Availability, price and affordability of selected medicines for treatment of NCDs in Sri Lanka

Abstract

INTRODUCTION AND OBJECTIVES: In Sri Lanka non-communicable diseases (NCDs) are the leading causes of mortality and morbidity. Therefore it is important to identify gaps in access and availability of essential medicines for NCDs. Objective was to assess availability and affordability of 35 medicines. METHOD: A representative country survey of nine districts was conducted in 45 public and 45 private sector pharmacies in 2013-2014. Medicine prices were expressed as ratios relative to the international-reference-prices (IRP); median price ratio or MPR. Using the salary of the lowest-paid unskilled government worker, affordability was calculated as the number of days' wages this worker would need to purchase standard treatments for selected NCDs. RESULTS: Mean availability of lowest-priced-generics (LPG) was 65.5% and 74.2% in the public and private sectors respectively. Highest and lowest districts for public-sector were Anuradhapura (78%) and Colombo (54.4%) respectively and for private-sector Galle (85%) and Batticoloa (59.4%) respectively. Only private-sector had originator brands (OB) but was low (16.2%) with lowest availability in Colombo which could be interpreted as good acceptance of generics by prescribers. Public sector procures medicines at 0.20 times the IPR. The private sector prices for LPG was 0.64 times the IPR indicating higher mark- ups. In contrast OBs are priced 4.28 times the IPR. In the private sector, affordability for LPG and OB were <0.1 to 1.5 days-wages and 0.4 to 12.6 days-wages respectively. CONCLUSION: Availability of low-priced-generics was high in both sectors and generally affordable in the private sector. However there are inequalities in distribution of medicines and pricing of original brands.