Journal Article > CommentaryAbstract
Int Health. 2014 May 6; Volume 6 (Issue 1); DOI:10.1093/inthealth/ihu005
Grais RF, Adamou HO
Int Health. 2014 May 6; Volume 6 (Issue 1); DOI:10.1093/inthealth/ihu005
Journal Article > CommentaryFull Text
Lancet. 2016 May 1; Volume 387 (Issue 10034); DOI:10.1016/S0140-6736(16)00656-5
Baron E
Lancet. 2016 May 1; Volume 387 (Issue 10034); DOI:10.1016/S0140-6736(16)00656-5
“We are not England, we are not France”, said Hillary Clinton about health-care insurance during a recent US presidential debate. European models of health care have their own history in which redistribution forms the cornerstone of social solidarity. Aiming to guarantee social cohesion, France's Etat Providence is rooted in models of a welfare state that developed in Germany and the UK. Ensuring universal health coverage and financed through payroll taxes, and increasingly through a general social contribution on all types of income, French health insurance is characterised by a strong redistributive scheme that benefits the poorest and the most sick.
Journal Article > CommentaryFull Text
PLOS Med. 2014 April 22; Volume 11 (Issue 4); DOI:10.1371/journal.pmed.1001632
Gerdin M, Clarke M, Allen C, Kayabu B, Summerskill W, et al.
PLOS Med. 2014 April 22; Volume 11 (Issue 4); DOI:10.1371/journal.pmed.1001632
Journal Article > ReviewFull Text
Global Health. 2011 October 12; Volume 7 (Issue 39); DOI:10.1186/1744-8603-7-39
Moon S, Jambert E, Childs M, von Schoen-Angerer T
Global Health. 2011 October 12; Volume 7 (Issue 39); DOI:10.1186/1744-8603-7-39
BACKGROUND
Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines.
DISCUSSION
We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that “de-link” the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term.
SUMMARY To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.
Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines.
DISCUSSION
We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that “de-link” the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term.
SUMMARY To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.
Journal Article > LetterFull Text
Lancet. 2013 March 16; Volume 381 (Issue 9870); 901.; DOI:10.1016/S0140-6736(13)60664-9
Fernandez G, Boulle P
Lancet. 2013 March 16; Volume 381 (Issue 9870); 901.; DOI:10.1016/S0140-6736(13)60664-9
Journal Article > CommentaryFull Text
Health Aff (Millwood). 2015 September 1; Volume 34 (Issue 9); 1569-1577.; DOI:10.1377/hlthaff.2015.0375
Kishore SP, Kolappa K, Jarvis JN, Park PH, Belt R, et al.
Health Aff (Millwood). 2015 September 1; Volume 34 (Issue 9); 1569-1577.; DOI:10.1377/hlthaff.2015.0375
The modern access-to-medicines movement grew largely out of the civil-society reaction to the HIV/AIDS pandemic three decades ago. While the movement was successful with regard to HIV/AIDS medications, the increasingly urgent challenge to address access to medicines for noncommunicable diseases has lagged behind-and, in some cases, has been forgotten. In this article we first ask what causes the access gap with respect to lifesaving essential noncommunicable disease medicines and then what can be done to close the gap. Using the example of the push for access to antiretrovirals for HIV/AIDS patients for comparison, we highlight the problems of inadequate global financing and procurement for noncommunicable disease medications, intellectual property barriers and concerns raised by the pharmaceutical industry, and challenges to building stronger civil-society organizations and a patient and humanitarian response from the bottom up to demand treatment. We provide targeted policy recommendations, specific to the public sector, the private sector, and civil society, with the goal of improving access to noncommunicable disease medications globally.
Journal Article > ReviewAbstract Only
Lancet Oncol. 2018 December 1; Volume 19 (Issue 12); e709-e719.; DOI:10.1016/S1470-2045(18)30658-2
Velazquez Berumen A, Jimenez Moyao G, Rodriguez NM, Ilbawi AM, Migliore A, et al.
Lancet Oncol. 2018 December 1; Volume 19 (Issue 12); e709-e719.; DOI:10.1016/S1470-2045(18)30658-2
Medical devices are indispensable for cancer management across the entire cancer care continuum, yet many existing medical interventions are not equally accessible to the global population, contributing to disparate mortality rates between countries with different income levels. Improved access to priority medical technologies is required to implement universal health coverage and deliver high-quality cancer care. However, the selection of appropriate medical devices at all income and hospital levels has been difficult because of the extremely large number of devices needed for the full spectrum of cancer care; the wide variety of options within the medical device sector, ranging from small inexpensive disposable devices to sophisticated diagnostic imaging and treatment units; and insufficient in-country expertise, in many countries, to prioritise cancer interventions and to determine associated technologies. In this Policy Review, we describe the methods, process, and outcome of a WHO initiative to define a list of priority medical devices for cancer management. The methods, approved by the WHO Guidelines Review Committee, can be used as a model approach for future endeavours to define and select medical devices for disease management. The resulting list provides ready-to-use guidance for the selection of devices to establish, maintain, and operate necessary clinical units within the continuum of care for six cancer types, with the goal of promoting efficient resource allocation and increasing access to priority medical devices, particularly in low-income and middle-income countries.
Journal Article > CommentaryAbstract
Int J Drug Policy. 2015 May 18; Volume 26 (Issue 11); DOI:10.1016/j.drugpo.2015.05.004
Ford NP, Wiktor SZ, Kaplan K, Andrieux-Meyer I, Hill AM, et al.
Int J Drug Policy. 2015 May 18; Volume 26 (Issue 11); DOI:10.1016/j.drugpo.2015.05.004
Journal Article > LetterFull Text
Lancet. 2002 April 13; Volume 359 (Issue 9314); 1351.; DOI:10.1016/S0140-6736(02)08303-4
Ford NP, 't Hoen E
Lancet. 2002 April 13; Volume 359 (Issue 9314); 1351.; DOI:10.1016/S0140-6736(02)08303-4
Journal Article > LetterFull Text
Am J Respir Crit Care Med. 2016 October 15; Volume 194 (Issue 8); 1028-1029.; DOI:10.1164/rccm.201605-1080LE
Varaine FFV, Guglielmetti L, Huerga H, Bonnet MMB, Kiria N, et al.
Am J Respir Crit Care Med. 2016 October 15; Volume 194 (Issue 8); 1028-1029.; DOI:10.1164/rccm.201605-1080LE