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Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan.

Waning B, Maddix J, Tripodis Y, Laing R, Leufkens HG, Gokhale M - Int J Equity Health (2009)

Bottom Line: The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region.Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices.Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price.

View Article: PubMed Central - HTML - PubMed

Affiliation: Boston University School of Medicine, Department of Family Medicine; One Boston Medical Center Place, Dowling 5 South, Boston, MA 02118, USA.

ABSTRACT

Background: A rural pharmacy initiative (RPI) designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region.

Methods: We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition.

Results: Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70%) medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57%) medicines, increased for 4 of 30 (13%) medicines, and remained unchanged for 9 of 30 (30%) medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price.

Conclusions: The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the potential to leverage medicine price competition as a means of achieving their goal. Evaluations of interventions to increase rural access to medicines should include impact assessment on both formal and informal pharmaceutical markets.

No MeSH data available.


Price changes for ferrous sulfate+ascorbic acid (Gyno-Tardyferon®) tablets.
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Figure 5: Price changes for ferrous sulfate+ascorbic acid (Gyno-Tardyferon®) tablets.

Mentions: For descriptive purposes, we calculated competitor price changes by comparing their average price for the last quarter observed in the study to their average price in the quarter preceding the first RPI price observed. Competitor final price changes are presented as percent price changes (Figure 2, Table 2) and calculated as follows: ((average pricelast quarter - average pricequarter before RPI introduction)/average pricequarter before RPI introduction) × 100. We plotted examples of competitor price changes for medicines that exhibited price decreases, price increases, and no price changes (Figures 3, 4, 5, and 6). The Health Insurance Fund reimbursement prices are provided as a reference but are not meant to be an indicator of retail prices. The reimbursement price is the amount reimbursed to pharmacies by the Health Insurance Fund, whereby the patient pays the difference between the retail and reimbursement prices. Each medicine has a unique reimbursement price, ranging from 30-100% of the retail price. These reimbursement prices are changed regularly but these changes are typically not related to changes in retail prices.


Towards equitable access to medicines for the rural poor: analyses of insurance claims reveal rural pharmacy initiative triggers price competition in Kyrgyzstan.

Waning B, Maddix J, Tripodis Y, Laing R, Leufkens HG, Gokhale M - Int J Equity Health (2009)

Price changes for ferrous sulfate+ascorbic acid (Gyno-Tardyferon®) tablets.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2803474&req=5

Figure 5: Price changes for ferrous sulfate+ascorbic acid (Gyno-Tardyferon®) tablets.
Mentions: For descriptive purposes, we calculated competitor price changes by comparing their average price for the last quarter observed in the study to their average price in the quarter preceding the first RPI price observed. Competitor final price changes are presented as percent price changes (Figure 2, Table 2) and calculated as follows: ((average pricelast quarter - average pricequarter before RPI introduction)/average pricequarter before RPI introduction) × 100. We plotted examples of competitor price changes for medicines that exhibited price decreases, price increases, and no price changes (Figures 3, 4, 5, and 6). The Health Insurance Fund reimbursement prices are provided as a reference but are not meant to be an indicator of retail prices. The reimbursement price is the amount reimbursed to pharmacies by the Health Insurance Fund, whereby the patient pays the difference between the retail and reimbursement prices. Each medicine has a unique reimbursement price, ranging from 30-100% of the retail price. These reimbursement prices are changed regularly but these changes are typically not related to changes in retail prices.

Bottom Line: The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region.Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices.Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price.

View Article: PubMed Central - HTML - PubMed

Affiliation: Boston University School of Medicine, Department of Family Medicine; One Boston Medical Center Place, Dowling 5 South, Boston, MA 02118, USA.

ABSTRACT

Background: A rural pharmacy initiative (RPI) designed to increase access to medicines in rural Kyrgyzstan created a network of 12 pharmacies using a revolving drug fund mechanism in 12 villages where no pharmacies previously existed. The objective of this study was to determine if the establishment of the RPI resulted in the unforeseen benefit of triggering medicine price competition in pre-existing (non-RPI) private pharmacies located in the region.

Methods: We conducted descriptive and multivariate analyses on medicine insurance claims data from Kyrgyzstan's Mandatory Health Insurance Fund for the Jumgal District of Naryn Province from October 2003 to December 2007. We compared average quarterly medicine prices in competitor pharmacies before and after the introduction of the rural pharmacy initiative in October 2004 to determine the RPI impact on price competition.

Results: Descriptive analyses suggest competitors reacted to RPI prices for 21 of 30 (70%) medicines. Competitor medicine prices from the quarter before RPI introduction to the end of the study period decreased for 17 of 30 (57%) medicines, increased for 4 of 30 (13%) medicines, and remained unchanged for 9 of 30 (30%) medicines. Among the 9 competitor medicines with unchanged prices, five initially decreased in price but later reverted back to baseline prices. Multivariate analyses on 19 medicines that met sample size criteria confirm these findings. Fourteen of these 19 (74%) competitor medicines changed significantly in price from the quarter before RPI introduction to the quarter after RPI introduction, with 9 of 19 (47%) decreasing in price and 5 of 19 (26%) increasing in price.

Conclusions: The RPI served as a market driver, spurring competition in medicine prices in competitor pharmacies, even when they were located in different villages. Initiatives designed to increase equitable access to medicines in rural regions of developing and transitional countries should consider the potential to leverage medicine price competition as a means of achieving their goal. Evaluations of interventions to increase rural access to medicines should include impact assessment on both formal and informal pharmaceutical markets.

No MeSH data available.