423:(WHO/HAI) made a conjoint effort to systematize the methodology of medicine price surveys and ERP usage, first publishing the WHO/HAI methodology in manual in 2003, which is frequently used in price studies in unregulated prices context often found in low and moderate income countries (LMICs), but it was also used in high-income countries. This methodology was devised to improve price transparency and ultimately medicines availability and affordability, and is the basis of most medicine price studies in the LMICs.
372:. This guide contains, for each drug, a set of prices from suppliers to developing countries and also a set of prices agreed by buyers such as government departments of health. The median of the supplier prices is preferred and even a single supplier price is superior to multiple buyer prices. The quality of the international reference price depends on the number of suppliers quoting for that product. For example, a single high supplier price may skew the survey results.
385:
510:
The HAI maintains a regularly updated database of worldwide drug price surveys following the WHO/HAI methodology, which is a method that offers data collection tools to obtain medicine price and availability information in countries or settings where access to price information is not accessible in a
523:
or the affordability. Affordability is "the number of days’ wages required by the lowest-paid unskilled government worker to purchase 7 days’ supply of a medicine to treat an acute condition, and 30 days for a chronic condition, based on standard treatment regimens". Affordability allows to express
502:
for all studies. Although the manufacturer's price is advised for prices analyses, it is advisable, or even key, for the design of pharmaceutical pricing policies to calculate ERPs at different stages of the medicine prices according to the WHO/HAI, to examine the contribution of each stage in the
439:
The reference basket is the set of countries where reference prices are sampled from. It is advised to select countries with similar income status as the target one, as including countries with higher income can lead to higher reference prices. However, it may not always be possible due to lack of
1010:
Wirtz, VJ; Hogerzeil, HV; Gray, AL; Bigdeli, M; de
Joncheere, CP; Ewen, MA; Gyansa-Lutterodt, M; Jing, S; Luiza, VL; Mbindyo, RM; Möller, H; Moucheraud, C; Pécoul, B; Rägo, L; Rashidian, A; Ross-Degnan, D; Stephens, PN; Teerawattananon, Y; 't Hoen, EF; Wagner, AK; Yadav, P; Reich, MR (28 January
43:
A price survey may look at up to 50 medicines. There are 14 global core medicines that enable international comparisons, 16 regional core medicines that enable regional comparisons, and 20 supplementary medicines that are locally important. When comparing prices, one dosage form and strength is
493:
Although the two taxonomies have strong similarities, the MWPP taxonomy relates to high-income countries with price regulation, whereas the WHO/HAI taxonomy includes more stages for non-price regulated settings, the major difference being the specification of landed price as a separate price
481:
Pharmacy retail price net (synonym of consumer or public price): price charged by community pharmacies to the general public. This includes the wholesale price plus any pharmacy remuneration (i.e., pharmacy markup, pharmacy margin or dispensing fee), but without including taxes such as
435:
levels), is considered the most robust method, although avoiding clustering then restricts the comparison to a subset of medicines available in all the surveyed countries since imputing may produce more bias. Survey medicines need to be described with a specific strength and dose form.
503:
supply chain to the final price and isolate them from the manufacturer's selling price. Multi-countries prices comparisons should be done using the same price type. The
International Medical Products Price Guide usually does not include insurance or transportation charges.
431:. The WHO/HAI mention the possibility of using different reference price providers in the same study, but this is challenging and no methodology is provided. The comparison of the prices of individual medicines, instead of an arbitrary clusters of medicines (eg, using
447:
The final price of medicines is impacted by several price components at various stages of the supply chain, with later stages likely increasing the medicine's price. The WHO/HAI provide the following 5 stages taxonomy of the medicines prices in the supply chain:
477:
Wholesale price (synonym of pharmacy purchase price): price charged by wholesalers to the retailers, usually community pharmacies. It includes the ex-factory price plus any remuneration for pharmaceutical wholesale (i.e., wholesale markup or wholesale
458:
Wholesale selling price for private providers, or central medical stores price for public providers: medicine price including the landed price plus any wholesale markup and regional or state taxes, and transport costs from the wholesaler to the
689:
If medicine prices are not regulated, they tend to vary between dispensaries and retailers of a country. To survey medicine prices in these contexts, the WHO/HAI methodology was developed, and it was frequently used for conducting price
497:
The ex-factory/manufacturer's price is considered more accurate and thus preferable for international price comparisons. The WHO recommends the use of the median supplier price for the reference countries of the target medication in the
915:
In all of the case study countries, a manufacturer submitting a new product for pricing is obliged to provide the price of the product in the reference countries. Failure to do so or to provide false information could lead to fines and
506:
The choice of the database(s) to use is also crucial and should not be solely made on considerations of availability, although this is an important factor. Adjustments to inflation/deflation are advised when comparing multiple years.
462:
Retail price (private sector) or dispensary price (public sector): wholesale price plus the retail markup added by pharmacies and other retailers to cover their costs, including their profit. Local or town taxes may be levied at this
426:
This methodology advises that the same provider of international reference unit price "must be used for all medicines surveyed – global, regional and supplementary", to ensure a consistent basis for comparison, such as the
524:
medicine costs as the ability of an individual's ability to pay for it, which is more relatable for the general public and "serves as an advocacy tool". Cross-country comparisons of affordability are possible.
452:
Manufacturer's selling price plus insurance and freight: the price charged by the pharmaceutical manufacturer, including the cost of insurance and shipping the medicines to the countries of destination.
31:. It developed a system and methodology for measuring the price, availability and affordability of medicines. The project surveyed over 50 countries. It also created guidance for
466:
Dispensed price: retail price plus sales taxes such as value-added tax (VAT) or a general sales tax (GST) and (dispensing) fees that are collected when the medicine is dispensed.
432:
851:
Rida, Nada Abdel; Ibrahim, Mohamed Izham
Mohamed; Babar, Zaheer-Ud-Din; Owusu, Yaw (2017). "A systematic review of pharmaceutical pricing policies in developing countries".
499:
428:
369:
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Landed price: medicine cost after importation in a country, after clearing customs and import requirements and then supplied to the main distributor.
444:. Increasing the number of reference countries in the basket has an important effect for decreasing prices when using ERP for drug price regulation.
587:
415:
The purpose of external reference pricing is to allow for a systematic comparison of medicine prices, both nationally and internationally. The
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632:
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Ex-factory price (synonym of manufacturer's selling price): the industrial price of the medicine as charged by a pharmaceutical manufacturer.
1095:
674:
368:
For each medicine surveyed, the local price is compared with an international reference price. This is usually drawn from MSH's
441:
739:"Chapter 6.2 - WHO/HAI Methodology for Measuring Medicine Prices, Availability and Affordability, and Price Components"
420:
97:
28:
527:
The same methodology can be applied to evaluate medicines availability, compared to a basket of reference countries.
930:"External reference pricing of medicinal products: simulation based considerations for cross-country coordination"
776:
Danzon, PM; Kim, JD (1998). "International price comparisons for pharmaceuticals. Measurement and policy issues".
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75:
24:
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specified for each medicine. To calculate affordability, a typical treatment schedule is specified.
35:
to help their governments and associated health organisations to implement policies on drug prices.
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896:"WHO/HAI project on medicine prices and availability-Working paper 1: external reference pricing"
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32:
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592:. World Health Organization & Health Action International. May 2016. pp. 123, 289.
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Pharmacy retail price gross: same as pharmacy retail price net plus taxes such as VAT.
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70:
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304:
118:
16:
Partnership between the World Health
Organization and Health Action International
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993:"Database of medicine prices, availability, affordability and price components"
595:
1076:
HAI medicine prices, availability, affordability and price components database
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Toumi, Mondher; Rémuzat, Cécile; Vataire, Anne-Lise; Urbinati, Duccio (2014).
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Saeed, Amna; Li, Zongjie; Kabba, John
Alimamy; Yang, Caijun; Fang, Yu (2019).
320:
273:
231:
1080:
872:
545:"WHO/Health Action International Project on Medicine Prices and Availability"
236:
134:
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797:
589:
Measuring medicine prices, availability, affordability and price components
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The external reference prices allow to derive connex measures, such as the
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The WHO later developed another taxonomy in 2018, the MWPP price taxonomy:
21:
WHO/Health Action
International Project on Medicine Prices and Availability
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992:
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210:
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325:
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centralized manner, such as in low-or-moderate-income countries.
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621:"Chapter 6 - Review of Methodologies to Conduct Price Studies"
379:
1072:, with scope and supply chain price component information.
1066:, with scope and supply chain price component information.
648:
646:
644:
969:
Encyclopedia of
Pharmacy Practice and Clinical Pharmacy
825:
Encyclopedia of
Pharmacy Practice and Clinical Pharmacy
396:
1013:"Essential medicines for universal health coverage"
653:Vogler, Sabine; Schneider, Peter (1 January 2019).
853:Journal of Pharmaceutical Health Services Research
614:
612:
610:
608:
606:
604:
743:Medicine Price Surveys, Analyses and Comparisons
659:Medicine Price Surveys, Analyses and Comparisons
625:Medicine Price Surveys, Analyses and Comparisons
745:(Monograph). Academic Press. pp. 209–228.
894:Espin, J; Rovira, J; De Labry, AO (May 2011).
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821:"External Reference Pricing and Medicines"
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500:International Medical Products Price Guide
429:International Medical Products Price Guide
370:International Medical Products Price Guide
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737:Raju, Priyanka Konduru Subramani (2019).
655:"Chapter 8 - Medicine Price Data Sources"
440:data, prices being better documented in
46:
1064:HAI list of multi-country price sources
536:
196:Paediatric respiratory tract infection
315:5ml three times a day for three days
7:
971:. Academic Press. pp. 188–201.
627:. Academic Press. pp. 187–207.
1070:HAI list of national price sources
667:10.1016/B978-0-12-813166-4.00014-0
14:
965:"Pharmaceutical Pricing Policies"
177:Adult respiratory tract infection
158:Adult respiratory tract infection
790:10.2165/00019053-199814001-00014
596:2008 original publication by WHO
383:
33:low-and-middle-income countries
999:. Health Action International.
86:Three times a day for a month
23:was a partnership between the
1:
1029:10.1016/S0140-6736(16)31599-9
395: with: . You can help by
364:International reference price
205:5ml twice a day for one week
108:Three times a day for a week
1081:Survey & Related Reports
903:Health Action International
661:. Academic Press: 247–268.
421:Health Action International
98:respiratory tract infection
29:Health Action International
1112:
199:8+40 mg/ml suspension
1096:World Health Organization
417:World Health Organization
186:Twice a day for one week
25:World Health Organization
330:0.1 mg/dose inhaler
309:24 mg/ml suspension
268:Twice a day for a month
247:Twice a day for a month
148:Twice a day for a month
48:The 14 global medicines
963:Vogler, Sabine (2019).
619:Vogler, Sabine (2019).
357:Once a day for a month
289:Once a day for a month
129:Once a day for a month
226:Once a day for a week
161:1 g/vial for injection
935:. European Commission
855:(Systematic review).
442:high-income countries
784:(Suppl 1): 115–28.
139:High blood pressure
119:High blood pressure
65:Treatment Schedule
49:
1023:(10067): 403–476.
865:10.1111/jphs.12191
827:. Academic Press.
521:median price ratio
180:500 mg tablet
102:500 mg tablet
59:Unit strength/form
47:
978:978-0-12-812736-0
834:978-0-12-812736-0
778:PharmacoEconomics
752:978-0-12-813166-4
634:978-0-12-813166-4
413:
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351:20 mg tablet
283:20 mg tablet
241:50 mg tablet
142:25 mg tablet
123:50 mg tablet
80:25 mg tablet
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305:inflammation
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939:27 November
909:28 November
758:27 November
376:Methodology
342:Simvastatin
333:One inhaler
299:Paediatric
295:Paracetamol
164:1 injection
154:Ceftriaxone
92:Amoxicillin
916:penalties.
780:(Review).
531:References
354:30 tablets
336:200 doses
321:Salbutamol
286:30 tablets
274:Omeprazole
265:60 tablets
244:60 tablets
232:Diclofenac
183:14 tablets
145:60 tablets
126:30 tablets
105:21 tablets
83:90 tablets
76:Depression
56:Indication
905:. WHO/HAI
873:1759-8893
685:170052588
551:2 January
459:retailer.
237:Arthritis
223:7 tablets
135:Captopril
1090:Category
1047:27832874
881:80486443
806:46985002
798:10186473
690:studies.
594:Mirror:
478:margin).
258:Diabetes
211:Diazepam
114:Atenolol
62:Quantity
1038:7159295
1011:2017).
216:Anxiety
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486:(VAT).
463:stage.
326:Asthma
96:Adult
933:(PDF)
899:(PDF)
877:S2CID
802:S2CID
681:S2CID
547:. WHO
167:Once
1043:PMID
973:ISBN
941:2019
911:2019
869:ISSN
829:ISBN
794:PMID
760:2019
747:ISBN
671:ISBN
629:ISBN
553:2020
419:and
312:45ml
303:and
301:pain
202:70ml
53:Drug
27:and
19:The
1033:PMC
1025:doi
1021:389
861:doi
786:doi
663:doi
433:ATC
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