04 April 2006

Drop-Dead Drug Prices

Sorry for being absent these past few days. It is getting to be hot and humid lately here as summer approaches. As the temps rise, so do the blood pressures of people. Complaints of headache, nausea, dizzyness, plus possible increases in the rates of heart and stroke attacks abound during the months of April-May. My own Dad paradoxically experiences his stroke attacks (mostly lacunar) only on the month of April of every year.

I got to read yesterday's papers only today (that's one way to describe how out-of-sync with time I am lately) and found this interesting observation by PDI's Neal Cruz:
[PDI, Apr 03, 2006] - WHY ARE MANY FILIPINOS DROPPING DEAD of heart attacks and strokes? (These two ailments are among the top killers in the Philippines.) Here is one reason:

Amlodipine besylate, an important drug used for the treatment of high blood pressure marketed under the name Norvasc, is sold in Pakistan by Pfizer, a multinational company, at the equivalent of P8.74 per 5-mg tablet and P17.09 per 10-mg tablet. In the Philippines, it is sold by the same Pfizer at P44.75 per 5-mg tablet and P74.57 per 10-mg tablet.

The same Norvasc is being sold in Indonesia at the equivalent price of P21 per 5-mg tablet and P37.93 per 10-mg tablet; in Thailand, Norvasc is being sold at the equivalent price of P26.65 and P45.65, respectively.

The same medicine is sold by Pfizer in India under the brand named Amlogard at the equivalent of P5.98 per 5-mg tablet and P8.96 per 10-mg tablet. Norvasc and Amlogard are both made by Pfizer, but Pfizer sells amlodipine besylate in the Philippines at prices 650 percent and 730 percent higher than in India and more than double the price in Indonesia and Thailand.

If your heart attack and stroke do not kill you, then, the drug prices surely will.

'Sounds amusing, but in a country like the Philippines, we have known this to be true for a long time already. Many have died. And yes, many continue to die. If you've grown cynical about the whole thing, you might even comment that, "Well, at least, our population explosion problem is getting remedied."

Neil Cruz says the reason has something to do with the LAW OF PATENTS, which allows a pharma company like Pfizer "a 25-year monopoly over its sale" of a new drug or medicine usually at prices described "for as much as the market can bear," which is nothing but the business-speak of pharma managers saying that only the rich and those with thousands and thousands of pesos can buy their medicines on a regular basis.

P1.2 BILLION PESOS or US$23.5 million- an amazing amount of money for any poor Filipino.

According to Cruz, P1.2 BILLION PESOS also happen to be the yearly amount of sales of Norvasc, in the Philippines, alone.

This is just one simple anti-hypertensive agent he is talking about. I wonder if Cruz knows about the prices of antibiotics, neuroenhancers for stroke patients, and other new medicines protected by this so-called LAW OF PATENTS.

Rare is the case when patients suffer from hypertension alone. The more frequent consultations (at least, in my case, ok?) involve co-morbidities like diabetes, tuberculosis, respiratory infections, and a gamut of other pathologies needing expensive medicines.

The poor die quietly and unnoticed most of the time.

Sure, there are already cheap generic medicines around, but for those drugs like Norvasc, we doctors can't really do much to bring its price down.

To be fair with Pfizer Philippines, it has offered drug discounts --- Norvasc included --- which prescribing doctors like me can extend to patients we think should need this financial aid. Also, the local governments' have their standard 20 percent drug discounts for senior citizens. But reality tells me that these moves aren't enough.

Bigger discounts are needed if we really want the poor, sick people to continue breathing.

18 reactions:

ipanema said...

It's sad reading this, but it's reality.

I'm not a lawyer, but can't anything be done with those 20-year patent laws? Who protects who and who gets what?

I'm taking Norvasc as maintenance. It's really expensive. But look at the price in neighbouring countries, it's a lot cheaper. From where I am now, locals and those working with the government including foreigners), pay 50 pesos(equiv)/visit, inclusive of medicines and consultation. They will give you a month supply of medicine. Aren't they lucky?

As a monopoly, Pfizer can dictate the price and reaps a lot of profit. But the people suffer and are suffering and will continue to suffer. No one will help us, not the government, they're parasites.

This is just one reason why we packed our bags and looked for the other end of the rainbow. To better our lives.

At the moment I have a sick loved one with an 800 pesos daily expenses for medicine alone. What's the price of becoming ill in our country? I say it's a lot. All from your own pocket with some pharma companies bleeding us till death.

psyche said...

yeah....sad thought. had my own experiences with very expensive antibiotics and antihypertensives. im hoping that things will improve in our country...


Sidney said...

Medicaments are always expensive. Should we not try to eat more healthy foods? I am not surprised that so many Filipinos are dropping dead from heart attacks and strokes. Look how much fat they eat... how everything is deep-fried... :-(
How many people eat a lot of fruits & vegetables?
Try to follow a healthy lifestyle. Do some sports, watch what you eat and you will not need doctors (sorry ! ;-) and medicaments...

ipanema said...

That's a good way of looking at it sidney, - change lifestyle and watch what we eat. But look at it this way.

Fruits and vegetables are expensive as well. An average Filipino would spend his income on meat which is a lot cheaper than fish (as of my last visit, correct me if the price has gone down). I think by nature, we are a meat-eating people. We do eat vegetables and fruits. The irony is that local fruits tend to be more expensive than imported fruits (again, my observation).

An average Filipino spends most of his time working for the next pay check. Others work overtime for extra cash. If they have time to exercise, that would be on a weekend, if they still have energy left (what with family and other responsibilities). Some even work on Sundays for unfinished work. See how stressful life is?

By the way, my doctor who looks fit has hypertension. I'll ask him if he's eating properly... next time. :)

ipanema said...

Seldom I read Philippine news as there are some things that remain unchange all through these years. I was supposed to write something on my blog about UK’s medical tourists opting for dental
procedure in Hungary which appeared on BBC News.

Call it intuition. I googled (new verb?) INQ7.net - lo and behold, Michael Tan of Inquirer did an editorial today on HB 3830, aptly titled "The Last Gasp". I call it Biron Bill, authored by Iloilo Rep.Ferjenel Biron. It aims at lowering drug price through a Drug Rehabilitation Board.

Read the article to have more insights on why neighbouring countries’ price of Norvasc is cheaper than it is in our country. The article is copyrighted, so I can't discuss any further.

It all boils down to economics and politics. These two always go together, never one without the other.

Let's pray that this Bill will pass. Otherwise, as Dr. Emer wrote, some people will just die quietly.

Their last gasp.

bing said...

I was taking Norvasc before. At present, I am taking Lacidipil because it is cheaper.

I hope and pray that the Bill will pass. It would do a lot good to the majority of Filipinos. The high prices of everything produces more and more impoverished people.

Dr. Emer said...

IPANEMA: Thanks for the sensible and enlightening comments. Thanks also for gracing my weblog. I can't see how a Drug Rehab Board will affect Big Pharma's monopolistic price hold via the Law on Patents.

Dr. Emer said...

BING: Is Lacidipil (GSK, I guess) equally effective? The question of quality over price and patient's pharmacologic adaptibility can be a problem, too.

ipanema said...

You're most welcome Dr. Emer. I'm an online nomad :)

Perhaps that's the reason why Michael Tan of INQ7 wished them LUCK :) Will this be buried like other bills supporting consumer rights? Probably big pharmas are clenching their teeth as news of HB 3830 circulated. Someone's just ruffled their feathers. This will be interesting to follow-up. See who wins.

Now most of you will understand what I meant when I say "Forget the government - they're parasites". This kind of bill don't sit well with oligarchs. Vested interest perhaps? And do you really think that multinationals will simply close shop especially if they monopolise the market? Fat chance.

What will the government do? Watch? The government for, of and by the people has long been gone and forgotten. No such thing in the Philippines. We will continue to suffer and slowly die.

Well, this will be a long fight. Let's keep watch.

moks said...

Can we just import the drugs, I mean if it is so cheap in India, why not import it, and sell it locally?

ipanema said...

Multinationals advised to import for it is cost-effective and that they say we don't have a population large enough to support a local drug industry. And if one compares the low price of neighbouring countries they'll say, "It's fake, it's counterfeit...etc."

When we import, we are not helping local generic companies either.

I think we should learn from countries such as India, China and Thailand who refused to sign patent laws that they think would not benefit them. What did our government do? Sign 20-year patent laws?

These countries exhausted their resources for research and manufacture of their own drugs. I think it's high time for us to do so.

bing said...

so far no adverse effects. i was asked by the company doctor to take Zestril but it has bad effects - i cant seem to sleep sound, i cough, and seem to drown. so i shifted to Lacipil. i still have to observe. Norvasc, i agree, is ok.

Dr. Emer said...

MOKS: Yes, I think the government has been doing that since the time of Mar Roxas as DTI Secretary. Dr Lesaca, a former mentor of mine, however, thinks it is not enough to stave off the prices of vital medicines. He gave 5 reasons why it does not work and what should be done.

Dr. Emer said...

IPANEMA: We have no choice but to import because there are not enough local pharma companies capable of producing the important meds needed. It is one of the neglected industries. Tapos, ayan na nga, i-add mo pa dito yung law of patents na problem. No one thinks long-term here. Puro, short-term.

Dr. Emer said...

BING: That is good news. Zestril is an ACE inhibitor, and what you complained about is common. ACE Inhibitors are effective anti-hypertensives but the downside are the many side-effects that go with their supposed actions.

ipanema said...

That's true Dr. Emer. Consumers are aware that we have been importing medicines. We simply don't have the means to produce such meds. That's why prices of such medicines are expensive.

Anonymous said...

I usually use www.HealthPricer.com website to find lower prices for medications at online pharmacies. Sometimes I can find prices that are 50-60% lower than anywhere else.

Does anybodybody knows other websites similar to this one, where you can compare drug prices per tablet, etc.?

Anonymous said...

There are a lot of AMLODIPINE BESILATES in the market that are as equally effective and bioequivalent to NORVASC which are priced 50 to 70% lower.

Once the product is BIOEQUIVALENT, it is deemed as effective as the original brand.

Even with NORVASC's 50% discount, the other amlodipines in the market are still cheaper and provides the same effect since they are BIOEQUIVALENT.

I hope MDs are one with the government in providing universally accessible cheap and quality medicines.