1. Strategies to improve the acceptance and use of generics. Jordan Pharmaceutical Association Dr.Taher Shakhashir

2. 2 Introduction to Pharmaceutical Association. HAI data analysis. Situation of pharmaceuticals in Jordan Generic Strategy proposal.

3. 3 1957 - 2007

4. 4 Jordan Pharmaceutical Association Established in 1957 celebrating our 50 th anniversary. Profession is highly regulated and governed by the Law of Pharmacy & Drugs of 2001. The JPA is run by an elected board. Membership in JPA: around 10100 registered pharmacists and most of them are active practicing pharmacists.

5. 5 Jordan Pharmaceutical Association Number of pharmacies: 1958 employing 3500. Number of drugstores: 317 employing 4500 Number of manufacturing plants: 16 employing 8000

6. 6 Jordan Pharmaceutical Association 1950 - 1990 : 2559 Pharmacists 1991 – 2001 : 5022 Pharmacists 2002 – Now : 3102 Pharmacists

7. 7 Jordan Pharmaceutical Association Males represent: 53% Females represent: 47%

8. 8 HAI data According to HAI data(2003), approximately 70% of the population is covered by health insurance, provided by: Ministry of Health (21%) Royal Medical Services (33%), Refugee missions (18%), Private insurance (10%). =========== Total of 82 % insured ….. Not 70% !!!!! i

9. 9 HAI data analysis The study was performed in 2003/2004, before implementing the new pricing guidelines. (JFDA Pricing regulations are used as a reference in neighbouring countries). Total Market consumption is directly affected by the following conditions in the area: »Jordan is one of the main destinations for MENA for Medical Tourism. »Iraqi crisis: number of Iraqis in Jordan, and medicine export to Iraq. »Palestinian crisis: Mobile hospitals, medicine donations. »International UN forces, and the accompanied Jordanian Hospitals.

10. 10 HAI data analysis 2004: »Total pharmaceutical market: JD 140 millions - Imported: JD 105 millions (export price) - Local manufacturing: JD 35 millions (25% of total market) »GDP: JD 8.1 Billions »Pharmaceutical consumption is: 1.87% of GDP. 18.4% of total health expenditure. »These figures include Export to Iraq, Palestine, UN international forces and Health tourism. »Refs: J-FDA statistical data, HAI data.

11. 11 HAI data analysis 2006: »Total pharmaceutical market: JD 220 millions: - Imported: JD 165 millions (export price) - Local manufacturing: JD 55 millions (25% of total market) »GDP: JD 10.3 Billions »Pharmaceutical consumption is: 2.13% of GDP. 22.7% of total health expenditure. »These figures include Export to Iraq, Palestine, UN international forces and Health tourism. »Refs: J-FDA statistical data, HAI data.

12. 12 HAI data analysis In 2006 New age groups were covered by MOH insurance: Population0-6 years: 901,00022% of population Population > 65 years: 240,000 Ref: Jordan Department of Statistics

13. 13 percentagePopulation 100 5723000 ُEstimated population 2007 92.3 5282300 Jordanian citizens 7.7440700 Non Jordanians 17.71011250 Population age 0 – 6 years 5.2296450 Population over 60 yrs 2007 Ref: Jordan Department of Statistics

14. 14 2007 Insured Jordanians before addition of new age groups: 82% New age groups insured: 4.1 % (0-6 & >65) Total insured Jordanians : 86.1 % (of total population including visitors) Total insured Jordanians : 93.3 % (of total population Excluding visitors)

15. 15 HAI data analysis – Although Jordan is classified as a developing country,yet its medical services are up to the standard of developed countries. »Leader in MENA in health services. »High caliber of medical professionals. »State of the art facilities and services. »Continuous education.

16. 16 HAI data analysis IVF : leading centers globally. Open Heart Surgeries Cancer treatment

17. 17 Situation in Jordan. The Pharmaceutical Industry is highly advanced in branded generics, ranked 2 nd in export. Over 8000 well trained employees. Exports over $ 400 mill. Local market share: 25-30% ( value). Compared to EU generic % in their local market Germany 21% value UK 18% value Denmark 35% Value Spain 3,3% value Ref: EU generic manufacturing Association

18. 18 Situation in Jordan. »Insurance covers: –Cancer Treatment 100%. –Kidney Dialysis. –Multiple Sclerosis (MS) –Vaccination of all children 100%. –Thalassemia. –HIV, AIDS.

19. 19 Jordan expenditure is moderate Moderate

20. 20 Jordan out of pocket is far less than 18% Jordan, less than 6.7%

21. 21 Our main goal is: Safety. Quality Efficacy. Availability. Affordability.

22. 22 Stakeholders Government Pharmacist Patient Physician

23. 23 Recommendations to enhance branded generics Government: – Support the procurement policies – Cancel import duties and VAT. – Establish proper guidelines & protocols for dispensing medicines.

24. 24 Recommendations to enhance branded generics Government: –Run cost effective studies for therapeutic classes. – Upgrade networking of insured population to avoid duplication of dispensing medicines. –Continuous proper training of MOH medical health providers. –Speed up registration of reliable generic pharmaceutical manufacturers, emphasizing: Safety, Quality, Efficacy.

25. 25 Recommendations to enhance branded generics Physicians: –Encourage physicians to prescribe generics. Consumers: –Improve awareness towards efficacy and availability of generics.

26. 26 Recommendations to enhance branded generics Pharmacists: –Implementation of Good Pharmacy Practice (GPP). – Implementation of Code of Ethics in medical promotion. –Raising awareness towards counterfeit drugs.

27. 27 In conclusion We need to: –Provide high quality affordable medicine. –Support Jordan`s mission to promote medical tourism. –Support local pharmaceutical industries. –Encourage availability of new therapeutic medications to match the high level of health services in developed countries. –Raise awareness among health care providers and patients regarding generics.

28. 28 THANK YOU