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LATEST NEWS UPDATES | A healthier India: Need to resolve conflict between drug price controls, innovation and affordable healthcare-David Taylor

A healthier India: Need to resolve conflict between drug price controls, innovation and affordable healthcare-David Taylor

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published Published on May 10, 2012   modified Modified on May 10, 2012

The debate about essential-medicine pricing and access in India illustrates the difficulties inherent in establishing policies that serve conflicting public interests in achieving goals such as caring well and ensuring safety for all, while also pursuing financially-sustainable success in scientific innovation and trade. It highlights problems facing those interested in continuing drug and vaccines development and ensuring that, once marketed, such products contribute effectively to improving public health. Modern pharmaceuticals played a significant role in increasing average life expectancy at birth in India from little more than 40 years in 1960 to the world average of about 67 years today.

Yet, because of this success, the burden of non-communicable diseases is growing . Further pharmaceutical discoveries will be essential for controlling such conditions and preventing long-term ill-health as the country's future population ages. India is now the world's thirdlargest medicines-maker . Yet, despite this, many people have deeply ambiguous feelings about synthetic drugs and the companies that discover and sell them. But as social change continues, legitimate public demand for science-based preventive and curative medicines will continue to rise.

Cost-based pricing?: Resolving such challenges demands economic logic and political courage, alongside world-class science. Against this background , critics of the recent draft National Pharmaceutical Pricing Policy ( NPPP) fear an extension of the essential medicines category that will include an ever-widening range of products, coupled with a narrowly-defined , cost-based pricing regimen. This combination could make producing such treatments for sale in the country so unattractive that their supply is curtailed rather than improved. The country already has among the lowest medicine prices in the world. Yet, experience shows that low costs are in themselves no guarantee of universal access to quality healthcare. Universal access to quality care demands adequate overall investment in sociallyjust and economically-robust health systems.

The response to such concerns by those favouring more restrictive drug price controls is to stress that drug costs are seen by the public to be the greatest barrier to treatment access. They argue that even among the middle class, the high cost of medicines is often seen as potentially ruinous. It is not surprising that such citizens want political action to improve their outlook. But in reality, it is misleading to suggest that better healthcare will be achieved simply by, for instance, cutting newer anticancer agents' prices. This is because in contexts like oncology , the main costs of effective treatment lie outside the pharmaceutical sphere. What is needed is an affordable and adequate system of healthcare financing that assures both continuing competitive market-driven investment in better therapies and community-wide support for those unfortunate enough to develop conditions like cancer.

More sustainable solutions: The resolution of questions about how countries such as India can most fairly and effectively provide healthcare and medicines must come from within their own unique societies . Yet, at the same time, India is so large that the entire global community will in time be affected by its policies. Given that humanity shares many common problems, there should be benefits to be gained from analysing other regions' experiences and needs. Seen from this perspective, key points to consider in thinking about essential medicines' pricing and supply in the country include:

By international standards, combined public and private spending on medicines in the country is not - at around 1.5% of GDP - unexpectedly high, especially when it is remembered that private drug costs often include large markups imposed by suppliers. Yet, publicly-resourced spending on health services as a whole is exceptionally low. So, focusing too exclusively on reducing drug or any other single set of factor costs could well mislead policymakers and distort public debate.

The poorest half to a third of the Indian population lacks reliable access to modern essential medicines. This appears in part to be due to problems like the improper diversion of supplies from public services and/or inappropriate additional charging. No centrally-imposed medicine pricing approach will address this issue. Global experience shows that when populations need free drug supply, simply driving down prices may benefit those able to pay, but leaves those unable to pay even worse off because it obscures their needs.

Like all other advancing nations, India must earn its living in the world by contributing to technical advances and selling products based on them at fair and viable market prices. Its success to date in producing generic and branded generic medicines has been related to a particular phase in history, during which there have been special opportunities for expanding low-price offpatent medicine sales. But the situation is changing fast.

To build further successes by contributing more to therapeutic innovation, policymakers will need to concentrate more on permitting an adequate price base for new products while they are exclusively available, and also allowing efficient market mechanisms to minimise the cost of older medicines. Health improvement everywhere is dependent on constructive and honest partnerships between all sections of society, including not only governments and health professionals but also the researchbased companies that succeed in bringing new treatments to the world market.

The Economic Times, 10 May, 2012, http://economictimes.indiatimes.com/opinion/comments-analysis/a-healthier-india-need-to-resolve-conflict-between-drug-price-controls-innovation-and-affordable-healthc


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