on. No promised number of medicines and supplier is paid by initial delivery
        
        Problem: In govt, dapat muna matapos yung contact bago mabayaran. Kaya nabblacklist ang govt offices kasi matagal pa bago mabayaran kahit andiyan naman ang pera
- - - - medications belong to the formulary of an institution
      - medications that can be part of formularies in government institutions should be part of the PNF
    - - requires medications bought should be generic
    - - aka Pharmacy Therapeutics Committee
        
        discusses and includes a commonly used medication in the formulary
  - - - highlighted that we have different additional procurement methods
      - . This law revises the previous Government Procurement Reform Act (RA 9184) to enhance transparency, competitiveness, efficiency, accountability, and value for money in public procurement processes in the Philippines
      - The procurement law requires that there should be a Project Procurement Management Plan (PPMP) which includes all medications that need to be purchased in a year.
        
        If a medication is already included in PPMP, the hospital/LGU can request
        
        Typical process: Verification (if the medication is listed in ppmp approved) -> Requisition (request to the procurement office, specifying the medication and required quantity) -> Approval (procurement office reviews the request) -> Procurement process -> Distribution
        
        importance: gives guidance and structure, resource optimization, transparency and accountability, risk management, compliance, efficiency and effectives
    - - drug price reference index (DPRI)
        
        required for DOH hospitals/DOH-retained hospitals
        
        required for other government agencies but not as strict
        
        It aims to ensure that national and local government health facilities can source pharmaceutical products at fair and reasonable prices
      - maximum retail price (MRP)
        
        executive order released from time-to-time from the office of the presdient
        
        gives the list of molecules that are subject to the MRP
    - - pre-procurement conference
      - advertisement
        
        The procurement opportunity is advertised to invite potential bidders. This ensures that the process is open and competitive
        
        procurement requests
        
        PhilGEPS
        
        Philippine Government Electronic Procurement System
      - pre-bid conference
        
        A meeting is held to clarify any concerns or questions from prospective bidders regarding the procurement requirements23.
      - eligibility screening
        
        Prospective bidders are screened to ensure they meet the necessary qualifications and requirements
      - submission and opening of bids
        
        Bidders submit their proposals, which are then opened in a public session to maintain transparency
        
        opening of 1st envelope
        
        eligibility bid security, NFCC,Technical Proposal
        
        opening of 2nd enveloped
        
        financial proposal
      - bid evaluation
        
        The submitted bids are evaluated based on pre-determined criteria to determine the most advantageous offer for the government
      - post-qualification
        
        The bid that appears to be the most advantageous is further scrutinized to verify the bidder’s capability and compliance with the requirements23.
      - award of contract
        
        The contract is awarded to the bidder who meets all the requirements and offers the best value for money23.
      - contract signing and implementation
  - - - procures it for itself (phase of distribution), then transfers it to various institutions
    - - Delivery of drugs -> receiving and inspection (QA) -> inventory management -> internal distribution -> monitoring and replenishment -> reporting and accountability
  - - - proper prescribing, dispensing, and patient use
- - - - simplified screening and qualification processes
      - introduces price-ceilings and capped price adjustments post-award
      - standardized procurement processes and forms
      - institutionalized civil society participation
      - adopted open and competitive bidding as primary mode of procurement
      - mandated the use of an electronic procurement system to ptomote transparency and competition
    - - inconsistent in compliace to GPRA process
        
        ex. gov set price of 150k for computer and specs are provided (even the specs is not worth the price)
      - difficulties in access and use of the government procurement system
        
        barangay lvl should be registered in PhilGEPS
      - limited in monitoring and enforcement mechanisms
        
        e.g. overpriced computers
    - - should be knowledgeable to the medicines being procured
  - - - requires generic name instead of brand name
  - - - problem with DPRI
        
        sets the price based on the year before
        
        problem if the DPRI is lower -> failure of bidding
        
        economies of scale
        
        if smal -> the have to buy small quantities -> more expensive but they have to base the price on DPRI
- - - - example during covid, this is to increase access to medicines
    - - stems from situations where importing is more economically cheaper than manufacturing the drug in the country
  - - - set the prices of different levels of supply chain because as medicines move in the supply chain, prices inevitably increases due to markups
        
        since the medicines are transferred to different stakeholders -> price increases once it reaches the patient
    - - composed of public health, epidemi9ologu, pharmacuetical policy,law, clinical, and economic experts to provide technical advice and guidance to the DOH in implementing measure to promote and ensure access to affordable quality drugs and medicines for all consumers in the Philippines
      - members of the council shall be co-terminus with the SOH subject to reappointment by the new SOH
      - chair of the council shall hold his/her position not exceeding three years unless he/she relinquished his/her position for reasons beyond his/her control
      - sets the price for the MRP and procurement of DOH of the HT
      - meet the market authorization holder to negotiate price
    - - recommended medicines, based on qualifying criteria evaluation
        
        medicines for top burden of diseases
        
        medicines with limited competition
        
        patented medicnes need to ahve a set price to avoid expensive drug pricing
        
        set a price cap to prevent extermely high pricing
    - - practice of using the price(s) of a pharmaceutical product in one or several countries in order to derive a benchmark or reference price for the purposes of setting and negotiating the price of the product in a given country
      - basket of countries
        
        asian countries: Thailand, Malaysia, Vietnam, India, Indonesia
        
        developed countries: UK, Australia, Canada
    - - Maximum wholesale price
        
        rate/price paid by a hospital when buying medicines
        
        lowest between median of asian countries, and minimum of developed countries
        
        assumes that asian countries are the same
        
        reason why we can't use the cheapest price for asian countries
      - maximum retail price
        
        rate/price paid by the patient when buying medicines
        
        mark-up adjustment (MUa) depends on MWP value
    - - entails the comparison of teh drug price within the Philippines
    - - developing countries are given prioritity
        
        but not always the case as the presence of a price regulatory board and an established HTA
      - EU countries
        
        sabay sabay pagprocure -> low price
        
        unlike in the PHL -> decentralized -> more expensive
  - - - Set ABC* at the level of previous years' procurement with an allowable variation of plus 10% to account for inflation
        
        *Approved Budget for the Contract - budget for the contract duly approved by the head of the procuring entity
        
        The ABC is already set in the purchase order
        
        PPMP contains equivalent price per good or services
        
        Purchase order contains price per piece and how many pieces will be bought
        
        DPRI should be the price per piece, but the problem is procurement price from last year that is consolidated then will be the price of DPRI for this year
        
        Does not account for inflation and public health emergencies
        
        Oftentimes, the price set by the supplier is already, which makes it hard for them to lower based on the price of the DPRI which becomes the problem
        
        DPRI provides benchmark prices for products, which helps in setting realistic and competitive ABC for procurement of medicines. By referencing the DPRI, procuring entities can ensure that they procure medicines at reasonable prices.
      - Another problem is that most LGUs dont know the existence of DPRI. They randomly set prices
        
        COA does not able to flag such activities
      - sets only maximum allowable prices of medicines procure by the govt, which helps prevent overpricing but does not directly influence market competition or consumer behavior
    - - lowest bid price or through external reference pricing (ERP) with countries of similar income status
    - - Regional DOH offices
      - DOH retained hospitals
      - Central Office Bids and Awars Committee (COBAC)
      - PITC Pharma, Inc (PPI)
  - - - talk to marketing authorization holder to lower the price (especially for medicines for cancer, mAbs, and other costly medicines)
        
        through Pharmaceutical and Healthcare Association of the Philippines (PHAP)
    - - GMAP list shall be made available in all pharmacies and shall be seen by the customers
        
        the price shall be lower or the same as GMAP, but not all medicines are in GMAP, only the expensive ones
- - - - lack of APIs and there are economic downturn; hence, expensive drugs
    - - drugs came from india, and pakistan because there ingredients are cheaper which drives the domestic manufacturer to close down
- - - - 20-25% every year for medicine, vaccines and health technologies.
      - medicines are a major cost-driver
  - - - RA6675, RA9184, RA 11223
    - - RA 11223, RA6675, RA9502, RA7432/9994 Expanded Senior Citizen Act, RA 7277/10754 Expanded Benefits and Privileges of PWD, RA 10963 TRAIN Law, RA 11534 Corporate Recovery and Tax Incentives for Enterprises Act
    - - Relevant laws: DOH AO 2019-0036: F1 plus bnb
    - - RA11223, RA9711
- - - - current state: lack of product selection standards, lack of quantification of guidelines and national committee, long procurement lead time, warehouse management gaps, adhoc distribution mechanisms, lack of inventory policy across all level, lack of data standards and master stock keeping unit list, fragmented systems, and lack of supply chain data visibility
        
        isang beses lang priprocure ang drugs sa isang tao -> expiry
        
        lack of warehouse -> masisira ang mga gamot
      - Future state: integrated procurement framework available, cost effective, uniform warehouse management, synchronized distribution and reverse logistics, master list of inventories or stock keeping units (SKUs), end-to-end supply chain data visibility, and integrated information system
    - - resources
      - capacity building of people who will using it
- - - - Which means there is indirect cost increase due to the overall increase in excise taxes on fuel and other goods which indirectly raise operational costs for pharmaceutical companies which might be passed on to consumers in the form of higher prices for non-exempt drugs
      - in distribution and transport, there is increased in fuel costs which has contagion effects on operational costs leading to an increase of prices in medicines
- - - - has the potential to decrease drug prices if enough competitors are found in the market through local manufacturing and parallel importation
        
        primary care medicines are benefitted by this; how about those for specialty care that is less accessible
        
        the only way to reduce the price of these medicines is through MRP
    - - There is a need to revist ERP and MWP/MRP formula
    - - need to study medium- and long-term effects of VAT-exemption
        
        price before and after vat exemption did not change
        
        retailers and wholesalers will increase their mark-ups