Summary from the Economics Track With thanks to all track participants, presenters, rapporteurs, moderators and organizers

What Do We Know?  Given the lack of research in low and middle income countries, there is an urgent need for well-designed studies of the impact of pricing interventions and related policies  Taxes on medicines, such as VAT and sales tax, increase the price of medicines, are inequitable, and add to unaffordability of medicines

What Do We Know?  Tiered pricing of originator products may not result in lower prices than competition and encouraging use of lower priced generic alternatives  Current risk protection models do not necessarily benefit the poorest  Perceptions that low cost medicine (generics) equals low quality have a significant impact on patient behaviour, access and affordability

Policy Recommendations  When designing pricing policies and interventions, consider the impact a policy will have in the context of the entire health care system and how it might be integrated with other policies  A system for monitoring and evaluation should be built into every policy change, using reliable data and a strong research design that compares pre- and post-policy outcomes and, if possible, includes a control group  Effective implementation and enforcement must be part of the design of pricing policies and interventions  Significant efforts should be made to share medicine prices and procurement practices in a structured/standardized way, especially at a regional level

Policy Recommendations  Regional cooperation mechanisms should be encouraged for regulatory activities such as drug registration, post-marketing surveillance, regulating company marketing activities, etc.  Adapt appropriate methods for economic analysis and use the results for decision-making and continued monitoring and evaluation  Quality of generics should be addressed first at the regulatory level to ensure that only high quality generics are registered and secondly at the prescriber and patient level through education and transparent information

Research Gaps  Multi-disciplinary, multi-method health system research is needed to evaluate the economic and health effects of complex policy interventions  More qualitative research on affordability (e.g, public perceptions, professional response to incentives, political and economic barriers to reform) to explain quantitative findings and generate new ideas for solutions  Targeted analyses of policy changes in insurance systems, such as changes in formulary management, benefit design, provider contracting, or educational outreach activities

Research Gaps  More research is needed on the components of medicines prices along the entire supply chain  We need to develop and evaluate interventions to enhance the use of quality- assured lower-priced generics that align incentives among patients, providers, and industry  Impacts of affordability on adherence and sustainability of financing for patients taking medicines for chronic illness