WHEREVER you are in the country, the prices of medicines are the same. Whether you’re in the less densely populated or more rural north, Lappland, or in urban and posh Helsinki, there’s no difference. That is the scenario in Finland as told to us by pharmacists, Ms. Katri of the Yliopiston Apteekki, a private pharmacy and Ms. Maaria of the University Hospital in Tampere, a public hospital pharmacy. This is so because the prices are regulated. A national board sets the “reasonable” price for each drug marketed in Finland. I found this fact very interesting since for a particular drug, price variability is so wide in the Philippines. And that this price variability is sadly on an upper range.
The pharmacy market is tightly regulated too, not liberalized. One cannot just set up a pharmacy anywhere and anytime he wants to. The number of pharmacies in a certain area is based on “needs” criteria.
I liked also how the University of Helsinki made its Yliopiston Apteekki pharmacies as its income generating project, well for more than two centuries now. Now they’ve gone international, setting up branches in other neighboring countries. Their students don’t have to scrounge for a pharmacy to accept them for their practical period or internship (unlike my then Pharmacy students at St. Louis University who’d have to look for a pharmacy for them to do practicals). University of Helsinki students have 17 branches all over to choose where they can be assigned. And they even get paid. SLU may also want to set up pharmacies for training and as IGP too.
It seems too that Finns wish to minimize the burden of spending on drugs by patients. There is a maximum limit for drugs to be paid and shouldered by patients each year. We were told its about 600 euros (P36,000). All drug costs exceeding this limit are paid by the national health insurance. VAT on drugs there is around 8 percent, ours is 12 percent. The reimbursement categories are classified according to the severity of the illness and the need for the drug treatment, where co-payment by patients for outpatient drug needs can be from around 58 percent to “zero”. For a higher special category, 100 percent is refunded for drugs for life-threatening chronic conditions! Katri cited for example, if you have diabetes (under higher special refund category) you would only pay 3 euros (180 pesos) no matter how expensive your medicine purchase actually is. It will seem just a token payment, short of saying it’s actually free. Chronic life-threatening diseases of course warrant long term treatments and repeated purchases of drugs and prices should not add up to woes of an already sick patient.
In the Philippines we have a joke that regards dying of diabetes as dying “sweetly” as diabetes is perceived to be due to too much sweets or sugar. With skyrocketing prices of not only diabetes medicines, it isn’t sweet really. I turn to a comparative survey done in May 2010 wherein “people from 60 countries collected the price a patient would have to pay (if they paid the full price) for a 10 ml traditional vial of 100IU/ml soluble human insulin injection (neutral, regular) in their closest private retail pharmacy”. And among us participants from the developing countries, I, the Filipino will pay the most. My classmate Pradip from Nepal only has to shell out $3.70 for Humulin R (Eli Lilly) procured in their capital Kathmandu. The same drug will cost me $29.95 (8 times more!) in a pharmacy in Philippines. Even my Tanzanian classmate Joyce will pity me. She can buy in their capital Dar-es Salaam a vial of the insulin Actrapid: Novo Nordisk at $17.81. I have to spend almost twice that amount to get the same drug in the Philippines which has it at $28.82. I am pretty sure a poor Filipino needing those drugs will die earlier compared to “ill counterparts”. Financial inaccessibility to the drugs is not sugary sweet; it is salt rubbed on gaping wounds. Well, nobody wants the Philippines to continue having the most expensive medicines in Asia, second only to Japan, which is of course a “can-afford” country.
Our mentor Dr. Delen dela Paz, concludes that “in the Philippines, access to medicines is an economic privilege. That like many basic and essential needs, sadly “from manufacturing to distribution to retail, the drug industry in the Philippines is an oligopoly”. She cites as a fact that “16 of the top 20 drug companies in the Philippines are multinational firms with combined sales of P58.23 billion in 2007, nearly eight times more than the Philippines’ P7.39 billion Gross Domestic Product in 2008”. These few increase costs by invoking pharmaceutical patent system, transfer pricing, and heavy advertising and drug promotions. Adding to our problems is that we forget our basics: our alphabet of PQRST defined in our Philippine National Drug Policy (P–people empowerment, Q–quality assurance, R–rational drug use, S–self-reliance, and T–targeted procurement).
Well, amid the reflections during our practical period, we had to enjoy and we had a karaoke night in a hall owned by the medicals students’ organization. Over cans of beer (I got a San Mig from the grocery - yes it is available in Finland), chips, and licorice candies, the group rocked the night away. I think I could recall Aerosmith’s “I Don’t Wanna Miss a Thing” and a particular line from this song: “I could spend my life in a sweet surrender”.
The only thing that is sweet about the medicine price matter is mentioned in our karaoke song: sweet surrender. With exorbitant prices, the sick pity their non-sick relatives and rather resort to a sweet surrender. They would not want to deprive their non-sick relatives of meager resources that should go to family needs and not vigorously sucked up by pricey medicine requirements for their sickness.
It will be sweet though if we heed the Council for Health Development’s stance that “The need of Filipinos for efficacious and affordable medicines can only be met when a strong national health care system is in place and under a government whose policies are in the best interest of its people.”
Decades back, the Philippines appeared impecunious and gained the economic moniker “the Sick Man of Asia”. Taking the pharmaceutical issue (the prices of drugs and access to it) as barometer, we don’t see the country into convalescence, becoming the Healed Man of Asia. If nothing earth-shaking will be done to reform how access to medicines is ensured in the country, the ordinary diabetic Sick Man of Asia, known for its vocal talent in a karaoke-crazed village will belt out Aerosmith’s song and with his last breath, feebly, powerlessly and helplessly fume “I could spend my life in a sweet surrender”.