Cheaper Medicines Act: Useless and Not Beneficial to Filipinos Continue to Fight for Cheap, Safe, and Available Medicines

After four years of implementation, the Cheaper Medicines Act proves itself a big failure. There are defective provisions and whatever maybe positive in the law is weakly implemented. Cheaper Medicines Act is useless and not beneficial to Filipinos. Patients expected R.A. 9502 or Universally Accessible Cheaper and Quality Medicines Act of 2008, more commonly known as Cheaper Medicines Act, to address the unaffordability and unavailability of medicines. However, prices of medicines have not gone down. In fact, prices of some medicines even increased over the last four years. As a result, more and more people, especially poor patients, suffering from chronic or long-term diseases are increasingly burdened with debts in purchasing badly needed medicines for their life-threatening illnesses.

The Consumers’ Action for Empowerment conducted the “Survey on Access, Affordability and Availability of Medicines of Medicines” to establish the impact of the Cheaper Medicines Act on patients who regularly use them. Questions asked pertain to the medicines prescribed to patients and their capacity to buy the medicines, where they buy their medicines, and their sources of funds to purchase their medicines.

The survey used purposive random sampling in selection of hospitals and communities. Respondents chosen were those undergoing long-term treatment or required taking at least a week’s dosage of medication. Included were seven hospitals as follows: Philippine General Hospital, San Lazaro Hospital, Jose Reyes Memorial and Medical Center, Tondo Medical Center, Philippine Heart Center, National Kidney and Transplant Institute, East Avenue Medical Center, and four communities from Pasig, Paranaque, Payatas and Tondo. Data gathered here was from May 10-May 25, 2012. The survey in on-going in other areas.

Patients’Profile

There were 840 respondents from the seven hospitals and four communities. Of, these 58 percent were female and 42 percent were male. Majority were married (55%), single (31%), separated (10%) and widowed (3%).

A big portion or 85 percent were from the National Capital Region while the rest were from CALABARZON (7%) , Central Luzon (5%), and a few from Bicol, Cagayan Valley and Eastern Visayas. A majority of patients or 42 percent had no jobs with an additional 23 percent who were housewives. Those employed were in the service sector (13 percent), and the rest in transport, construction, agriculture, service sector, housekeepers, sales, professionals, or retired. It is interesting to note that 2 percent were oddjobbers who survived by scavenging, were “barkers,” (individuals who earned tips from drivers by callilng/”barking” to passengers to ride the jeepney), peeled off the skin of garlic cloves, and made charcoal from scrap firewood.

Diseases and Medicines Used

Top ten diseases of respondents were namely heart disease (28.50%), rabies (13.32%), upper respiratory tract infection (12.92%), renal (11.19%), cancer (7.86%), diabetes (7.72%), lung disease (7.59%), gastro-intestinal (3.99%), bone/musco-skeletal (3.46%) and tuberculosis (3.46%). The top 10 medicines by categories of use were anti-hypertentensive (24.16 %), cardiovascular (14.54%), anti-bacterial/anti-biotics/anti-infectives (13.70%), vitamins, 11.12%, analgesics (9.38%), vaccines/immunologicals/sera (9.31%), respiratory drugs (6.85%) gastro-intestinal (4.39%), anti-diabetic (3.97%) and central nervous system disorders (2.58%)

Note that these diseases require essential medicines that are needed on maintenance or long term-basis and are usually expensive. Some patients still rely on vitamins, probably unaware of rational drug use and that these vitamins are not essential.

The respondents listed 2,033 prescription medicines that they use for their various illnesses. Only 828 medicines (44.67%) were taken on full or complete doses. More than half or 1,026 medicines (55.33%) were taken only on partial basis. An overwhelming 99.8 percent said that they lacked the money or did not have money available for medication.

Availability of Medicines

There were 37 percent respondents who bought their medicines from the government-hospital pharmacy or botika ng barangay where they maybe cheaper. But when these are not available or there are no stocks , 63 percent go to commercial pharmacies. Of these, 29.53 percent bought medicines from Mercury Drugstore to buy their branded medicines. Interestingly, another 29.53% also went or to the Generics Pharmacy for generic prescriptions, an indication that patients buy generic medicines when these are available.

Affordability of Medicines

The survey showed that only 21.86 percent of respondents could afford to shoulder their own medical expenses. Other respondents rely on relatives to give them money for medication, resort to solicitations from government, private organizations or church organizations. Loan and mortages were resorted by those who did not have money or needed to augment their incomes. In summary, patient-respondents for the Survey on Accessibility, Affordability and Availability of Medicines are those in need of maintenance medicines for long-term/chronic illnesses, or need a week’s dose. Medicines are expensive and essential, especially those which are branded. The patients go to the government hospital pharmacies to buy medicines, but when these are not available they often go to Mercury Drugstore or the Generics Pharmacy. Many patients have no job, or lack income derived from their work. Many have to be supported by their families. Others rely on solicitations from government or private institutions. Others loan or mortgage property to enable them to buy medicines.

Though patient-respondents were not asked about the impact of the Cheaper Medicines Act, their experiences bear witness to the sad state of implementation of the Cheaper Medicines Act.

Related Article: Cheaper medicines law hasn’t served the poor

DOH Fails to Implement the Cheaper Medicines Act

In a rally on June 6, 2012, the four years after then Pres. Gloria Macapagal Arroyo signed the Cheaper Medicines Act, The Consumers’ Action for Empowerment gave the Department of Health a failed mark for its inability to bring down the prices of medicines.

Consumers’ Action for Empowerment scored the Department of Health based on its failure of four major provisions of the Cheaper Medicines Act. These provisions are:

1. Regulate prices of medicines. Prices of medicines have gone up. As per monitoring of the Senate committee of Trade and Commerce on five medicines, prices of medicines monitored in 2008 when the law was implemented and the current prices June 2012 have gone up, except for Norvasc. These medicines are: Plendil 5mg for hypertension was P23.76 and is now P30; Ventolin inhaler for asthma was P352 and is now P 430.50; Ponstan 500mg for pain was P26 and is now P29.75; Bactrim which is an antibiotic was P17 and is now P33.75. Only the anti-hypertensive Norvasc, has gone down then P44 is now P22.85. Is it because of Cheaper Medicines that the price of Norvasc has gone down or because it went off-patent in 2009?
   
   In addition, the Department of Health claims to regulate and monitor the prices of about 200 medicines. What is the basis for the selection of these medicines which is nowhere near the 600 essential medicines needed in the country. It uses an electonic data monitoring system which is hard to access; thus making it virutally ineffective.
2. Increase parallel importation. Importation of patented medicines from abroad competes with the medicines manufactured in the Philippines, thus threatening the very existence of the fledgling drug industry in the country.
3. Promote and educate the Generic Laws. After more than two decades of the existence of the Generics Law, sales of generics medicines is only four percent. Though generic medicines are cheaper, still patients could not complete the required dosage or take their medicines on a maintenance level because of lack of money. Those aware of savings incurred through use of generic medicines use branded medicines because there is no generic equivalent available in the country. These medicines include eye and ear preparations, dermatological or skin infections, medicines for kidney, heart, anti-depresssion and cancer.
4. Widen availabity by allowing the sale of over-the-counter medicines to non-pharmacy outlets. Sales personnel are not knowledgeable of the rational use of these medicines, which may create adverse side effects and damage vital organis like the kidney and liver.

The Consumers’ Action for Empowerment calls for affordability and availability of medicines vis-à-vis quality and rational use of the medicines and the development of a comprehensive health care. The government through the Department of Health, as well as other government institutions, has a central role in this. Patients need free essential medicines in government hospitals and the exemption of medicines from the 12 percent VAT. These may bring the temporary relief while government still has to seriously define steps in developing a genuine national drug industry that is free from transnational control.

A position paper submitted to the Quality and Accessible Medicines Oversight Committee (QAMOC) on the Universally Accessible Cheaper and Quality Medicines Act of 2008
(19 March 2012)

CONSUMERS' ACTION FOR EMPOWERMENT works on the premise that health is a basic human right and it includes the right to accessible, safe and affordable essential medicines.

We believe that the key to improving people's access to affordable and safe essential medicines and other goods and services can only be achieved when people are provided full economic and social opportunities in a democratic society.

From the start, the Cheaper Medicines Act had its inherent flaws and was not expected to effectively bring down the prices of medicines. The act failed to address exorbitant drug prices and failed to promote and ensure access of majority of the people to quality affordable medicines mainly because:

First, the law while avowed to help generic firms to develop quality and affordable generic medicines does not truly support the development of a local drug industry. The law favours parallel importation of branded medicines from countries where these are more affordable even if their generic drug equivalents are available in the Philippines. Parallel importation promotes dependence and virtually kills whatever is left of the Filipino drug industry.

Second, the law does not address the monopoly control of transnational corporations on patents. Though 80 to 90 percent of essential drugs sold in the Philippines is already off-patent, their generic equivalents still cannot be manufactured and made available to the people. To date, local drug manufacturers produce only 200 of 600 essential medicines. The government fails to fully support local drug manufacturers.

Third, the price of medicines has been left to unregulated free-market forces. The President of the Philippines was given the power to set price ceilings of medicine but transnational drug corporations in the marketing, distributing and pricing of medicines still maintain the control of drug prices.

Consumers’ Action for Empowerment believes that the problem of unabated high prices of medicines can be abated through the implementation of national policies and programs that will:

Establish a self-reliant nationalist drug industry that is responsive to the health needs of the people;

Develop technology that will extract and refine raw materials and chemicals for medicine production;

Improve the potentials of herbal medicine and natural components that are locally available as complementary forms in health management;

Create a temporary drug price regulatory board with representation of stakeholders from people's organizations, consumers, academe, health and industry professionals, etc.

Support the genuine development of the local drug industry and provide incentives to local drug manufacturers in the manufacture of essential medicines;

Facilitate selective importation of essential medicines t not locally produced and available and have gone through extensive testing for safety and efficacy;

Implement the National Drugs Policy and Generics Law of 1988.

The need of Filipinos for efficacious and affordable medicines can only be met when a strong national health care system is in place and under a government whose policies are in the best interest of the people.##

CONSUMERS' ACTION FOR EMPOWERMENT works on the premise that health is a basic human right and it includes the right to accessible, safe and affordable essential medicines.

We believe that the key to improving people's access to affordable and safe essential medicines and other goods and services can only be achieved when people are provided full economic and social opportunities in a democratic society.

From the start, the Cheaper Medicines Act had its inherent flaws and was not expected to effectively bring down the prices of medicines. The act failed to address exorbitant drug prices and failed to promote and ensure access of majority of the people to quality affordable medicines mainly because:

First, the law while avowed to help generic firms to develop quality and affordable generic medicines does not truly support the development of a local drug industry. The law favours parallel importation of branded medicines from countries where these are more affordable even if their generic drug equivalents are available in the Philippines. Parallel importation promotes dependence and virtually kills whatever is left of the Filipino drug industry.

Second, the law does not address the monopoly control of transnational corporations on patents. Though 80 to 90 percent of essential drugs sold in the Philippines is already off-patent, their generic equivalents still cannot be manufactured and made available to the people. To date, local drug manufacturers produce only 200 of 600 essential medicines. The government fails to fully support local drug manufacturers.

Third, the price of medicines has been left to unregulated free-market forces. The President of the Philippines was given the power to set price ceilings of medicine but transnational drug corporations in the marketing, distributing and pricing of medicines still maintain the control of drug prices.

Consumers’ Action for Empowerment believes that the problem of unabated high prices of medicines can be abated through the implementation of national policies and programs that will:

Establish a self-reliant nationalist drug industry that is responsive to the health needs of the people;

Develop technology that will extract and refine raw materials and chemicals for medicine production;

Improve the potentials of herbal medicine and natural components that are locally available as complementary forms in health management;

Create a temporary drug price regulatory board with representation of stakeholders from people's organizations, consumers, academe, health and industry professionals, etc.

Support the genuine development of the local drug industry and provide incentives to local drug manufacturers in the manufacture of essential medicines;

Facilitate selective importation of essential medicines t not locally produced and available and have gone through extensive testing for safety and efficacy;

Implement the National Drugs Policy and Generics Law of 1988.

The need of Filipinos for efficacious and affordable medicines can only be met when a strong national health care system is in place and under a government whose policies are in the best interest of the people.##

Cheaper Medicines Act not properly implemented — Villar

A study conducted by the Senate committee on trade and commerce has shown that four years after the ratification of Republic Act No. 9502 or the "Universally Accessible Cheaper and Quality Medicines Act of 2008," prices of some medicines have yet to go down.

At the bicameral hearing of the quality affordable medicine oversight committee on Monday, it was revealed that of the five drugs included in the study, only the price of one has decreased since 2008 — and it was not even because of the law.

“Norvasc lang ang bumaba. Nabanggit kanina na kaya bumaba ito [ay] dahil naalis na ‘yung patent protection at talagang normally bababa na ‘yun. Walang kinalaman ang batas sa pagbaba nun,” Sen. Manny Villar, chairman of the Senate committee on trade and commerce, told reporters in an interview after the hearing.

Other drugs that were part of the study were Plendil, which cost P23.76 before the passage of the Cheaper Medicine Law but is now P32.25; Ventolin (inhaler), which used to be P352 but is now P432.50; Ponstan, which used to be P26 but is now P29.75; and Bactrim, which used to be P17 but is now P33.75.

70-percent decrease

But according to Reinier Gloor, executive director of Pharmaceutical & Healthcare Association of the Philippines, prices of some medicines have gone down by as much as 70 percent since the law was passed. He said most of these medicines were those sourced from abroad.

“There are lots of Filipino companies… 125 local firms, some competing with multinational products. In certain products sourced from India or China and so forth, the reduction is 60 to 70 percent. For products made in Europe and the United States, the product price reduction goes down to 60 percent,” Gloor said.

Still, Villar said he would further study the implementation of the Cheaper Medicines Act.
“Hindi ako titigil hanggang hindi nakakagawa ng rekomendasyn ang aking komite dito sa implementasyon ng batas na ito. Mahalaga na bumaba ang presyo ng gamot, ito ang objective ng batas na ito at ‘yan ang dapat mangyari,” he said.

“Lobbied”?

Villar said it is “possible” that pharmaceutical companies had a hand — through intensive lobbying — in drafting the Implementing Rules and Regulations (IRR) of the law.

“Possibleng nagkaron ng lobbying sa IRR pero wala akong inaakusahan. Ang sinasabi ko lang ay posible… Masyadong maaga para malaman kung sino pero definitely sa ating pagre-review may mga kumpanya na nagva-violate nito,” he said.

Villar said his committee would invite health officials who drafted the IRR to the third bicameral hearing.

Out with VAT

To further lower the prices of medicines, Villar proposed to remove the value-added tax on medicines.

“Pino-propose ko rin na tanggalin ang VAT sa gamot. Hindi naman talaga dapat na papatungan pa ng VAT ang mga gamot [dahil] talaga namang napakahalaga ito sa ating buhay, kaya hindi ko naiintindihan kung bakit naipasama yan sa VAT natin noon,” he said.

He said his son, Las Piñas Rep. Mar Villar, has already filed a bill for this, noting that tax measures must originate from the House of Representatives.

Free medicines for cancer patients

Meanwhile, Villar also proposed to provide free medicines specifically to cancer patients.

“Ako’y talagang nag-propose noon pa na dapat itong mga gamot sa cancer ay ibigay ng gobyerno na libre. Naniniwala akong kaya ng budget 'yan,” he said.

The senator claimed that the government may opt to buy in bulk to avail of discounts.

“Ang isang Pilipino ay hindi dapat mamatay dahil sa cancer na hindi lamang nagkakaroon ng pagkakataon [makatikim ng gamot],” he said. – KBK, GMA News


Cheaper Medicines Act not properly implemented — Villar