Even if seriously implemented, the Cheaper Medicines Law would still fail to bring down the prices of medicines because it did not break "the monopoly control of transnational corporations on all aspects" of the drug industry. This monopoly is the main reason why drug prices in the Philippines are among the highest in Asia.
MANILA - Filipinos have long awaited relief from high prices of basic needs including that of medicines, which have been found to be twice, thrice or many times more expensive locally compared to prices in other countries such as India and Pakistan.
Ponstan (mefenamic acid), for example, can be bought in India for the equivalent of P2.58 and in Pakistan P1.29. And yet, the same pain killer is sold for P11.25 in the 10,000 or so Botika ng Barangay outlets set up by the Arroyo administration, which promised medicines for half the price compared to commercial pharmacies. Ponstan is sold for P25 pesos in these private pharmacies.
This is why, last year, Filipinos welcomed the passage of the Cheaper Medicines Law.
Proudly unveiled at the time by Senator Mar Roxas and the Department of Health, the law, however, proved to be a failure after a year of implementation. Medicines in the Philippines remain high despite the passage of the law.
On the first anniversary of the law, the Consumers' Action for Empowerment (CAE) pointed out the fatal flaw of the Cheaper Medicines Law: the law, it said, was designed to fail.
Even if seriously implemented, the law would still fail to bring down the prices of medicines because it failed to break "the monopoly control of transnational corporations on all aspects of the [drug] industry." This monopoly, the CAE said, is the main reason why prices are high.
According to CAE, the Cheaper Medicines Law does not support nor strengthen the Filipino drug industry. And while supposedly supporting cheaper generics drugs, the government has not buttressed the capacity of the Bureau of Food and Drugs Administration to check the quality of drugs being sold in the market. This leaves the public vulnerable not only to fake and defective drugs but to the propaganda of big drug corporations against generic medicines.
On top of all these, those who crafted the law also scuttled proposal from health practitioners to form a regulatory board for drugs and medicines.
What remains as a potential saving grace of the Cheaper Medicines Law was the power it gave the president to impose a maximum retail price on select essential medicines, upon the health secretary's recommendations.
The Making of EO 821
Besieged by stinging rebukes for the failure of the law, Duque and Roxas, in mostly parallel efforts, tried to salvage the law. Roxas talked about reviving it with reforms or amendments. He and Duque both talked about the president's mandate to impose the maximum retail price of essential drugs. This could reduce massively the profits of drug companies. Expectedly, it became the subject of intense lobbying, including bribe offers.
Executive Order 821 took shape under a cloud of public suspicion as big pharmaceutical firms, whose representatives were frantically lobbying and holding talks with Malacañang and public officials, were reported to have offered bribes and other inducements to counter any attempt to regulate prices.
The bribes were spurned, Duque said, but in his recommendations, he had listed only 21 out of 600 essential drugs to be capped with a maximum retail price. After talks between Malacañang and representatives of big pharmaceutical firms, the list was further cut to just five drugs. The big pharmaceutical firms offered to voluntarily reduce the prices of the other 16 drugs in the DOH list, a move that was greeted with skepticism.
"History has proven that the biggest obstructions to making drugs affordable in this country are the drug transnational corporations (TNCs) themselves," said the Health Alliance for Democracy (HEAD), a progressive health NGO. "The last 25 years reveal how big pharmaceuticals plotted and schemed to subvert all efforts to reduce the prices of their medicine."
Malacañang also decided to peg the effectivity of EO 821 on Aug. 15, prompting strong reactions. "Why wait this long?" asked a Dr. Elmer in his blog. Meanwhile, he wrote, "chronically-ill patients whose survival depends on these medicines will bear the unnecessary risk of becoming worse or dying."
Doubtful Efficacy of EO 821
Starting August 15, the prices of five specific medicines will be cut by half. These include the anti-hypertensive amlodipine, the anti-cholesterol atorvastatin, the antibiotic/antibacterial azithromycin and the anti-neoplastics/anti-cancer cytarabine and doxorubicin.
Signed by President Gloria Macapagal-Arroyo last July 27, EO 821 marked the first time she exercised the mandate given her by the Cheaper Medicines Law. But instead of earning praises, her executive order's efficacy is being doubted by consumers and health service providers themselves.
EO 821 is "deceitful and illusory," said Eleanor M. Nolasco, a registered nurse and spokesperson of the CAE. Essentially, the consumers' group said EO 821 will not respond to the people's need for safe, affordable medicines.
EO 821 should have included "more essential medicines that are most widely used and are first-line medicines needed for the treatment and cure of more prevalent diseases in the country," Nolasco said. She cited the medicines needed to treat the 10 leading causes of morbidity and mortality, which include respiratory diseases, pneumonia and tuberculosis, among others.
Misleading
While the CAE commended the price regulation of medicines as "a step in the right direction," it appears the step is far too small to truly matter. They said the maximum drug retail prices (MDRP) set for the five selected medicines in EO 821 are misleading.
"The mechanism used in determining the drugs for compulsory MDRP has been pegged on the drug originator price, which, though slashed to about 50 percent, is still expensive," said Nolasco.
Originator brand refers to the product that was first authorized worldwide for marketing, usually as a patented product. Meanwhile, a generic product is a product other than the originator that is marketed after the expiry of the patent of the originator, regardless of whether it is marketed under a brand name or not.
As example of the misleading MDRP under EO 821, Nolasco cited amlodipine which is used to lower blood pressure. The maximum retail price of amlodipine 10mg would now be P38.50, about half the price of its originator brand Norvasc 10mg sold at P77 in a leading drug store. "Why set an MDRP for this medicine at this amount when its generic equivalent is sold at P15 at a known drugstore selling generic medicines?" CAE asked.
Drugs Still Not Affordable
In a survey led by the Health Action Information Network (Hain) on medicine prices and availability in the first quarter of 2009, they found out that originator brands of medicines are "several times more expensive than the lowest priced generic counterpart." Amlodipine, one of the five medicines selected by EO 821, is over three times more expensive than its cheapest generic counterpart.
This means that cutting the originator brand price by 50 percent would still leave drugs like amlodipine 150 percent more expensive than its cheapest generic counterpart.
Relating the drugs' prices to the daily lowest wage earners in the government, Dr. Marlene Bermejo of Hain found out that a course of treatment for select medicines usually requires several days' wages- almost five days' wages for the originator brand of amlodipine, and one and a half days' wages for its cheapest counterpart. For those not regularly earning as much as P279.50 per day, the lowest government wage at the time of Hain's survey, it would take more days' work to buy the required course of treatment.
In the interest of Filipinos, the list of medicines to be placed under MDRP should include more essential medicines that are widely used, said CAE. The MDRP should also be pegged at prices that an ordinary worker can afford with his meager income. "Government should promote and make available quality generic medicines as a viable alternative to expensive brand medicines," the CAE said.
Yet, despite the limitations of the EO 821, private hospitals are opposing it and are even planning a "hospital holiday" in light of the law's implementation.
But the "hospital holiday" will affect patients even more, said HEAD's Nolasco. "The government must exhaust all means to settle the problem and spare the people another burden." (Bulatlat.com)