Cheaper medicines law hasn’t served the poor

Four years ago last June 6, the Cheaper Medicines Law (Republic Act 9502, the Universally Accessible Cheaper and Quality Medicines Act of 2008) passed after contentious debates in the 14th Congress, was signed into law by President Gloria M. Arroyo.

R.A. 9502 was intended to achieve two correlated goals:

1. Reduce the cost of medicines — especially those that are commonly bought by the poor — to 50% of their 2001 prices and make these available nationwide; and

2. Require and ensure the production of adequate supply, distribution, use and acceptance of medicines identified by their generic names, which are priced much lower than patented drugs mainly produced by multinational corporations.

This second goal was supposed to have been realized through the Generics Act of 1998. But that law was proven inadequate, thus R.A. 9502 was enacted to complement it.

Through amendments to the Intellectual Property Code, the 2008 law allows generics-producing firms to test, produce, and register their own versions of patented drugs, and prohibits the grant of new patents based only on newly-discovered uses of a known drug substance.

However, a “rider” provision says that “when the public interest is at stake” — which can be interpreted in varied ways — the government can resort to procuring patented drugs.

When R.A. 9502 was passed, medicine prices in the Philippines were among the highest in Asia: per an ASEAN survey, 5 out of 9 medicines here cost 40-70% higher than those in Indonesia, Malaysia, and Thailand.

As one solution to the problem, R.A. 9052 gives the President the power to set price ceilings on various drugs, upon the recommendation of the Secretary of Health, including medicines for chronic illnesses, for prevention of diseases, and those found in the Philippine National Drug Formulary Essential Drug List.

Moreover, it allows the parallel importation of patented medicines from abroad when these are more affordable than those available domestically. And to ensure the availability of affordable medicines, the law requires drug outlets to carry a variety of brands for each type, including imported ones, to give the consumers more choices.

After four years of implementation, how far has the Cheaper Medicines Act gone towards attaining the twin goals?

As far as the poor patients of seven big government hospitals are concerned, the law’s positive impact seems negligible, if not zero. These are the Philippine General Hospital, San Lazaro Hospital, Jose Reyes Memorial Medical Center, Tondo Medical Center, Philippine Heart Center, National Kidney and Transplant Institute, and East Avenue Medical Center.

At least, such can be concluded from the findings of a “Survey on Access, Affordability and Availability of Medicines” conducted in these hospitals last May 10-25 by the Consumers’ Action for Empowerment, a nongovernmental group involving health and social workers. The survey, using “purposive random sampling,” was extended to four communities in Pasig, Parañaque, Payatas (Quezon City), and Tondo.

There were 840 respondents (58% female, 42% male), mostly undergoing long-term treatment or were required to take at least one week’s dosage of medicines.

The top 10 diseases afflicting the respondents were: heart disease, 28.50%; rabies, 13.32%; upper respiratory tract infection, 12.92%; renal, 11.19%; cancer, 7.86%; diabetes, 7.72%; lung disease, 7.59%; gastrointestinal, 3.99%; bone/musco-skeletal, 3.46%; and tuberculosis, 3.46%.

Most of these, the survey report notes, require essential medicines for lifetime maintenance or long-term use and are usually expensive.

The top 10 medicines used by categories were: anti-hypertensive, 24.16%; cardiovascular, 14.54%; anti-bacterial/antibiotics/ anti-infectives, 13.7%; vitamins (not essential), 11.12%; analgesics, 9.38%; vaccines/ immunologicals/sera, 9.31%; respiratory drugs, 6.85%; gastro-intestinal, 4.39%; antidiabetic, 3.97%; and drugs for central nervous system disorders, 2.58%.

All together, the respondents listed 2,033 prescription medicines that they used. But note this: only 828 medicines (44.67%) were taken in complete doses; 1,026 drugs (55.33%) were taken just in partial doses.

The reason: 99.8% of the lifetime or long-term patients claimed they didn’t have the means to pay for their complete treatments. Only 21.86% shouldered their own medical expenses. The rest relied on relatives for help or solicited from government, private, or church organizations; or they resorted to loans and mortgages.

The dismal picture is validated by the economic profile of the patient-respondents: 42% were jobless; 23% were housewives without incomes; 13% were employed in the service sector; 2% were oddjobbers (scavengers, “barkers,” etc.); the rest worked variably in transport, construction, agriculture, sales, housekeeping, miscellaneous services, or were retirees.

Where did the patients buy their medicines? Only 37% of the respondents were able to buy from government-hospital pharmacies or the Botika ng Barangay, where prices were lower; 63% had to buy from commercial pharmacies because stocks were unavailable in the state-hospital pharmacies.

Interesting finding: those who went to commercial drugstores were equally split — 29.54% bought branded medicines and 29.54% purchased generic drugs.

The survey covered only patients in the NCR (85%) and adjacent regions. What of those in the rest of the country? The report doesn’t cite the current medicine prices to see if they had gone down as projected. The results simply mirrored the wide-scale incapability of the respondent-patients to afford them.

The findings are worrisome enough as to require a wider, deeper review of R.A. 9502 implementation.