(2007; 36 pages)
Background: A field study to measure the price, availability and affordability of selected medicines was undertaken in Jordan in May 2004 using a standardized methodology developed by the World Health Organization (WHO) and Health Action International (HAI).
Method: The survey was conducted in four areas: Amman (Middle Region), Zarqa (Middle Region), Irbid (North Region), and Karak (South Region). Data on the patient price and availability of 38 medicines was collected in 18 public sector outlets and 20 private retail pharmacies, selected using a validated sampling frame. Data was also collected on public sector procurement prices. For each medicine, data was collected for the originator brand and lowest priced generic equivalent (generic product with the lowest price at each facility). Prices are expressed as ratios to international reference prices (Management Sciences for Health International Drug Price Indicator Guide 2003). Using the salary of the lowest-paid unskilled government worker, affordability was calculated as the number of days' wages this worker would need to purchase standard treatments for common conditions. Availability was determined on the day of data collection.
Results: In the public sector, the procurement agency is purchasing medicines at prices comparable to international reference prices, indicating a high level of purchasing efficiency. However, some high priced originator brands are being purchased. Public sector patient prices for generic medicines are similar to procurement prices, indicating very low or no mark-ups in the public sector distribution chain. However, median availability of generic medicines in the public sector was only 28%, indicating that many patients must purchase medicines through the private sector. In the private sector, the median availability of originator brand and generic medicines was 60% and 80%, respectively. Generic medicines in private pharmacies were priced about 10 times higher than in the public sector, and 10 times higher than international reference prices. When originator brand medicines are dispensed in private pharmacies, patients pay about twice the price of generics. To treat common conditions using standard regimens, the lowest paid government worker would need between 2.1 days to treat arthritis with diclofenac and 4.6 days to treat an ulcer treated with ranitidine when purchasing lowest priced generics from private pharmacies. If originator brands are dispensed, costs escalate to between 4.6 and 8.6 days wages respectively. Some treatments were clearly unaffordable specially for chronic conditions e.g. ulcer treatment with originator brand omeprazole costs 19.9 days' wages. Affordability is much better for medicines purchased in the public sector but availability is poor.
Recommendations: The results of the survey show that the affordability, availability, and prices of medicines in Jordan should be improved in order to ensure equity in access to medicines, especially for the poor. This requires multi-faceted interventions, including the review of policies and regulations, and the implementation of educational interventions to improve the use of generics. There is an urgent need to improve the availability of low priced quality generics in the public sector through improved financing and distribution mechanisms. The current review of pricing policy can also lead substantial reduction of prices in the private sector.