Medicines account for 20–60% of health spending in low- and middle-income countries, compared with 18% in countries of the Organisation for Economic Co-operation and Development (OECD). Up to 90% of populations in developing countries buy medicines through out-of-pocket payments, making medication the largest family expenditure item after food. High prices of medicines might force people to forego treatment or go into debt. As a result, medicines are inaccessible to large sections of the global population and a major burden on government budgets.i This inequity is recognized in the Millennium Development Goal target: “[I]n cooperation with pharmaceutical companies, provide access to affordable, essential drugs in developing countries.”ii
Affordable prices are designated by WHO as a determinant of access to medicines – together with rational selection and use, sustainable financing, and reliable health and supply systems.iii Despite some clear successes, many countries are still failing to implement policies and programmes to improve access to affordable medicines. The challenges faced differ by country but a common problem is the lack of technical capacity to analyse and interpret the relation between price data and local policies and to respond effectively to high prices or unusual price variations. A related issue is the paucity of published evidence on the effectiveness of policies in low- and middle-income countries. Lack of political commitment due, for example, to conflicting industrial or trade policies, can also act as a barrier to the adoption of strategies to reduce the price and improve the availability of medicines.iv
The past ten years have seen the introduction of several global and regional initiatives, including a collaboration between WHO and the international nongovernmental organization Health Action International (HAI) to improve medicine availability and affordability in low- and middle-income countries. Project activities included development of a standard survey methodology for measuring medicine prices and availability, which has been applied in more than 50 countries. Medicine pricing activities are also under way in WHO regions, such as development of regional reporting systems for government pharmaceutical procurement prices. Several regional networks, such as the European-based Pharmaceutical Pricing and Reimbursement Information, have been established to share information on pharmaceutical pricing and reimbursement decisions. Efforts have also been made by the Pharmaceutical Pricing and Reimbursement Information, the OECD, and others to document the pharmaceutical pricing policies being implemented in countries. However, evidence of the impact of such policies is generally scarce, especially in low- and middle-income countries.
As part of the WHO/HAI project, a series of six reviews was completed to identify and describe policies used to manage medicine prices, increase availability, and make medicines more affordable, particularly in low- and middle-income countries. These WHO/HAI policy reviews include published and unpublished materials, country case studies, and key informant interviews. The topics of these reviews, plus the definitions used throughout this guideline, appear in .
WHO/HAI review series – topics and definitions.
The purpose of this document is to provide advice for countries on managing pharmaceutical prices that: (i) consolidates the evidence from countries at all income levels; (ii) builds on the reviews done as part of the WHO/HAI project; and (iii) reflects experiences from a range of countries.
