1. 1 INTRODUCTION Price of a medicine has impact on affordability and therefore access to essential medicines. Sound data for price, availability and affordability of essential medicine is not available for Haryana State. Hence, the present study was undertaken to –Study the prices and availability of commonly used medicines in public and private sector –Affordability of medicines for common ailments for ordinary people of the State

2. 2 GEOGRAPHIC REGIONS SURVEYED <-- indicates survey region

3. 3 METHODS Survey was conducted according to the methodology described in the manual –The Prices of Medicine, WHO-HAI, 2003. Survey was conducted in November-December 2004. Data was collected from six districts –Panchkula, Faridabad, Yamunanagar, Panipat, Rohtak & Hissar In each area five public facilities and five private pharmacies near to public facilities were surveyed. Total of 30 public and 30 private facilities were surveyed. A total of 32 medicines (27 from core list of Manual and 5 supplementary medicines) were surveyed. For each medicine, 3 products were surveyed – Innovator Brand (IB), Most Sold Generic equivalent (MSG) and Lowest Priced Generic (LPG).

4. 4 Two trained data collectors surveyed all the facilities and collected the procurement price from public sector and the price patient pays, from private sector. Data entry was done in an excel workbook and it generated some automated analysis. Results are expressed in comparison to international reference price. Prices are expressed in Median Price Ratio (MPR). The MPR is the median unit price across the facilities surveyed in a sector (in local currency) divided by the international reference price (also in local currency). Affordability was calculated using daily wages of Unskilled Regular Govt worker.

5. 5 Median Price Ratio (MPR) in Public Sector (Procurement Price) and Private Sector (Sale Price)

6. 6 18 77 3 14 15 3 9 20 0 5 10 15 20 25 No. of Medicines found in 0% facilities No. of Medicines found in 1%- 50% facilities No. of Medicines found in 51%- 100% facilities Number of Medicine IB MSG LPG Availability of medicines in Private Sector

7. 7 COMPARATIVE AVAILABILITY OF MEDICINES Public vs Private Sector 00 19 11 25 27 0 5 10 15 20 25 30 No. of medicines Private sector Sector Comparative avalability of medicines IB MSG LPG Public sector

8. 8 AVAILABILITY & AFFORDABILITY OF LOWEST PRICED GENERIC ConditionMedicineAvailability in Public Sector (%) Affordability in Private Sector (# days work for unskilled government worker) DiabetesGlibenclamide 1 BD X 30 days 83.3 %0.3 days HypertensionAtenolol 1 OD X 30 days 90%0.3 days Adult Resp.Infections. Amoxicillin 1 TDS X 7 days 73.3%0.3 days Pediatrics Resp. Infections. Co-Trimoxazole suspension 1TSF BD X 7 days 6.7%0.1 days GonorrhoeaCiprofloxacin 1 OD X 1day 80%0 days

9. 9 MEDICINES AFFORDABILITY

10. 10 OTHER INTERESTING FINDINGS Price variation of drugs in Private sector (Sale Price) and Public sector (Procurement Price) Variation in prices of IB, MSG and LPG brands of Ciprofloxacin, a price controlled drug No variation in prices of IB, MSG and LPG brands of Ranitidine, a price controlled drug. Even the same brand of medicine found being sold at different prices in different areas. S. NoMedicineProcurement Price per unit in INR Sale Price per unit in INR Variation 1.Ciprofloxacin tablet 500 mg 0.82168.40 (Cipla)10 times 2.Ceftriaxone injection 1g 21.8473.00 (Aristo)4 times 3.Diazepam tablet 5 mg 0.051481.76 (Roche)35 times 4.Amoxicillin cap/tab 250 mg 0.53044.00 (Rexcel)8 times

11. 11 Price variation of same generic medicine in different regions (when medicines are found in min of 2 outlets) S. No. Medicine NameMin MPR in INRMax MPR in INR 1 Albendazole tab 400 mg3.19 (Rohtak) 10.49 (Panchkula) 2 Atenolol 50 mg tab/cap1.69 (Rohtak) 4.75 (Panchkula) 3 Cephalexin 250 mg tab/cap1.05 (Rohtak) 2.82 (Panchkula) 4Diazepam 5 mg tab2.52 (Yamunanagar)7.16 (Panipat) OTHER INTERESTING FINDINGS (cont)

12. 12 CONCLUSIONS Haryanas public health sector was found efficient in procurement of medicines. Medicines are supplied free of cost in public facilities to all the patients (outdoor and indoor). Availability of medicines in the public sector was found comparatively less than the private sector. Innovator brands were found being sold comparatively at higher price than their lowest price generic equivalents Prices of generic medicines also vary and the cheapest generic equivalent is not always the most sold. Price of generic drugs which the patient pays, varies from region to region (example already given).

13. 13 THOUGHTS ON IMPLICATIONS FOR POLICY Public procurement system to be expanded so that availability of medicines is augmented in Public sector. Generic prescription and dispensing be encouraged to achieve good affordability. Uniformity in various taxes and duties levied on medicines through out the country. Effective regulatory mechanism to achieve uniformity in prices charged from the patients.