[e-drug] Kuwait Medicine Price Survey

["Douglas Ball" <douglasball@yahoo.co.uk>]

E-DRUG: Kuwait Medicine Price Survey
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Last year we conducted a Medicine Price Survey in Kuwait using the HAI/WHO methodology. The report has been published on the HAI website and the data will be available soon from the same. 

Public sector procurement was very efficient with a median price ratio (MPR) to MSH reference prices of 5.0 for brands and 1.2 for generic equivalents.

Private sector retail prices varied but were generally high with a MPR of 18.3 for brands and 15.9 for generics. Brand ciprofloxacin capsules had the highest MPR at 110. Retail prices on average were almost twicethose in Australia.

The executive summary is copied below and the full report can be downloaded from:

http://www.haiweb.org/medicineprices/surveys.php

The Kuwaiti-only list of drugs mentioned in the full report has since been abolished.

Regards

Douglas Ball
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Dept. of Pharmacy Practice
Faculty of Pharmacy, 
Kuwait University
E-mail: dball@hsc.edu.kw
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Background: A survey of the availability and prices of 35 medicines was undertaken in the public and private sector pharmacies in Kuwait in 2004 using the HAI/WHO medicines price survey methodology. 

Methods: Public procurement prices were obtained from the Central Medical Stores (CMS) and 25 private retail pharmacies were surveyed for prices that the patient would pay. Availability of innovator brand (IB), most sold generic (MSG; generic product with the highest sales nationally) and lowest priced generic (LPG; generic product with the lowest price at each
facility) equivalents was assessed in 25 public health facilities (5 general hospitals and 20 polyclinics) as well as the 25 private pharmacies.

Results: Central Medical Stores had over 90% availability of the survey medicines. Availability of the survey medicines at public health facilities on the day of the survey was low (IB 12%, MSG 0%, LPG  12%) but this was mostly related to the restricted distribution of many of the survey medicines within polyclinics. Innovator brands were more likely to be found in private retail pharmacies than generics (IB 84%, MSG 0%, LPG 0%). 

The public procurement median price ratio (MPR) to MSH reference prices was 5.0 for IB and  equivalents; in the private pharmacies, the median MPRs for IB, MSG and LPG were 18.3, 16.1, and 15.9 respectively. In private pharmacies, IB beclometasone inhaler had the lowest MPR (3.7) whereas IB ciprofloxacin had the highest MPR of 110. For medicines from private pharmacies, the median MPRs compared to Australian PBS prices were 1.7 (IB), 1.9 (MSG) and 1.9 (LPG). On average, MSG products were 87% of the price of the corresponding IB in private retail pharmacies.

The lowest paid government worker of Kuwaiti nationality would need between 0.1 and 3.8 days? pay to afford the model treatments (for example for gastric ulcer, hypertension and asthma) from private pharmacies. For non-Kuwaiti unskilled workers, however, the model treatments were generally not affordable and would require between 0.8 and 22.0 days? wages. 

There was an error rate of 15.5% in the pricing of IB products compared to official price lists, with a tendency towards higher prices. Generic product pricing showed a similar error rate. However, there appeared to be no systematic attempts of overpricing on a product-wide basis. Private pharmacy medicines prices included a total mark-up of 70% over the CIF
price based on 2004 drug prices.

Conclusions: Public sector procurement of medicines in Kuwait is effective and efficient although the reliance on some innovator brands does not seem necessary. Increased procurement of generics in the public sector could lead to more cost-effective
utilisation of resources. Medicines prices in the private sector are almost twice those in Australian PBS reference prices, with a wide range between
individual medicines. Limited generic penetration of the market means some medicines would be unaffordable to low-paid non-Kuwaiti workers if they had to purchase them from private retail pharmacies. When generic pharmaceuticals are available they are often
priced only 10-15% below the innovator brand price due to lack of competition and the pricing regulation system. Increased availability of low-cost generic medicines in the private retail pharmacies e.g. through taking advantage of the public sector procurement system, could result in dramatic reduction in out-of-pocket pharmaceutical expenses to patients who need to purchase medicines from the private sector.