Dr Yuppadee Jarroongrit, Thailand

Thailand improves the accessibility of medicines by ensuring the availability of medicines at an affordable price. However, there are still some accessibility problems in Thailand, particularly in relation to orphan drugs and “high-price” medicines, such as those for AIDS and related diseases.

Thailand has developed strategies and approaches to support the importation of orphan drugs, such as providing fast-track registration. Thailand is also coordinating the updating of the list of orphan drugs, as well as dealing with tax issues. Public hospitals and the health sector are also allowed to import certain orphan drugs without a licence or registration. Research and development of drugs for neglected diseases is promoted. However, these efforts are still at an early stage, and a lot of work needs to be done on funds, infrastructure, resources and other related issues.

For the high-price medicines, especially for AIDS and related diseases, we have developed strategies and approaches on two levels. The first level is prevention. Antiretroviral medicines are provided to new mothers and their babies 2 hours after delivery to prevent vertical transmission of HIV infection. The second level is treatment. Negotiations have been held with pharmaceutical companies for a lower drug price and broader provisions have been implemented to obtain generic ARV medicines as soon as possible. In addition, research and development of these drugs has been promoted and supported. The major achievement is the local manufacture of a three-drug combination containing stavudine, lamivudine and nevirapine, which offers the advantages of good patient compliance, assured treatment quality, affordable price and high accessibility. Fast-track registration has been provided for this drug.

In addition to the national essential drug list, other strategies and approaches include negotiation with companies to lower the price of medicines, parallel import measures, Bolar Provision measures, research and development, priority-setting and fast-track registration, though these are still at an early stage. Moreover, further work such as simplification of the drug registration process is required.

In view of the above, we have some suggestions for the future. Regional cooperation on regulatory issues, to meet country-specific public health needs, should be encouraged. There is a need to promote research and development, public sector drug development and also public-private partnerships. Parallel imports and Bolar Provision measures should be empowered with full support from WHO.