Index of /enm/images/dokumen

ISI BERITA

Merujuk pedhal

tersebd

dial,as,

bersarna ini dengnn hormat disampaikan

haltal

sbb:

1.

Berdasarkan

data lGntor

W-|o

Wilayah Timur

Mediteriania,

deuasa

ini

jumlah

penduduk

Yaman yang berkisar

19,7

iuta

orang

llang

s€kitar

71c/o diantananya

tinggal

di

daerah

pedesaan

dan

tkqkat

buta

hurufnya relatif

tinggi

dengan

prosentase

55,7o/o.

Yaman

juga

digolongkan

ssbagai negara

ber.endapatan

perkapita

rendah,

dengan

GDP

nyra

sekitar

tJSi$

659.00.

EXsisi

ldin,

Yaman

membelanjakan

sekilar

5,5016

dafi

GDP nya uniuk

sektor kesehatan (pada tahun

2003) dengan total behnia kesetratan per

kepatarrya

mencapai

US$

32.00

2.

Befanja

sektor

srm$al

or

i'rarte

expnditure

Udang kesehatan

dari

prosentase total

pengeluaran

kcs€hdan

diperkirakan

befiisar 59%

da

tdrun

2003-

Fasilitas

kesehatan berupa rumah sakit (baik milik

pemerintdr

maupun snasila)

tedapat

di

sejurrilah kota-kota

besar

(sepedi

Sana'a,

Aden

dan

Hodeklah)

dan

fasilitas

kesehatan

dibawah rumah

sakit

seperti poliklinik

dan

unil

kesehatan umumnya

tersedia sampai

dacrah pcdc:laar.

Namun demikian, pelayanan

saklor

kesehatan

tidaklah gratis

-

pasktn harus

rcmbalar

baya

konsultasi

doktemya

dan

biaya untuk

mendapatkan obat-obatannya dengan

harga

nnfl(

up

sekitar

109o (kecuali untuk

sejunlah

obat-obatan

yang mcndaeattan

subsldi

yang dibcrikan kcpada

pasien

dengnn gratis).

3.

Indusfi fannasi lokel (yang beriumbh 10

pabrik) harrya rnampu

rnemenuhi

kebutuhan

donestik sekitar

1O%

*ia

dan

sebbifnya

dlimpor

dad

negana-negaftl

Arab,

produsen

fannasi

di

Eropa

dan negr+negara Asia

Selatan

serta

Asia

Tenggara

meldui

perusahaan importir fannasi

Yaman.

Terdapat hal menarik bahwa

produlr

fanmsi yang diinpor dari

negar&negara

Asia

(klrususnya

lrdia

dan

Pakistan) harganya

relatif lebih

murah daripada

yang

diimpor

dad

negaftFnegara

diluar lndia dan

Pakisilan.

4-

Gambaran

urnrm

produk-produk

fannasi

di

Yeman ditandai dengan

masih

te6atasnya

ketersediaan poduk-produk

Fannasi

di unit+nit

kesehatar umum; pada

toko

penjualan

produk-produk farmasU

apotk $rasta,

harga

iual

obatan-batan

bermerak relatif mahal

dan

obd-obatan gcncdc

bervariai

harganya,

mubi

dari

sangat murah sampai

dengnn

rnahal;

serta,

perEpbatan

penyakit rnenggunakan

obat-obatan generic relatif

tefangkau

hargarrya

dibanrlingkan menggunakan

obat-obatan

bermerek

5.

Secara umurn, pada wilayeh

yatg

dinaungi

oleh WHO Easfem lilditenanean

Rqion

ditandai dengpn kenyataan bahwa masyalakat terpaksa

harus

membayar

biaya kesehatan/ pengobatannla

jika rnendataqi

fasilitas kesehatan swasila yang

kadangkala harganya

mahd dan

kondisi

hi

memunculkan

desakan

kuat

bagi

pemerintah untuk campur tangnry' memperbaiki hebijakan farmasi nasionafnya dan

kebijakan pcrrcntuan harya yang

cbktif-6.

Bagi prcduk-produk

f;annasi

impor sebelum rnemperoleh

lfrn

bercdar di Yaman, pihak

berwenang

di

Yaman

(Supenn

Boad for

Drugs ancl

tyledtcall

Applianes)

mengirimken

lim

pemeriksanya rneniniau cara pembuatan

obatobatan/

on

the

spot

di

pabrik-pabrik

farmasinla untuk

memastikan

bahwa

poduksi

obatobatannya

sudah

mernont

hi

standar

(di

Indonesia,

dikenal dengen

pemberien

fabel

cara

pemb,uatan

obat yang baiU CPOB).

7.

Dilihat

dad

aspek

ketefirngkauei

haqe

obat-obaten

bagi

masyaraftat

di

Yaman,

diukur dari jumlah hari heria dan dikaitkan dengan perolehan gnii terendah pegawai

pennrintah

unsUlled

yang akan

digunakan

untuk

membayar

biaya

pengobatan

2t12

9.

suatu penyakiU

aqr{e

cnn&fun

ataup{.tn

pengobdan

selama sebulan bagi kondisi/

penyekil

yang

kmniU

drrcnic

@trtlior,

dengan gaii terendah

pegmai

pemedntah di

tahr.rn

2006

addah

sebesar

555

Yemena

nlBls

(setara

US$

2-81)

per

harinya.

Dengan

denikian,

untuk

mcmpcrdotr obet

gorcric temurah

di toko farrnasi/ apotilc

akan

nrrmkan

tfaya

krang

dad

gafr

pernenrrya

yang sebeser 555 Yemeni

riyals,

kecuali

untuk

pembelian amitriptyline

(deprassion),

captetil

(hypertension),

metfonrin

(diabetee)

dan carbrrp2sp*

(cptlopry)

yang

msing-masing

membutuhkan Uaya 1,8i 1,4:1,4;

d*r,

1,1

dari upah

habnnya.

Sementara biaya pengobatan

menggrurnakan

obat-obatan bernerck adalah 2

sampai

12 lebih

mdral

harganya bilarnana

rrnggunaken

obgtobatan gernric.

Pengobatan

menggunakan

obd.obdan

bcr?ncrek umumrrya

nrcrbutuhl

n Uaya lebih dari 3 hari

upah

harian

peganrai

penFfitah,

dengan

bfrya

tertinggi

s:ld

merryembuhkan

penyakit

peptic ulcer

mernakai ranitfdine

(5,8 had

dad

upah

hadannya),

menyembuhkan

hlperlension

manggunaltan

@Fn

(5,4 hati dari upeh harbnnya)

dan menyernbuhkan artbdtis nnnggundran didofenac (5 hari dad upah hariannya).

Pembefian/

pengadan

obd$atan

gcnedc dilakukan

deh

ffp

lhtional

Prqnmfor

fil/eidial

Sr/npry

dengm har3n

Zffi

lGUh

rcnd*t

dathada harga

referensi

intemasional.

Namm denikbn, kofipornn

hargn

pada

toko-toko penjual

obat-obatarV apotik milik

suvasta

urrrJrnnya tcrdapet

dlldd

cunuffiive

nnr*-up

sebesar

57,4Vo

baak

terhadap

obat+batan lokal

maupun irxpor

dan

baik terfiadap

obat-obatan gwredc

nEupun bermerek. Angka

57,4%

tersebuil

ferdiri

dari

ma*

up

pada

distributor sabcsar l()96 dan

nn*

up

peda

loketoko

obet-obetan/ apotik esbeser

20%.

Pengamatanl

G€trn

l(BRl

10. Dewasa

ini

juntah

toko penjual obatobatan/ apotik di selunrh

Yanun

berkisar

10O0

buah dan

iumlah/

jenis oba{obatm yang

sudah

ierdallar pada

Kementerian

Kesehatan

oq.

Snpnanr

Mrd

for

&

lgs

atd

*|edicall

Afliarws

berkisar

16.000

buah.

ll.Obatobatan

yang

diinrpor

bcrasal dari

rtegar*-nogara

Arab

(Suriah,

Mcsir,

Arab

Saudi,

Yodania

dan

PEA), negara-rng€fia Eropa (lnggeris,

Peranciq

Jennan dan

Turki) dan negara-negara

Ash

(C}ilna,

Korta

Selatan, India,

Pakisilan.

Malalaia dan

sebagian

kecil

dari

Indonecia). Produk

farmasil

obat-obatan

dari

lndonesia yang

sudah

mag.rlr

dan

beterhr

di Yaman

dixodultsi

obfi

PT-

Intedat

(dengan agonnya

Dadsih

G€rnral

Trading

d[

Sana'a),

PT.

Carung

Indah Abad,

-

hethl

ndicine

industryl

jarrujam.en

(dengan

agsmp

AFMa?br

phanna

dli

Sana'a). PT. Dragon

Pnma

Farna dan PT.

Deirya

Varia yang

saat

ini

sedang melakukan peniaiakan

lapangan.

Tidak rnenutlp

falde

d

hpangan betrua

ada

jugn obat-obdan/

farmasi

produk Indonesia yang

masr*

melalui

jalurli@k

resni

12.

Obat-obatm/ farrnasi yeng umumnya dipakai di Yaman untuk rnengobatil mengatasi

penyakit

hipcrtcrld,

infiuenza,

bsiut

dan

jed+ienis

pernfalcit

lainnya

yarug

bersitat

epiderilc

Selain

obetdaten/

fannasi yang

nerniliki

potensi pasar, alat kesehatan

fainnya

seperti iarum strntik,

det-alat

kontrascpi, debsftop,

alat

tcni

darah (baik

yang konvensbnal maupun

dbttal),

tetqDet

lidr

pasien, kursi tpda,

alel

penyangga

lraki,

tangan dan kaki

palsu

juga mempunyai proqpek yang

cerah.

13.

Saat bertemu

dengm

pcrusahaan importir

fernasi di

Yaman. kualitas obatobatan/

14.

Terlampir

disanpaikan

ddar

pcrulaltaart

ifTrpoftr

famrai

d

Yaman dan artikel dari

WF|O

&sfem

,ifclcfrforfiarcn

Wn

mcr4rcnai

q(cnpn:

ttledieirc

Nes,

avaih ffifty,

atrorlaltifity

and

prtn

@marlnellls'-Demikian

disanpaikan,

alas

pcrfidan rhn

brfr$rnanya

diucapbn

tedma kasih.

Sana'a.

0E

Maret 2009

4112

1.

Pharmaceudcals, Healtlrcare and

He6al

Producti

NationalTrading

Company Ltd.

Natco,

Yemen

Head

Office: Djibouti

Str., ln

front of

Pol-

Seorrity

BuiHing;

Sana'a

Tel/Fax:

(967-t@l5@;

Fax:

{96i1-1H4.754115-274L18-274r69,

P,O. Box:

1182

1105, 1108

We

b

site: www-

natco-ye

me

n.corn;

e-ma

il: natbnal@

natco.ciom.ye

Arraafah

Corporatbn,

Yemen

Leading Yemeni

lmport€r

and Agent

of

several

leadi,ng

mmpanies in

medical

field

Head Otticn:

Ali Abdulmughni Street,

Behind

Taj Sheba

ll'otel,

Sana'a -

Yemen

Tef

:

(

957-1)

27

3W-273988;

Fax:

1962 -L127

23U,

P.O.

Box

:

109O

Web

site:

urwtry.arraafah.bir;

e-mail: arraafah@y.netye

Ala'bed

Medical

suppliesCo.

Ltd., Yernen

Leading Yemeni Company Specialized

in

lmport and

Marketing

of

Pharmaceuticals

and

medicines.

Head

Office:

Sana'a -

Yemen.

Te t :

(967-1)

47 287 5

I

617

;

Fax: (967-1)47

287

4,

rc

Box:

8286

We bs ite : unrrvu.a la

bedpha

rma.com;

e- ma

il:

info@a

labed

pharma.co

m

AFFurqan

Trading,

Yemen

Leading

Yemeni

Corporation

Specialized

in

lmport

and Marketing

of

Pharmaceuti,cals and

medicines.

Head

Office:

Sana'a

-Yemen.

Tef

: (957-1)47

2883

|

a _I

5; Fax:

(967- 1)47 28t82,

Po

Box :

8285

E-mail: info@atfu

rqanpharma.com

Al-Ghazali

For

Trade

&

Medicines

,

Yemen

Head

Office;22nd

May Str.,

Sana'a.

TellFax

(967-11675280/81;

Fax:

(967-1167s277,

P.o.

Box: 2069

Web

Site:

wvnn.ghazalipharma.com;

e-mail:

f.ghazali@yernen.net-ye

MIASS

Trading Center

for

Medicines & Generaf Agencies

,

Yemen

Head

Office: 45

St,

in

front of Af-(ohali

Tower,

Sana'a -

Yemen

Tef;

(96-l-1l6l440t;

Fax;

(967-1f

6t4d,ffi,

PO

Box

:2O299

E-mail: miasspharma@yemen-net.ye; miassphanna@yahoo-com

tnffii

ffsassy

etutW,

fujMr,

bfu(

79mtH&,fuPb'Ycrrwr

Td:

(571)

A721AQ7211; htt:

(67-4

qZZ2tZ;

E;mil:

tu

6at

@/.,reLF

7.

A'alam

Al-Dawa

Co.

ttd.,

Yemen

Head

Office:

Al-Shera'ee Str,

Behird

C.enbral

Bank

of

Yemen Building,

Sana'a.

Tef/Fax (967-U271831;

Far

(967-11272635,

P.O.

Bor

4242

Web

Site:

wnnr-aal-dawa.com;

e-maih

aal-dawa@y.netye; aaldawa@yemen.net.ye

8.

Amir Aldin

Co. For

Trading

& Agencbs

Ltd.,

Yemen

Pharmaceuticals and

medirzl

appliances

Head Offrce:

Altahreer-Saif

ben

thi

yaaen

stree$

Sana'a

Te |

:

( s67 - I l

n

1ffi3

/

27

5395;

Far: l96t

-r127?t330,

P.

o.

Box : 843

2

Website: wmry.amiraldinco.com; e-mail: info@arniraldinco.com

9.

Al-Marwan

Medical

Corporation,

Yemen

Head

Office:

Al{aser

Str, Behind

Taj Sheba

Hotel,

Sana'a -

Yemen

Te

l/Fax:

(%f

-tl29Tn1;

Mobile:

{967Vn

LLT

6L7,

P.O. Box:

43

23

E-ma

il:

ma

rwan80@yemen.net.ye

10.

ARJA'A TRADING,

Yemen

Head

Office:

Taiz

Str.,

Sana'a -

Yemen.

Tef

:

(967-1)633677 -

Fax:

{96'7-l)633674,

P.O. Box:

2685

We

b

s ite :

www.arjaagrou

p.co

m;

e

-mail:

aria a @ye rne

n.net.ye

11.

Al-Razi

Pharmaeutical

Center, Yemen

ALRAZI

is an importing

&

markeUlg company

with

long experiences,

import

&

distribute

pharmaceutical products

&

Medlcal appliances

,

Baby Food

and

Veterinary medicine

in

Yemen

market.

Head

Offrce: Seiun,

Hadramout

-

Yemen.

Tel:

(95-f-5)4O3803; Fax:

(967-11403336,

P.O-Bor

9il)2

E-mail:

ZUBAIDI €!Y.NET.YE

12.

Bilquis Drugstores, Yemen

Bilquis Drugstores

are

a

private company importlng pharmaceuticals,

foodstuff

and

baby

mifk and

fmd to

Yemen market

for

more

than

30 years. The company represents

many

world

companies

that

produce rnucft rnercftandise.

Head

Office:

Eehind

Central

Bank

of Yerneo

Sanab

- Yenren.

Tel: (967-1)272274 -278136

- Fax:

{95-l-1l27$tq

P.O.Bor

305

Website: www.bilguis-ye.com; e-mail: Bilquis.d.s@y,netye

lndonedan Embrcy

eift W,

hjAffir,

h

tu

l*tft

t&

*Be

- feaw,

Td:

(%7-t)

427214427211;

hx: (fi7-l)

427214 Eraril:

inM@t'.ne.re

6112

&Srx**ctm*

grrie*s,

sv**taxLt*ttuy.

mff*r'c$mh*

*it.v

erl# pri*;*

jiil

S,: ei i ;r. i ;t,".: _;:'.: i f: 13 :" _i'li"tt

if

*

f

Rapidly rising costs of hcalth care and high medicine prices arc

a grorving conc€rn *'orldwlle, especiallv in d*<{oping

counritl

w'hr:re patierrts oftcn havc ro pa;, rhe 6rll price of medicincs. This

bricf rcport about mudicine prkes and availzbiliqv in l'etnen is onc of a seritx of papcrs strrnmariring the tcsults nf national mcdicine

pricc and arailabilitv suncys carried our around the globc using

a standard survry m.thodology devdogd hy the $9orld Hr>alth

Organization

{\fHO)

and H<alth Acrion lnrcrnational (}IAD.

It

trs<* a group of 3() mcdicines, widr prt-tet dosage fornrs, strengths,

and pack sircs that are le'lcr:ot co thc glohcl bunlcn of disease,

pltrs st'lected medicins of nati rnal imporance, TheYcmcn sunev

rras undcrtaken in rnid-2006 bv thc Supremt Board for Drugs and

J\'ledicat Appliances (drug regulatorv authoriry).

rFidrin _l'emen:

.

Thc, availabiligv of mcdicines in the public srxtor outlets was

vcry l,:w

.

In prirate pharmacies, the prices of originator brand products rverc gencrally ver.v higlr wherras prices of generk

cquivalents varied from vcry cheap to high.

.

Trtattnents with lr*v pric<d gcnencs

rcrc

re,larivelv

affordable compared to originator brands.

Generelly, across

the

WHO

Fascern

llltditerrantln

Rr.gion,

a

sinrilar picrurc

crncrgr::

rcasonebly cffic,icnt public c,xtor

procuremcnt, people having to pay for their own tncdicincs in thc

prirate i(€tor; ofren at high and froquentlv unafiondablc' priax; and

thc need firr str<,ngct governmcnt action to intrtrdtre or imprcvc

nati,rnal rncdicinrs policies alrd

efrrtire

pricing polici<*.

ir,:i:fliir?

_{r:riif{i.if,iirls}}

x}ri::#

,*fxi aii,i}ii*i}ii!t-v

${{{\i€:.v-Yemen has a population of approx. I 9.7 million inhabltants, 7196

of rvhom livc in rural arrrs. The illite,racy rate is high and reachs

about 55.79.r.

ltmcrr

is a lor+'-incomc countr;v

with

per cagira

L _WI

io/tl.tl.

_{M<lijnc pri*s:}

a ncw appwch to m636s6mgnr" (-rncs,

\forld tteelrh Orsuttarion, 7Oo3. Ar'.rth\|. fFm hnpr//*lnthdwb.o€,/

ln&li.ineprii'e5

t _{\ilHOiH.f. llc&drc pnrs, atuibbrtry ajfui&rk1' dtd prie .e,ipo4ftt.}

i

''ariAa rylw r d{ n2dittnt 2ttzc xttr4 radatt*at i* nhacl twilrta ol d:c Wi,li

lh.alth

Qrytwrt*

fnlaa M&tolvnan Rtla*, (ldru, Vorlil I lcrhh Orgrni

arion Frsiond Ofhcc lbr rhr

lxwn

Medimnm, ?ff)3 (in

pre)-@)H,tlg#:ftL*

Rcgbnrl OftiGG fof thr E5rlrn fqfttcrr.ncrn

*sr}tf3{}ffi#nts

T;rliie

i..

i.".::',. -i ';'f', '::rjit-l.ij

Procurefitsrt

Price

r'

-ilr

ifi".:i:

_{i:i.u:r..'i-'}

fijltr

iii:.r

l

Availabilrty

ri

V

grosr

domcrk

product (CDP) of US$ (r59. Yemcn sprcnt 5.5olo

of irs GDP on

hahh

in 2003 with a roral hcalth txpendirure pcr

capis,rf US$

32.

Private c'xpenditure on health as a percetrtEl",r[

toml expcnditurc on hcalth rvas <stimaced to bc 5996 in 2003.

ln

genczal hcalth sen'icet (either public or prirat€) ere mainly found

in

major cities,

ddrou$r

primary trealth .are centres/units and

polyclinics are scattered throughout the w'holc countrv, including

$ome nlral areas, Putrlk hcalth sen'ice.s arc not fuc; the paticnt pap

a precription

ftr

and the (a-store cost of mcdicincs with a I()Yo

mark-up (trcept for cenain sub,$idibd mrdicines which are given

for free) and thc cost ofany diagnostic tests, as n.rdcd. The local

pharmac<utkai industrv coven appr<rxioretely

l0%

of

the

tool

pharmxeutical markct; most medicin,:s are imponed vie _Prirate

se(tor agcDrs. A total of J5 etsential rledicinrs rverc samPled: 27 frorn thc

WHO/HAI

corc tist arxl 8 strpplcnrentary nredicine*. A toral of 20 public s,rtor outlcts and 20 private phamraci<s wert

includod in dle curv'ey in the capital Sana'a and

tle

majn citics

of

three other populated govcrnorat€s: Aden, Taiz and Hodeidah. In

oach cit)', one principal public generat hospital' four public

hakh

ccntres and 6ve

pri'atc

pharmaci:s wcre sampled (oe Tablc 1).

Thc prccuremetrt prices vlerc obtained from the Natirtnal Progtanr

for Medical Supply

F y+*

l*

_{-ctteti $ !'i'*"}

f

i:' ri i: r.? i *

f*

F":: Et';

i*

li

lb€

WHO/HAI

survey rnethodologv prcscnts

prics

as median

pricc ratios (MPR). Thc MPR is cdculatod bv dividing thc l rcal

prke b.7 dre intcrnationd rcfercne price {convcrtxl

into

krcal

crrrrr'ncy). An MPR of

I

mans rhe local price is cquivalcnt to thc

rcfenrncc price, whercas an MPR of2 m.:ans the lmal pricc is twicc the refergrrr prke. The inrcrnatio.ml refcrcncc prkrs used

6r

this

suft-cy,*cre takcn from the 2005 Man4lement Sciencr= for Hcalth (I4SH) Inrcrnational

Dng

Price Indicator Guidc (nrdian

prkr:

of

high

quality multi-source medicines offercd

to

dcve.loping

countri$ by different suppliets). Use o[ referencc

prics

facilitatcs

intemationat comparisons.

i i1{.,* v _l.:rti:'t;rf ir: i'+ i: f, fi

trciirrgl*

Corrntrt

sprrilir

facrors, ruch as pncing polkicrn

nla*.a

si'ts,

competition, national economic and othcr facrors. ma)'inflrrncc priccs.

Rrr the

purposcs

of

thetc

sun-eys

in

a

low-incr>me

dcvcloping countrif an MPR of

les

rhan r:r cqr.url

to

I

for public

s*tor

procurcm€nt

pric6

and public $ertor pattent prkcs is

considcred trr iodicate a-ceptahlc (not scrssivc) prices.

.4.1"itt vi-i;i i.itl ii;ir

Affordabilitv is calculetcd ss the numbcr

ot&p

tlre lornst paid

unrkillcd gaveutmxnt worker would hare

ro

work

to

pay for a

tRatmcnt coursc for en acuc condition or one mDntht tteatmcnt f,lr a chronic condition. At the time of thc surtc''. the

lowct

paid

Ycmeni government

wo*er

carncd 555 Yemcni riyele fYER)

(US$ _{2.81) per da.v. Owing}

to

the

limited availability

of

the

medicincs sur-gvcd, it rxas possible ro calculatc affordabilir'' in the

prrblic sector

for

onlv

thre

conditionr,

witt

dl

three medicirxs

costing le$s than half a dat's.,r.agc.

O'-crall

in

tlre

private

rctail

plurmacies a Ycmeni workcr,

if

purclrasing l,>w<st priced gencrics, would gencrally necd less then

,,ncdayt wagefor rhesandard tnatmentsanalped foraffordabilitv,

cxccpt

for

anritripqvline (deprcssion), _ceptopril (hvpertcnsion),

mctforn'rin (diabettx) and carbamanr:pinc (epilepsy) wherc 1.8,

1 .4, 1.4 and

LI

days wagcs arc rcquirct, rc'spcttivd,v Figurc

l).

Thc r-ost o[ standard treatmeo$ wirb originaror brands were 2 to

I 2 tinres greatcr than the cost when usingi lowesr priccd gcnrric

cquivalents. Treatmc-nts r+'ith originator brandc thendore geoo"elly

cost more than 3

dayi

wages. The most e{rcnsirrc trcatm€nts

r+'l'rcn usiug originator bralds included thc trcatmc'nt rrf peptk

cdctr rcith ranitidinc, 5.8 deyt' wages; tftirtfilcnt ,rf hyperuension

rvith captopril, 5.4 de,v's wages; and trrathrent

of

anhriris with dicloftnac, 5 dalr' rvagcs.

Pelic

ukt

tta*ota

aitEln

r

m€tto.dn

Hypctt**n

Drpcssiffi

c+loFrl

rrtriltyfE

G

F.

;3-l

ozl i

1:

ffi&fu.fi

13

*i:ii*: s':.jtt!t-

pricsJii

The data on public scrdor procuremenr priccs wcre lirnitcd as

tcndcr price information was available

for

only six medicincs

(all generics). Due

to

the low availability

of

medicincs

in

thc public

sctor,

therc was

litde

dae

6rr calculating ptice ratios

for

prices

tbar

paticnts

pry in

ptrblic

sctor

health facilities,

On avr.ra€le, generic oredicitrcs werc purchasd b-v the National

Prograrn fnr }ledi<al Sapply ar 2O*o lower pricc (nrcdian ,\lPR =

0.79) than intcmational refcrencc

pricc

{Table 2). This sLrggicsts

tlur

tlw Natinnal Progranr for Medical Supply is cfficicnt lvhcn procuring medicins. although it is _{dilEcult to iudgt} dre cflicicncy

of

public procurement

of

pharmaccuticals

in

Ycmen bascd orr

such limited. dara- Likcwise, patient priccs

in

thc public sector

wme gcnerally acceptablc (ncdian

l.{PR l-09

for lowcst pricttl

gcrericr). Howtlcr, orling to poor mcdicinc arzilability. data for

onl,v sir medkines could

te

includd in thc analvsis (Table ?) and

ir was not possiblc ro ass6s tbe diference hct*een public sector

procurrmrntpricts and

paticntprks

(i.e. puhlk scctor mark-up).

Pr.:l>i

ir:

sri{:i{:}i

*t.+i!;ihi$iir

The

results shc,t'cd

overdl public

scctor median arailability ,rf

only 5%

flable

l).

Only

6

of thc

35 survcrrcd rncdicines

rvcre

frxrnd

in at leart four of the

survcycd oudcts. For individual medkints, a completc abcence of more than 459o

of the targetcd mcdicinesrvas obscn'ed (16 out of 35) which are

ussd t<, ar€.a irnpofianr disr:ases srch as h.tpertencion, epilcpsy

(plrcnltoiu), d'rat'ctes(metformin),thyroiddirordcn (levorhvroxini)

and asrhna

(salbutamol

and

beclometasone inhalers).

Only tw<l nredicincr werc in ctock io at leant 309" of rhc public

helth frllititx

surteyr:d:

captopril

(30'q?, _{aveilability) and}

chloroquine phosphatc (70,q6 3veihhiliq)- Cltarh, _{mosr Paiicnts}

h:ve to purdrase medicineo hom private rcail pharnracic.

'lt';i:i* t. _{";r.r:ll','.::i} '.:,1':,,:.,':-, liir.:', r:i.1 :.:;':','ii,,' ::i-'..

?gi-it,r,:.:i .:: ::: :.:1, ..,:'1. :..::, :ii.:11:i,': r J li.

tr::;r ,.' :,il rr- ::,1

8112

iit:I'ivrii?r.,t i:;,3ir:!fi

f prieas

Thc median retail price of originator brands in the privctc sector

in Yemc,n u.as about

l8

times higher than intematianal refcrcnce

price

(Thble

d).

The

prico of

there odginator brands varicd bcru'.r:n 2 and 130 rime* morc, with 75% of rhe.m costingg at

k:st

7 tinrc.r morr than the interrrarional rfercncc

pricc.

For lorcst

pricc generic <quivalents, MPRs varicd from 0.3

to l8

tinres

grcater dran internarional rcfcrcnce prices. The medbn

IIPR

rrar

-1. >.

At the individual medicines

lqd.

thc results shos'

tfnt:

.

IIPRs of some low<st priccd gencrics werr

mrrh

less rhan

thc refcrcnce prices, srch as risperidom (0.2O. This ma,v be attr ibutcd to rgistercd chcaper sources Fmm south

md

south-crst,&ia, such as lrrdia, Pakistan.

.

The difen:nces betrvtrn priccs oforiginator brands and thcir

lo*'est priced gcneric cquivalcnts wene often vcry high. For

insrance, originator brand ciproflox.xin was 24

tims

highcr prked than thc lowcsr priced gcncric txluir2Ln.. Origirrattir

hrands of fluconaz-ole, omcprazrle aod ralritirCinc wcrc a

lirtle over I

I

tinres morc than their lowcst priced gcneric

equivalents.

[n somc casts, br>th tlre originatrrr brand and dre lorxtrt priced gcncric cqtrivalent wcre cxcc'ssivcly

cpcnsire

Figrrc 2 illurtrat<x

*arnples of high priced nrcdicines (both originator brands and lon'est priced generks) with MPRs rn-er 5.

Acmss

rhc

privatc pharmacics, thcrc

wrre

considerable prke

rariations for sr>mc

lowsr

priced generk medkines and originrtor brand

prodtts,

As shown

in

Figure

3,

dr

irrerquartih

.-g.

for

originator brand glibenclamide nas

z0.n

Q5&

F

€.mile)

-

56.24 C/5th percentilc),

wi&

tlrc m.dirn

MPR

of

5t.92.

For originator brand

diloferrrc

drcrc wzs lers veriability; thc intcr,qurtile rangs

rrs

43.4

-

52.09 (median lvtPR 44.62).

;1,

S

;m;:t*"."

l&fltu&

Crdlo(sn

Brconaztt Glbrn[hfiiJe t/bbehdszde c

0

liii*r;: *.

!j::i.::''rr.;,;

i0r

:

50 1

T

i

R',

D

g.-i

a {1

ii

Et-tr

M

x'+bfFEbFltFi.trd Dicbtctcililirtrbild

Glimc$ti$dv

gffit

hild

fi,gi:l::

3.- :l:..; r, , :-..'r 'r 'i,'r, r. ' : ^ i.

Slei;ri

Bytli?iiir{?}s

i* ti:s

pr-iv;it* riectrJr

For the 24 nredicines available in private pharmacies as both the,

originator brand and lmvcst priccd gencric equivalenr, th€ leriation

in

price {mcdian brand premium) was 26Vo, i.c. on everagc the cost of the lowest priced gcnerk equivalent vvas a quarrcr of that

of tlre origioator brand produrt- Ttre interguanile range was l59o

-38%-Akhough rhe

rarious sources

of

medhines {domcstic, Arab countriei, soudr-cast ,fuian countries and Eurog:an producers) may txplain thc largc price rnariations of l

x,txt

priccd or bnnded

generics,

it

is

very

dificult

to

givg

3

feasible explanation or inrerpretation for originator brand prodrrrs unltxr somc

of

the

significantly'lower ccxt originator brand prodrrts wete imported

from a suhtsidi"rd fact<rr.v in countrics with vcry ehcap labour. f3

ri.;aett:

*

t;,tii.i

:. d$!, A ii?s

flilr

ti:

ilrr

S a:: r:ii:r,i:!i- i-:?a-l

No

products, cither originator

bran& or

gcnerics, were frxrnd

in

thc

privare retail pharmacies survr:vod

for

thn:e medioncs: rrcr'irapine, lcrr,astatin and hydrochlorothiaz)de.

i ;: *1+; 1'5q'41q,;

tii *rl$lil.*f

i

s€'irt

The overall price pcoplc pay

for

kru,cs priccd pgnc'rics

in

the

privarc sector was twic€ the patient price

in

_{drc Aublic} sectoc

end tcn timcs rhe gol€rnmeoa procrrcrnent pt'rc. Howerer, Iow pubiic sector availabiliw makcs

it

difficult

to

nrake sound

cross-,scctor conclusions except the possibility that ccftriaone inicctior

had lxen purchased from thc locd prirate nrar{<e nrhich would

eccount for the similarity in price across the scctors (privatdpublic

ratio L

l8).

This contrasts wirh a t6-fold &f,er.nce in ttre pricc

of

gcrreric raniridinc.

i::' j'{i:'.:: i:;i: t:ririr_-}It*,

tt.*

The .rfficial curnulative mark-up in tlrc privais

*.,.r

supply drain

is 5?.449(,, whethcr thc nredkinc is imgoned or locallv pnduced.

gcncric or originator

btand.

This includcs a rvhole'sale matk-up

of l0qi'

and a pharmacv mark-up of Ltt%. This rcpreseots 379i' of the total paticnt price in the casc of _{E:neric aciclovir,} with thc

manufacturcrls price contributing 63% of rhe

find

pdient prk€

(Figurc 4),

,).lj:

I.1ii:

,'"t"r"nent data

we

obniml t-mr olicial nums end mr r"elk{ared

Tir see

if

the official c.umulative mark-up

of

5?.44% is appl-kd,

paticnt

pric6 of

originatot brands

in

the

privatr

soctor were

compared

to

rcgisercd

CIF

pricas.

lf

an ofFer

of

t1096

of

the

official cumulative marL-up is

applid,

only

fl

of

26 originator

brand products bclong to this category Table 5 shou's s.rmc oFthe wide variations in mark-ups, basad

"n

ch< di{fcrcncc .rf rcgiscrcd

CIF price and observcd petirnt price.

There r:right

be

sr+'eral nasons

for

such

*'ide

variabilitv in

cumulative mark-up*:

.

.rf6ciallvset retail nrarginsare violatrrd by rvhoksalcrsandl

,rr rsailcrs to incrca.sc profits;

.

registcrcd CIF pricrx are incornrt or manipular.-l te d*reasc liabilirks (thc t % impons;jon

fe

for thc cosr r,f

each pro-forna invoicc and the 596 custonrs fte for the cost of each shipmcnt);

.

dre oficial margin af 57.441m is not feasiblc and considercd

to bc unfair bv mcdicines treders.

Fletd oan{-up 1b-*

ttft&iale d.lr.,Jo 8t

orts c14rs 1%

Tgg4Y

gqzgE _di

tEnsfo.rdril 3\

Cudmr d'Jq 3*

tt4r8 $EDo.t ftd 13 _frer8hr Co6l" in$rarce._{{cFi 6J9c}

F:iL.-iis.

4.

a'ri! ri

Carbamare€tne

-LB,Va

Srritzerland

ilq

i.:,+ioiirliitil#+*qg

lil;,+rtr

i.:i:r.

Glib€ndamde

393.8%

E$rpt

i:i

i:i

liiiiri;ttiii*.

s

:it:

ri

'''':,.:I.r:

!-1{}11*1u.*i*B*

r

Because of the limited puhlic procurement data and very

low evailabilitv of rnost nredicinc in public

hr:lth

faciliries

ir is

di6nrlt

ro make a rcund;udgemenr abour prrblic

lxdth

s<cor prices, rhat is not alsn misleding. Holvevel

pubhc procurerncnt appeerd to be efficient for the fcw

srn'Ev'cd medkins bc-rng procured, and pricts paid bv

patients in thc putJic sctor wctt cl()se to procurelneilt

prkcs.

.

Overall the availahiliq'of gcncrics in private t<tail

pharmrc'es rvas trcellcot. Otiginator brand producrs rverc

also wir{dy available for m,:st of rhe s.rrvcvcd medicines.

Howewr, the 10096 availabiliw of some third geoerarion

anribiotics, such as ceftriaxonc injcction *'hich is nraint,v

u.eed to trtat meningitis, pneumonia and septicaentia, nra'r'

indicatc the abr:-ri: of tbe nen'er gsncrations of antihiotics.

.

ln conrpa,rison with intcrnational reierence ptices, thc pliccs

of lowest pricerl branded-grlerk I gencric rncdrcinr:s in r:bc

prirrate scctor varied from verv chcag to considerablv high

priced- Mosr originator brands werc considcrablv higher

pricrd rhan rhe refcrence

prics

(?5'/ohsd an MPR>7).

i.lj :,.1,:,:::- i,:ri: : ii:1' 8n* !hl3E 1%

10t12

.

Almost

hglfofthc

priccs of 1 5 originator brands lcrte

higher in l'cmen compared to three Arab crxrntries with

mtrh

highcr GDP per capita, namcly. Jordan, kbanon and

Kuwait.

.

In comparison with thc registered CIF pricec of medicins'

thc cumulative marlaups varied wrddy- Some vrcrcles than

thc officially allowod ma*-up {t7.44Vo) or tr-cn n€atiye

(providing ev-idencc of exagg<ration in rhe registcred CIF

priccs) whilc rxhcrs reflrrt significantly grcatcr mark-up

value*, showiog violation of Yemeni pricing poliry.

tt" i,r* #f 'r't _It3#

a'} r3:* f

it

ri

s

Bascd on the findings of thc strdy, nrommcndations made by

rhe

invtstigators

to

thc

Govrernment

of

Yenren irK{udrd t}E following.

l.

Enhance *re role ofthe public sector to ensurc the anilabiliqv ofall mcdicines on the national ctsentinl list, after rerrising and uprlating the lint to arcommodate ncnt thcrapeutic catcgorits and emerging illncsses.

2. Find alternative sources offinancing for thc purchasing oF

medicines and implementing suiublc mechanisms to retionalize

expenditure thc National Health Accounts nrethodolog.v might

be rlscful in this reg;and.

3. Adopt a pricing system that takes into considcration:

.

rvhether medicines are locally produced or imponed; odginator brands or genericsi branded-gcnerics; life saring

or otherwise;

o

comparing priceri across a well-chosen range of countri.x

which use cost-efiectiveness anatyris, taking into account diffcrcnces in thcir wealdr to that ofYemcnl

t

applying regressivc mark-ups that is, sening lorrrrer

mark-ups for more expensive rn6ll.1not

.

tlre price of theraperrticdly equivrlent products with thc

same risk-bencfi t tradc-offs;

.

using thc registration of ncw medicincx t.r reduce

the prices of older brands prodrred by the.same

pharmaccuticd company;

.

compariot pricrx cornpilod by non-pro6t orgahizdion$/

institutions strch as Manag9ment Scicncer for Hcalth,

Australian Pharmaccutkds Beneft Scheme and othcr

sourc€s;

.

ccensive usc of pharmaco-economic tools and

fir€asurcm€ots, including coat-benefit analvsis'

cost-cffectiveness and,vsic, cost-minimization anabsis and

crxt-{rtil iqv tnd}'s is.

r

srrioeconomic sittntion an lysis of the countEv as wdl as

tbe affordabiligv of treatments for poor _Patients.

4.

Ch6k

and revise rcgistcrcd CIF prico on a fair, rcliable and regular besis, given that prkcs of raw materids are dccrcrsing

anoudly fur origlnator braods with the iutroducti.rn ,rf

numeror$ gencric/ btandcd-gencric

quivdcnts-5. Encourage drc prescribing of mcdicincs bv the gencric rame; information diss€minated in thc media and through htalth

ryndicater/ prolessionel associations could play an importanr role

Furf

ir*r

irrfr:rs:

rai

ian

Dr Yasccn Ahmod Al-Qgbati

Dircctor of Planning and Statistical Depanment

Suprane Board of Dnrgs and \'ledicat Appliancrx Ministr.v of Health

Email: sbdma@Jrnet.ye

Essential Mcdicincs and Pharmrceuticd Policies Unit

\forld

Hcalth Organization, Regional Ofice for

tlr

Eastern Mediterranean

AMul

RazzakAl Sanhouri Strc*, PO.Box 7608 Nasr Cky, Cairo, Eg1ryt F- mail : emp@mro.who. int

Thc fi.rll survry rcport end data can be found at httpJ/www.haiweb,org/modicincprices/survess

@\0orld Health Organization 2008 Document no- VHO-EM/EDB/090/E

12112