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Access and Affordability of Medicines in Malaysia: Need for a National Pricing Policy

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Abstract

Background

High medicines prices are a barrier to medicines access, and their impact is greater in developing countries.

Objective

This study assessed the availability, prices and affordability of medicines in public and private sectors in Malaysia to understand the pharmaceutical environment and guide policy recommendations.

Methods

This nationwide cross-sectional study adapted the World Health Organization/Health Action International (WHO/HAI) methodology. A total of 87 premises from both public and private sectors participated in this study. Data on 50 medicines were collected to analyze availability, prices and affordability. Medicine prices were compared against the international reference prices (IRPs), and affordability was assessed by daily income level.

Results

In the public sector, the average availability of generics (74.8%) was higher than that of the originator brand name products (19.4%). However, in the private sector, the availability of originator brands was higher (52.2%) than generics (49.1%). Procurement prices in the public sector were up to 1.5 times the IRPs, but up to 8.4 times in the private sector. The study also observed large price variation across medicines in the private sector. Median retail mark-ups in private hospitals (generics 166.9%; originators 51.0%) were higher than in retail pharmacies (generics 94.7%; originators 22.4%). Generics were generally affordable, but originator brands were unaffordable.

Conclusion

Current policies on generic medicines need to be strengthened to improve the availability and use of generics in the country. High medicine prices and large price variation in the current free market suggest that coherent pricing policies and regulations are needed to safeguard the accessibility and affordability of medicines for the people.

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References

  1. Hoebert JM, van Dijk L, Mantel-Teeuwisse AK, Leufkens HG, Laing R. The world medicines situation 2011: national medicines policy—a review of the evolution and development process. Geneva: WHO Press; 2011.

    Google Scholar 

  2. Cameron A, Ewen M, Ross-Degnan D, Ball D, Laing R. Medicine prices, availability, and affordability in 36 developing and middle-income countries: a secondary analysis. Lancet. 2009;373(9659):240–9.

    Article  CAS  PubMed  Google Scholar 

  3. World Health Organization. Medicines pricing and financing. 2017. http://www.who.int/medicines/areas/access/en/. Accessed 17 Aug 2017.

  4. World Health Organization. Fact sheet: paying for health services. 2007. http://www.who.int/mediacentre/factsheets/fs320.pdf. Accessed 18 Aug 2017.

  5. Niens LM, Cameron A, Poel EV, Ewen M, Brouwer WBF, Laing R. Quantifying the impoverishing effects of purchasing medicines: a cross-country comparison of the affordability of medicines in the developing world. PLoS Med. 2010;7(8):e1000333.

    Article  PubMed  PubMed Central  Google Scholar 

  6. World Health Organization, Health Action International. Measuring medicine prices, availability, affordability and price components. Geneva: World Health Organization; 2008.

  7. Ministry of Health Malaysia. Malaysia national health accounts, health expenditure report 1997–2014. Putrajaya: Ministry of Health Malaysia; 2016.

    Google Scholar 

  8. Chua HT, Cheah JCH. Financing universal coverage in Malaysia: a case study. BMC Public Health. 2012;12(Suppl 1):S1–7.

    Google Scholar 

  9. Jaafar S, Mohd Noh K, Muttalib KA, Othman NH, Healy J. Malaysia health system review. Geneva: World Health Organization; 2012.

    Google Scholar 

  10. Pharmaceutical Services Division, Ministry of Health Malaysia. Pharmacy Programme annual report 2015. 2015. http://www.pharmacy.gov.my/v2/sites/default/files/document-upload/ar-pharmacy-2014-final_1.pdf. Accessed 28 Aug 2017.

  11. Pharmaceutical Services Division, Ministry of Health Malaysia. Pharmaceutical Services Programme annual report 2005. 2005. http://www.pharmacy.gov.my/v2/sites/default/files/document-upload/annual-report-2005.pdf. Accessed 28 Aug 2017.

  12. Pharmaceutical Services Division. Laporan Statistik Program Farmasi 2016. Petaling Jaya: Pharmaceutical Services Division, Ministry of Health Malaysia; 2016 (in Malay).

    Google Scholar 

  13. Nguyen T, Knight R, Roughead E, Brooks G, Mant A. Policy options for pharmaceutical pricing and purchasing issues for low- and middle-income countries. Health Policy Plan. 2015;30(2):267–80.

    Article  PubMed  Google Scholar 

  14. Management Sciences for Health. Pharmaceutical pricing policy. In: MDS-3. Managing access to medicines and health technologies, Pharmaceutical regulation in 15 European countries: review. Health Syst Transit. Arlington: Management Sciences for Health; 2012.

  15. Ministry of Finance Malaysia. Malaysia’s government procurement regime. 2010. http://www.treasury.gov.my/pdf/lain-lain/msia_regime.pdf. Accessed 28 Aug 2017.

  16. Vogler S, Paris V, Ferrario A, et al. How can pricing and reimbursement policies improve affordable access to medicines? Lessons learned from European countries. Appl Health Econ Health Policy. 2017;15:307–21. https://doi.org/10.1007/s40258-016-0300-z.

    Article  PubMed  Google Scholar 

  17. Babar ZUD. Pharmaceutical prices in the 21st century. Switzerland: Springer; 2015.

    Book  Google Scholar 

  18. Ministry of Health Malaysia, Malaysia’s health 2008. 2008. http://www.moh.gov.my/images/gallery/publications/mh/Malaysia%20Health%202008-2.pdf. Accessed 28 Aug 2017.

  19. Babar ZUD, Ibrahim MIM, Singh H, Bukahri NI, Creese A. Evaluating drug prices, availability, affordability, and price components: implications for access to drugs in Malaysia. PLoS Med. 2007;4(3):e82.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Rachagan SS, Syed M Haq AH, Sothirachagan S. Affordable medication with a dose of competition. In The 15th session of the intergovernmental group of experts (IGE) on competition law. Geneva: United Nations; 2016.

  21. Hassali MA, Shafie AA, Babar ZUD, Khan TM. A study comparing the retail drug prices between northern Malaysia and Australia. J Pharm Health Serv Res. 2012;3(2):103–7.

    Article  Google Scholar 

  22. Medicine Price Management Branch, Pharmaceutical Services Division. Medicines prices monitoring survey in Malaysia, 2011–2015. Petaling Jaya: Pharmaceutical Services Division, Ministry of Health Malaysia; 2015.

  23. Sooksriwong CO, Yoongthong W, Suwattanapreeda S, Chanjaruporn F. Medicine prices in Thailand: a result of no medicine pricing policy. South Med Rev. 2009;2(2):10–4.

    Google Scholar 

  24. Kotwani A. Medicine prices, availability, affordability and medicine price components in NCT, Delhi: WHO/HAI methodology. New Delhi: SEARO, World Health Organization; 2011.

    Google Scholar 

  25. Malaysia Competition Commission. Market review on priority sector under competition act 2010: pharmaceutical sector. 2017. http://www.mycc.gov.my/sites/default/files/media-review/Market%20Review%20on%20Pharmaceutical%20Sector.pdf. Accessed 28 May 2018.

  26. Chong HY, Chan TH. Market structure and competition: assessment of Malaysian pharmaceutical industry based on the modified structure-conduct-performance paradigm. 2014. https://mpra.ub.uni-muenchen.de/59537/1/MPRA_paper_59537.pdf. Accessed 28 Aug 2017.

  27. Consumers Association of Penang. Our high medicine prices are killing patients. 2017. https://www.consumer.org.my/index.php/health/medicine/1133-our-high-medicine-prices-are-killing-patients. Accessed 28 Aug 2017.

  28. World Health Organization. Out-of-pocket payments, user fees and catastrophic expenditure. 2017. http://www.who.int/health_financing/topics/financial-protection/out-of-pocket-payments/en/. Accessed 25 Aug 2017.

  29. Shafie AA, Hassali MA. Price Comparison between innovator and generic medicines sold by community pharmacies in the state of Penang, Malaysia. J Generic Med. 2008;6(1):35–42.

    Article  Google Scholar 

  30. Siang T, Hassali M, Saleem F, Alrasheedy A, Aljadhey H. Assessment of medicines price variation among community pharmacies in the state of Penang, Malaysia by using simulated client method. J Med Market. 2014;14(2–3):115–24.

    Article  Google Scholar 

  31. Gelders S, Ewen M, Naguchi N, Laing R. Price, availability and affordability: an international comparison of chronic disease medicines. Cairo: World Health Organization/Health Action Initiative; 2006.

    Google Scholar 

  32. Management Sciences for Health. International medical products price guide. 2016. http://mshpriceguide.org/en/drug-search-page-2/. Accessed 20 Dec 2016.

  33. Public Service Department Malaysia. ‘Pekeliling Perkhidmatan Bilangan 8 Tahun 2006’. 2006. http://docs.jpa.gov.my/docs/spp/2006/spp082006.pdf. (in Malay). Accessed 8 Sept 2017.

  34. Public Service Department Malaysia. ‘Pekeliling Perkhidmatan Bilangan 3 Tahun 2012’. 2012. http://docs.jpa.gov.my/docs/pp/2012/pp032012.pdf. (in Malay). Accessed 8 Sept 2017.

  35. Public Service Department Malaysia. ‘Pekeliling Perkhidmatan Bilangan 8 Tahun 2015’. 2015. http://docs.jpa.gov.my/docs/pp/2015/pp082015.pdf. (in Malay). Accessed 8 Sept 2017.

  36. Public Service Department Malaysia. ‘Pekeliling Perkhidmatan Bilangan 1 Tahun 2016’. 2016. http://docs.jpa.gov.my/docs/pp/2016/pp012016.pdf. (in Malay). Accessed 8 Sept 2017.

  37. Attorney General’s Chambers. Federal government gazette: minimum wages order. 2016. http://www.federalgazette.agc.gov.my/outputp/pua_20160429_P.U.%20(A)%20116%20-%20Perintah%20Gaji%20Minimum%202016.pdf. Accessed 2 Dec 2016.

  38. Pharmaceutical Services Division, Ministry of Health Malaysia. Malaysian national medicines policy. 2012. http://www.pharmacy.gov.my/v2/sites/default/files/document-upload/buku-dunas.pdf. Accessed 30 Aug 2017.

  39. Kumar R, Hassali MA, Saleem F, Alrasheedy AA, Wong ZY, Kaur N. Knowledge and perceptions of physicians from private medical centres towards generic medicines: a nationwide survey from. Malaysia. J Pharm Policy Pract. 2015;8(1):11.

    Article  PubMed  Google Scholar 

  40. Hassali MA, Wong ZY, Alrasheedy AA, Saleem F, Yahaya AHM, Aljadhey H. Perspectives of physicians practicing in low and middle income countries towards generic medicines: a narrative review. Health Policy. 2014;117(3):297–310.

    Article  PubMed  Google Scholar 

  41. Yang H, Dib HH, Zhu M, Qi G, Zhang X. Prices, availability and affordability of essential medicines in rural areas of Hubei Province, China. Health Policy Plan. 2010;25(3):219–29.

    Article  PubMed  Google Scholar 

  42. World Health Organization. Regional framework for action on access to essential medicines in the Western Pacific (2011–2016). 2012. http://iris.wpro.who.int/bitstream/handle/10665.1/5549/9789290615705_eng.pdf. Accessed 2 Dec 2016.

  43. Nguyen AT, Knight R, Mant A, Cao QM, Auton M. Medicine prices, availability, and affordability in Vietnam. South Med Rev. 2009;2(2):2–9.

    Google Scholar 

  44. Sharma A, Rorden L, Ewen M, Laing R. Evaluating availability and price of essential medicines in Boston area (Massachusetts, USA) using WHO/HAI methodology. J Pharm Policy Pract. 2016;9(1):12.

    Article  PubMed  PubMed Central  Google Scholar 

  45. The Sun. Mystery over drugs task force. 2013. http://www.mps.org.my/newsmaster.cfm?&menuid=36&action=view&retrieveid=3710. Accessed 4 Jan 2018.

  46. Ministry of Health Malaysia. ‘Arahan penyeragaman tawaran bonus harga jualan farmasi komuniti klinik dan hospital swasta’. 2018. https://www.pharmacy.gov.my/v2/sites/default/files/document-upload/arahan-penyeragaman-tawaran-bonus-harga-jualan-farmasi-komuniti-klinik-hospital-swasta.pdf (in Malay). Accessed 26 Dec 2018.

  47. Malaysian Association of Pharmaceutical Suppliers (MAPS). President’s Message—Jun 2017. 2018. http://www.i-maps.my/1a.htm. Accessed 24 Dec 2018.

  48. World Health Organization. WHO guideline on country pharmaceutical pricing policies. Geneva: WHO Press; 2015.

    Google Scholar 

  49. Fang Y. Medicine prices, availability and affordability in Shaanxi province, western China. 2012. http://www.haiweb.org/medicineprices/13082013/2012_shaanxi_survey_report.pdf. Accessed 2 Dec 2016.

  50. Meng Q, Cheng G, Silver L, Sun X, Rehnberg C, Tomson G. The impact of China’s retail drug price control policy on hospital expenditures: a case study in two Shandong hospitals. Health Policy Plan. 2005;20(3):185–96.

    Article  PubMed  Google Scholar 

  51. The Star Online, Healing Malaysia’s healthcare system. 2016. https://www.thestar.com.my/news/nation/2016/12/11/healing-malaysias-healthcare-system/. Accessed 28 Dec 2017.

  52. Li Y, Xu J, Wang J, et al. Overprescribing in China, driven by financial incentives, results in very high use of antibiotics, injections, and corticosteroids. Health Aff. 2012;31(5):1075–82.

    Article  Google Scholar 

  53. Paolucci F. Health care financing and insurance: options for design. Vol. 10 of Developments in health economics and public policy. Canberra: Springer Science & Business Media; 2010. pp 37–8.

  54. World Health Organization/Health Action International. WHO/HAI project on medicine prices and availability. Review series on pharmaceutical pricing policies and interventions. Working paper 3: the regulation of mark-ups in the pharmaceutical supply chain. 2011. http://haiweb.org/wp-content/uploads/2015/07/Working-Paper-3-Regulation-of-Mark-ups.pdf. Accessed 5 May 2018.

  55. Leopold C, Rovira J, Habl C. Generics in small markets or for low volume medicines. Vienna: The European Commission; 2010.

  56. OECD. Pharmaceutical pricing policies in a global market. 2008. http://www.oecd.org/els/pharmaceutical-pricing-policies-in-a-global-market.htm. Accessed 2 Dec 2016.

  57. Pieter D, Vulto A, Simoens S. Reference pricing systems in Europe: characteristics and consequences. GaBI J. 2012;1(3–4):127–31.

    Google Scholar 

  58. Vogler S. The impact of pharmaceutical pricing and reimbursement policies on generics uptake: implementation of policy options on generics in 29 European countries—an overview. GaBI J. 2012;1(2):93–100.

    Article  Google Scholar 

  59. Martikainen JE, Maljanen T, Koskinen H, Vogler SV. Impact of generic price linkage system and reference price system on prices of pharmaceuticals—comparison of Austria and Finland. J Pharm Policy Pract. 2015;8(suppl 1):P2.

    Article  PubMed Central  Google Scholar 

  60. Santerre R, Neun S. Health economics: theory, insights, and industry studies. 5th ed. Mason: Cengage Learning; 2012.

    Google Scholar 

  61. Ghosh BN. Rich doctors and poor patients: market failure and health care systems in developing countries. J Contemp Asia. 2008;38(2):259–76.

    Article  Google Scholar 

  62. Mailankody S, Prasad V. Five years of cancer drug approvals: innovation, efficacy, and costs. JAMA Oncol. 2015;1(4):539–40.

    Article  PubMed  Google Scholar 

  63. Hawkes N. When the price is right: drug costing and NICE approval. BMJ. 2016;355:i6519.

    Article  PubMed  Google Scholar 

  64. World Health Organization. Report on the fair pricing forum 2017. Geneva: World Health Organization; 2017.

    Google Scholar 

  65. Management Sciences for Health. Managing procurement. In: Managing access to medicines and health technologies. Arlington: Management Sciences for Health; 2012. http://apps.who.int/medicinedocs/documents/s19577en/s19577en.pdf. Accessed 27 Dec 2017.

  66. Panteli D, Arickx F, Cleemput I, et al. Pharmaceutical regulation in 15 European countries: review. Health Syst Transit. 2016;18(5):1–118.

    PubMed  Google Scholar 

  67. Ng CW. Universal health coverage assessment: Malaysia. Global Network for Health Equity (GNHE). 2015. https://umexpert.um.edu.my/file/publication/00008779_131499.pdf. Accessed 24 Dec 2017.

  68. World Health Organization. World Health Day 2018—Lessons from Malaysia on universal health coverage. 2018. https://www.who.int/malaysia/news/detail/18-04-2018-world-health-day-2018-–-lessons-from-malaysia-on-universal-health-coverage. Accessed 2 Nov 2018.

  69. David Q. The Malaysian healthcare system: a review. In Intensive workshop on health systems in transition: Kuala Lumpur; 29–30 Apr 2009.

  70. Kumar VA, Azmi HA, Fahad S. Health care financing in Malaysia: a way forward. Arch Pharm Prac. 2015;6(4):93–6.

    Article  Google Scholar 

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Acknowledgements

We wish to thank all Ministry of Health’s pharmacists who helped in data collection. Many thanks to the pharmacists in the private hospitals and retail pharmacies who volunteered to participate in this study. We are grateful to Aisha Adam and Ee Vien Low for their help in editing the manuscript. We would like to thank the Director General of Health, Malaysia for his permission to publish this article.

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Authors and Affiliations

  1. Pharmaceutical Services Programme, Ministry of Health Malaysia, Lot 36, Jalan Universiti, 46200, Petaling Jaya, Selangor, Malaysia

    Shui Ling Wong, Saliza Ibrahim, Norazlin Abdul Kadir & Salbiah Mohd Salleh

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  1. Shui Ling Wong
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  2. Saliza Ibrahim
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  3. Norazlin Abdul Kadir
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Contributions

All authors certify that they have participated sufficiently in the work to take public responsibility for the entire content of the manuscript. SLW, NAK and SMS conceived and designed the study. SLW analyzed and interpreted the data. SLW and SI participated in writing the manuscript. All authors edited and revised this manuscript and gave final approval before submission.

Corresponding author

Correspondence to Shui Ling Wong.

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Funding

This work was supported by the Pharmaceutical Services Programme, Ministry of Health Malaysia.

Conflict of interest

Shui Ling Wong, Saliza Ibrahim, Norazlin Abdul Kadir, and Salbiah Mohd Salleh, declare that they have no conflict of interest.

Ethical approval

Ethics approval was obtained from the Medical Research and Ethics Committee, Ministry of Health Malaysia. The study is registered under the National Medical Research Registry (NMRR-16-2476-33791).

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Wong, S.L., Ibrahim, S., Abdul Kadir, N. et al. Access and Affordability of Medicines in Malaysia: Need for a National Pricing Policy. Appl Health Econ Health Policy 17, 641–654 (2019). https://doi.org/10.1007/s40258-019-00480-9

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