Friday, October 04, 2013

Generic Drugs 4: DOH Generics Summit 2013

The Generics Act of 1988, RA 6675, turned 25 years old last month. The Department of Health organized the "Generic Medicines Summit 2013" at the DOH Convention Hall, DOH Compound, Manila last Monday, September 30, 2013. It was a whole day activity, I was not able to attend the morning session, I went to the afternoon sessions.

Panel Session No. I, 1-2:30pm, the theme was “The Impact of Generics Policies in Improving Access to Medicines and Health Outcomes”. The speakers were:

Presentation No. 1:
Global Achievements in Implementing Generic Policies

Presentation No. 2:Local Market Trends

Presentation No. 3:
Analysis of the Prescribing and Dispensing of Generic Medicines as Prescribed by Generics Act of 1988

Panelists: PCPI, PHAP, PPhA
Dr. Brian Godman

Mr. Romeo Castro,
GM, IMS Health Phils., Inc.

Dr. John Q. Wong,
Consultant, PIDS

Panel Session No. II, 2:30-5pm, the theme was “Progress of Pharmaceutical Reforms and  Continuing Efforts of Government in  Assuring Availability and Affordability of  Quality Generic Medicines”. The speakers were:

Presentation No. 4:
Impact Evaluation and Monitoring of the Cheaper Medicines Act of 2008

Presentation No. 5:
The Impact of the Cheaper Medicines Act on Households in Metro Manila:  A Quarterly Study”

Presentation No. 6:
Philhealth’s Initiatives in Promoting and Using Generic Medicines

Presentation No.7:
FDA Efforts to Assure the Quality of Generics in the Market
Dr. Jesus N. Sarol, Jr.
Consultant, PCHARD

Dr. Eleanor De Guzman
Research Consultant, PIDS

Dr. Poch Soria
Vice President, PHIC

Dr. Kenneth Hartigan Go
Director General, FDA

The panel of reactors were Dr. Delen de la Paz of HAIN and UP College of Medicine, Dr. Isidro Sia of the National Formula Board, also of UPCM, and Atty. Pau Tanguieng of AGAP. Pau was not around, Before panel 1 ended, Dr. Melissa Guerrero of NCPAM asked me if I can be a reactor, speak as representative from civil society. It’s not a difficult task, I quickly said Yes.

So I was seated in the front table beside Docs Dela Paz and Sia, have a good view of the speakers and their presentations. Nice.

Dr. Sarol and Dr. de Guzman spoke about their respective assessment reports about drug price regulation of the Cheaper Medicines Act (CMA) of 2008, FDA Director KHGo spoke about the reforms that FDA is doing, and Doc Soria spoke about new thrusts of PhilHealth.

My comments to the four presentations:

1. Dr. Jesus Sarol presentation...

Their study covering 2009-2011 simply confirms what we already know, that medicine prices are just following the law of gravity, they are coming down. In fact even before CMA became a law, ave medicine prices have been declining slowly, thanks to that good old reliable law of competition.

I added that CMA is more than drug price regulation or control. The law is mainly revising the Intellectual Property Code (IPC) of the country to accommodate compulsory licensing (CL) and other IPR concerns.

2. Dr. Elanora de Guzman paper:

Good findings in their study, confirms that the main beneficiaries of the drug price control policy were the upper middle class and the rich, class AB and C, not the poor, class DE. Before price control was imposed, many cheaper generic drugs were available, so when Pfizer's Norvasc (anti-hypertension) price was forced down from P44 to P22 a tablet, there were several generics already selling at P7.50 or lower. The poor will find the P22 still expensive and won't buy it, they'll go for the P7 or P5 other branded generics.

3. FDA Director, Doc KHGo:

Happy that FDA is promoting the rule of law in ensuring the safety of food, medicines, drinks, other consumer (chemical, biological) products, law based on science. Congratulations.

But it is simply impossible for FDA to monitor all such products, from anti-cancer medicines to barbeque sauce or new energy drinks or skin whitening soap, etc. Commiserations. The number of products to be monitored and approved is directly proportional to their misery.

One option is to partner with private or civil society accreditation bodies, also industry associations, that will police their own ranks and disallow unsafe products from being manufactured and sold. This way, FDA can focus its resources and manpower on firms and products that are not covered by those private or civil society accreditation bodies and industry associations. Spot checks by FDA to these bodies, so that repeated cases of unsafe food and drugs being allowed will mean revocation or blacklisting of such bodies, and firms will have to go through the usual, stringent FDA approval process.

4.  Dr. Poch Soria:

PhilHealth is somehow a victim of its huge and monster existence, there is also monster expectations, monster disappointment by the public. The more they promise to do something or correct past inadequacies, the more expectations and even more loopholes that will be introduced.

Their data that of the 315 govt hospitals they surveyed (42 DOH hospitals + PGH, and 273 LGU hospitals), only 7% complied with the no balance billing (NBB) for indigent patients. 93% of them required out of pocket (OOP) spending by the poor. This shows that often, government is a big violator of its own rules.

PhilHealth then should learn to step back on certain promises, reduce the expectations. One area is on NCDs (non communicable diseases) patients. Someone with communicable disease like dengue is easy to treat, after the disease is killed, a patient won't go back to the hospital for several/many years. Compare that to a hypertension or other adult NCD patient, who will be patient for the next 10, 20 years or more. Can drain the reserves.

(Photo, from left: Dr. Virgie Ala, Director of DOH-NCPAM, DOH USec Madz Valera giving the certificate to the 4 speakers: Dr. Jesus Sarol, Dr. Eleanora de Guzman, FDA Dir. Doc Kenneth Go, PhilHealth VP Dr. Soria.)

I took this photo before our names, the 3 panel reactors, were called to join the 4 speakers on stage for our certificate too.

Two years ago, during the "Generic Medicines Summit 2011" at Richmonde Hotel in Eastwood, I was also drafted as a spontaneous or "replacement" panel reactor as the assigned reactor did not come, and these were my notes that day, 

I like the DOH NCPAM people, they know that my bias is towards less government but they trust me to speak without spoiling the event. 

I posted those comments above in my fb wall, three physician friends commented:

1.  Di Va: That's why there's not much motivation for pharmaceutical companies to develop more antibiotics -- bec it's only used short-term. The existing antibiotics must be protected from drug resistance, lest we lose our battle against microorganisms.

2. Jed Inciong: It's very disturbing that there is rampant non-cimpliance with NBB in government and LGU hospitals. Even deplorable is they do this despite the fact that the Professional Fee allocation in the PhilHealth payment is pooled and is then divided among the hospital personnel. If those units that practice this pooling if PF will use these instead for the indigent patients...

3. Tony Leachon UHC is still a pipedream.  Execution is important for Philihealth. The point of care infrastructure is key to success. Perhaps a balanced score card per hospital should be implemented. Outpatient Philhealth card should be done with a national healthcare workforce plan to ensure achievement of the UHC Goals.

Question : how many doctors do we have? how many work in government? what's the ideal ratio of doctors to population? how many more doctors do we need to achieve the ideal ratio? what's the plan to achieve this ideal ratio? note: these questions are important because the plan to increase philhealth coverage of the poor will aggravate the shortage of doctors. .

I thanked Docs DiVa, Jed and Tony. Many in the audience shook their head when they saw that data from PhilHealth, that a big majority of govt hospitals are violating the NBB for the indigents.

It is not just in the number of government doctors, it's also on the quality of their service too. In many provincial or City hospitals, the drugstores in front are owned by the govt doctors, so the latter would always prescribe medicines (the more costly ones or at higher cost?) that should be bought only in their drugstores, then ask the patients to come back.

PhilHealth system creates big moral hazards problem especially among certain HC providers. They see that PHealth will raise the fees per case or service, the hospitals and physicians will also raise their fees. Some hospitals, even govt ones, see that NBB must be observed for indigent patients provided that they are in charity or ward rooms, this section is small so the poor are forced to take the regular paying rooms, the NBB policy won't apply.

See also 
Generic Drugs Asia 1: CGDA Notes, November 23, 2011
Generic Drugs Asia 2: My presentation at CGDA 2011, November 23, 2011 
Generic Drugs Asia 3: FDAs and the Consumers, November 25, 2011

Generic Drugs Philippines 1: Generics Summit, September 2011, February 09, 2012r th
Generic Drugs Philippines 2: 24 Years of Generics ActFebruary 09, 2012

Generic Drugs Philippines 3: Dr. Alran Bengzon on Medicines, February 17, 2012

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