To date over 80 medicine price and availability surveys have been completed or are underway using the WHO/HAI methodology (see database and survey reports). The results of the surveys confirm that substantial opportunities exist to increase availability, lower prices, and improve the affordability of medicines in all regions of the world and at all levels of economic development. However, it can be challenging to identify and prepare suitable lines of response.

Chapter 11 of the WHO/HAI price measurement manual outlines general pricing policy options but, at the request of national policy-makers, WHO, HAI and a group of international experts have developed in-depth guidance on various policies and interventions to increase medicine availability and make medicines more affordable, with a focus on low- and middle-income countries.

This guidance takes the form of a series of in-depth reviews. The reviews are not meant to recommend one policy intervention over another, but rather provide guidance to policy-makers on the design and implementation of various policy approaches. For each review, a policy brief will be published that highlights key points from the review.

The results of the policy reviews undertaken to date show that relatively little has been published about the use of pharmaceutical pricing policies and interventions in low- and middle-income countries. Therefore, the review papers are published as working drafts, to be developed as more becomes known on the use of these interventions in low-and middle-income countries. We welcome information and comments that will strengthen these reviews (please forward them to Margaret Ewen, Health Action International email marg@haiweb.org).

We hope these papers will be a useful resource, and encourage national policy-makers to tackle the challenge of developing and implementing policies and strategies that ensure universal access to affordable medicines.

The first five reviews are now available (click on title to access the paper):

Review 1: External reference pricing

This is the practice of using the price of a medicine in one or several countries to derive a benchmark or reference price for setting or negotiating the price of the medicine in a country. The paper outlines where and how external reference pricing is used, its effects and indirect effects, whether it is an appropriate price regulation mechanism, components of an external reference pricing system, and more.

Review 2: The role of health insurance in the cost-effective use of medicines

Insurance systems have great potential to improve the cost-effective use of medicines by leveraging better prescribing, more cost-effective medicine use by consumers and lower prices from pharmaceutical companies. The paper discusses product selection strategies (formularies, generic substitution policy etc), product purchasing strategies, reimbursement design and contracting strategies (financial incentives, separating prescribing and dispensing, and more), and utilization management strategies (education campaigns etc). The review includes four case studies.

Review 3: The regulation of mark-ups in the pharmaceutical supply chain

Mark-ups in the supply chain are variable, and often unregulated in low and middle-income countries, which can result in patients paying more than double the manufacturers selling price for a medicine. This paper reviews the evidence on the extent of mark-ups regulations, different approaches in regulating wholesaler and retailer mark-ups, the viability of wholesalers and pharmacies, enforcement issues, the impact on medicine prices and more. Three case studies are included.

Review 4: Competition policy

Competition can reduce medicine prices and increase availability if the right conditions are in place. This paper looks at competition in the pharmaceutical sector and the role of competition law (effects of competition on prices, common problems with the functioning on the medicines market, examples of applying competition law to manufacturers of originator brands, generic manufacturers, retail pharmacies etc). Health sector policies and practices that affect competition are reviewed - those that can support competition (generics policies, public procurement policies etc.) and those that can limit competition (trade and industry protection policies etc). The paper includes a comprehensive case study on competition law in South Africa.

Review 5: Sales taxes on medicines

Many governments apply VAT and other taxes on medicine to generate revenue.This paper discusses the extent such taxes affect access to care, the economic case for taxing medicines and the case against taxing medicines, and proposes healthier ways to raise public revenue.

The following reviews are in development:

• Promoting the use of generic medicines
• Cost-plus pricing
• Pharmacoeconomic analysis
• Tariffs on medicines