Drug Price Control 40: CWF Wants Price Dictatorship for Lipitor

Last Wednesday, an email from James Auste (below), founder and Executive Director of Cancer Warriors Foundation (CWF) was forwarded by email by the Secretary General MeTA Philippines, Ms. Cecile Sison, to members of the Medicines Transparency Alliance (MeTA) PH, Coalition for Health Advocacy and Transparency (CHAT), ETHIKOS and Alternative Budget Initiative (ABI) Health cluster. I am a member of MeTA PH and CHAT so I saw it.

The email therefore was widely circulated to many stakeholders in the PH health sector – government, industry players, NGOs, academe. James is asking for  another round  of drug price dictatorship aka price control. Price dictatorship is the  subject  of my book in 2011, Health Choices and Responsibilities, and it is a policy that I will  always oppose.

James addressed his letter to the President/CEO of Pfizer, but it was distributed to various network in the  health sector, so  it is implicit that he also addressed it to us, hoping that other stakeholders in the health sector will support his call for a new round of drug price control, but targeted to only one medicine, Lipitor.

I posted these comments by email to members of CHAT and MeTA PH early today. Reposting it here.

--------

James  wrote,

(1) “SABI NG MGA BATA,HINDI KAMI HUMIHINGI NG AMING GAMOT PERO PARA SA AMING MGA LOLO AT LOLANA GUMAGAMIT NG LIPITOR!”

O, this  is new. The children cancer patients are now lobbying part time not to get cheaper cancer medicines for themselves,, but to get cheaper Lipitor for their grandparents. And soon maybe, they will also lobby for cheaper Norvasc for their parents, cheaper Augmentin for their older siblings and relatives?

(2) ANG ANNUAL SALES NG LI[PITOR AY 750MILLION PESOS! NUMBER 1 IN THE MARKET! AT NUMBER 1 PA ATA SA BUONG MUNDO!

Good data, but Pfizer themselves gave this data to James? Or IMS did, or someone who dislikes Pfizer and has access to industry data did?

(3) “PARA general health and well-being of every Filipino ( NA CORE VALUE RIN NG PFIZER) IBABA NATIN SA 14 PESOS ANG 10MG AT 17 PESOS ANG 2OMG!”

O, part 2 of price control. Part 1 was made in August 2009 under the administration of former President Arroyo.  Price control  is price dictatorship. Government regulators – the DOH and DTI in particular, backed up by the Office of the President, Congress, LGUs, etc. – would act as the price dictators. Those who will not obey the dictated price will be harassed and penalized.

Btway, it was former DOH Secretary Duque and DTI Secretary Favila who coined the Gloria Macapagal Arroyo Price (GMAP), aka Government-Mediated Access Price, an illegal term (not in RA 9502, not in the IRR) which until now  is being used, four years after GMA’s term has ended.

I am not exactly a great fan of Pfizer. I am more a fan of “boycott medicines”, innovator or generic, whenever possible and have healthy lifestyle instead. But I will  always be an enemy of government  dictatorship including price control, wage control, fare  control, rent  control, income control (via high income taxes).

The call for another round of drug price control or price dictatorship  is lousy James. Better focus your energy on lobbying for cheaper childhood cancer medicines. You are more effective there.

----------

DEAR SIR/MAM PRESIDENT/CEO OF PFIZER!

HI AT MABUHAY! I AM JAMES AUSTE A BRAIN CANCER WARRIOR! PATIENT ADVOCATE! FOUNDER! EXECUTIVE DIRECTOR OF THE CANCER WARRIORS FOUNDATION! SINCE JUNE 2000 WE HAVE SUPPORTED AT LEAST 1000 KIDS WITH  CANCER AND THEIR FAMILIES IN THEIR BATTLE FOR LIFE! RIGHT NOW WE HAVE 400 SCHOLARS UNDER OUR CARE FROM PAMPANGA TO DAVAO!

SABI NG MGA BATA,HINDI KAMI HUMIHINGI NG AMING GAMOT PERO PARA SA AMING MGA LOLO AT LOLANA GUMAGAMIT NG LIPITOR!

SABI RAW NI LOLA AT LOLA NIYA 34 PESOS ATA SA MERCURY! ANG 10MG! 39PESOS ANG 20MG! DAHIL SA MDRP(MAXIMUM DRUG RETAIL PROGRAM) NUNG 2009! ANG DATA NATIN  NA NAHANAP NAKITA AT NABASA NG ATING SENIOR WARRIORS

 ANG ANNUAL SALES NG LI[PITOR AY 750MILLION PESOS! NUMBER 1 IN THE MARKET! AT NUMBER 1 PA ATA SA BUONG MUNDO!

MAM SIR BAKA PASOK NA SA ATING CORE VALUE NA MAXIMIZE REVENUES AND MANAGE COSTS! ANG REVENUE NA ITO

PARA general health and well-being of every Filipino ( NA CORE VALUE RIN NG PFIZER) IBABA NATIN SA 14 PESOS ANG 10MG AT 17 PESOS ANG 2OMG!

BAKIT GANUN KABABA DAHIL SA MASIGASIG NA PANANALIKSIK NG ATING SENIOR WARRIORS MAY BAGO RAW TAYONG GAMOT NA TAWAG AY Rhea GALING DAW SA AMERIKA!

PERO SAME DRUGSTORE MAGBEBENTA--MERCURY DRUG STORE-NUMBER 1 SA PINAS

SAME MANUFACTURER--PFIZER

SAME ADDRESS--KM 1.9 ROAD 689, VEGA BAJA, PUERTO RICO USA

SAME PACKER-PFIZER MANUFACTURING DEUTSCHLAND GMBH, BETRIEBSSATTE, FREIBURG MOOSWALDALLEE1, FREIBURG, GERMANY

SAME IMPORTER-PFIZER,INC- 23RD FL, AYALA LIFE-FGU CENTER, 6811 AYALA AVENUE, MAKATI CITY

SAME SA SUKAT, KULAY, AT PAREHO PA ANG MARKING NA PO156

PAREHO LAHAT PERO ANG PANG PINAG KAIBA AY 20 PESOS SA 10MG! 60% CHEAPER NG LIPITOR! ANG 20MG 55% CHEAPER!

MALIIT SA INYO PERO MALAKI SA MGA MAY SAKIT NG PUSO NA ARAW ARAW ANG GAMIT NG GAMOT NA ITO

MALIIT SA INYO PERO MARAMING MATUTULONG SA ATING SENIORS AT MAY PANG JEEP PEDICAB, O MRT PAPUNTA SA MERCURY!

MALIIT SA INYO PERO MARAMING MABUBUHAY SA BENTE PESOS

SABI NG ATING SENIOR WARRIORS LIPITOR ANG GUSTO NAMIN KESA RHEA KASI BAKA

IBA ANG TAMA SA AMING MGA PUSO

IBA ANG  TAMA SA AMING MGA KATAWAN

IBA ANG AMING PATUTUTUNGUHAN

KAYA ANG AMING PANAWAGAN  SA PAMAHALAAN SIR MAM SANA I SUPPORT NIYO AY PAG ARALAN ANG SECTION 5 EO821 ".... MEDICINES,,, SHALL BE REVIEWED AFTER 3 -6 MONTHS BY THE DOH"KASI 5 YEARS NA PALA ANG MDRP! AT WALANG PANG NAG RE REQUEST NG REVIEW!

PANAHON NA PARA BIGYAN NG PANSIN ANG  ISA PANG HINAING(BUKOD SA CHILDHOOD CANCER) SA ATING LIPUNAN NA WALA PANG PUMAPANSIN ANG HINAING NG ATING MGA LOLO AT LOLA! NA KAILANGAN NG LIPITORFOR LIFE!

                                           KONTING SAKRIPISYO MARAMING MAGBEBENIPISYO!

THANK YOU FOR YOUR TIME!  WILL BE HOPING AND PRAYING FOR A POSITIVE RESPONSE!

INGAT GODBLESS!

JAMES AUSTE

BRAIN CANCER WARRIOR

PATIENT ADVOCATE

FOUNDER ONLY MEMBER OF CANCER WARRIORS SENIORS TEAM!SAMA NA!

**THIS WILL BE THE FIRST PROJECT OF THE CWF SENIORS TEAM!

----------

See also: 

Drug Price Control 36: Advisory Council, James Auste and China, July 12, 2013 

Drug Price Control 37: Four Years of the Policy, August 16, 2013 

Drug Price Control 38: Presentation at USC, Cebu, March 2010, March 01, 2014 

Drug Price Control 39: Presentation at USC, Cebu, March 2014, March 25, 2014

ETHIKOS 2: Pharma Companies and Patients, April 01, 2014

UHC 24: Corruption in Government Purchase of Medicines, April 02, 2014

MeTA 17: CHAT General Assembly, March 2014

Last March 14, 2014, the Coalition for Health Advocacy and Transparency (CHAT) held its General Assembly this year at Dolce Latte Restaurant, Quezon City. Minimal Government Thinkers is among the original charter members of CHAT when a Civil Society Mapping was held in January 2009 at Diamond Hotel in Manila, two days before the 3-days MeTA National Forum, same venue.

CHAT is an alliance of health-focused civil society organizations (CSOs), people's organizations and public policy research organizations or think tanks (including IBON Foundation and MG Thinkers) that works with the Medicines Transparency Alliance (MeTA) Philippines as its civil society partner. It is a big coalition as some member organizations are themselves alliances or coalitions of their own. Like AGAP (Ayos na Gamot sa Abot-kayang Presyo) and 3CPNet (Cut the Cost, Cut the Pain Network).

The first speaker was Dr. Virgie Ala, former DOH-NCPAM Director, and she gave a health situationer of the country. I came late that day and was lucky to catch perhaps the second half of her presentation. Second speaker was Atty. Paula "Pau" Tanqueing of AGAP and she discussed various activities that  CHAT and its member organizations have undertaken, 

Ms. Cecile Sison of Philippine HealthWatch Initiatives, also of MeTA Philippines, discussed the covenant of CHAT. Then nice lunch. 

It was a working lunch, participants were paired and we discussed and suggested steps the alliance can take to re-engage and strengthen its role and advocacies, facilitated by Dr. Elmer Soriano. I did not speak during the open foru, and I did not stay long, after lunch I headed to the airport to catch my flight for Cebu City. I was going to give a talk at the University of San Carlos (USC) the next day about government price control and mandatory discounts for medicines policies. See Drug Price Control 39: Presentation at USC, Cebu, March 2014.

Despite some disagreement on certain health policies with some key members of CHAT, I like the coalition. I am the "odd-man out" in most cases for advocating less government (but not zero government) intervention in many health policies, while majority of member-NGOs support more government involvement. Still, members learn to tolerate such divergence in ideas.

Photo credit: Ian Nuevo of MeTA Philippines Secretariat.

-----------

See also:
Health Transparency 13: MeTA International Visit to Manila, April 16, 2013
Health Transparency 14: IMS-CHAT Meeting, April 18, 2013, Friday, July 12, 2013 
MeTA 15: Forum 2014 on Healthcare Ethics and Transparency, January 30, 2014 

MeTA 16: Day 1 of Conference 2014, February 11, 2014 

Drug Price Control 35: DOH Procurement Price and Lobbying for Another Price Coercion, June 29, 2013 

UHC 19: Health is a Right, Health is a Responsibility, September 19, 2013

ETHIKOS 1: MeTA-PH, PCPI, PHAP and FDA on launching

(Note: This is an expanded version of the paper that I wrote last Friday.)

Last Thursday night, the ETHIKOS (Ethics in Healthcare) Movement was launched at C3 Events Place in Greenhills, San Juan, Metro Manila. Many participants from different groups and sectors. Some quotes from some speakers that night.

All photos I got from the MeTA Philippines facebook page. Thanks Ian Nuevo.

1. Former Gov. Roberto “Obet” Pagdanganan, MeTA Philippines Chairman

Gov. Obet thanked the participants, particularly the organizations that formed movement – the Medicines Transparency Alliance (MeTA) Philippines, the Coalition for Health Advocacy and Transparency (CHAT), and the British Embassy’s Foreign and Commonwealth Office (FCO).

Then he introduced the Convenor Group of the ETHIKOS Movement: (1) Princess Nemenzo of WomanHealth, (2) Celia Carlos of the Drugstores Association of the Philippines (DSAP), (3) Girlie Lorenzo of Kythe Foundation, also of the Philippine alliance for Patient Organizations (PAPO); Tony Leachon of the Philippine College of Physicians (PCP), and himself.

He discussed what ETHIKOS is – a movement to encourage ethics in delivering healthcare to the patients, ethics in dealing with healthcare professionals  and other private players in the sector, ethics in government.

2. Atty. Dave Escalona, Philippine Chamber of Pharmaceutical Industry (PCPI) and United Laboratories

Dave said that the local pharma industry is supporting the Mexico City Principles (MCP) for voluntary codes of business ethics in the biopharmaceutical sector. He introduced a similar term, “Manila Principles” where the basis of such code of ethics are the Generics Act of 1998 and the Cheaper Medicines Law of 2008 (RA 9502), and the object of such ethics is the welfare of the patients.

Thus, the Manila Principles should consider TRIPS flexibilities as contained in RA 9502, avoid whenever possible prolonged data exclusivity, disallow frivolous patents, allow early working of soon-expiring patents of innovator drugs. He lamented that many local pharma companies are small and lesser known compared to big multinational pharma.

3. Teodoro “Ted” Padilla, Pharmaceutical and Healthcare Association of the Philippines (PHAP) Executive Director.

Ted narrated that in 1993, the association introduced and adopted a code of ethics called the PHAP Code of Practice. He quoted the late Doc Alberto “Quasi” Romualdez (a former DOH Secretary, founding chairman of MeTA PH) who said that “The most important achievement of PHAP now is that they have made ethical behaviour an import part of their commitment…”

He emphasized that no amount of health reform will be truly universal if people and players ignore the consequences of unethical behaviour. He also expressed support for the FDA to implement the MCP. Then he mentioned the important role of the innovator companies for endlessly producing new medicines which help save lives and improve the quality of life of Filipinos.

4. Kenneth “Ken” Hartigan Go, Food and Drug Administration (FDA) Director-General.

Doc Ken discussed certain FDA guidelines regarding senior government officials (SGOs) who make follow up calls at FDA. There are four possibilities where SGOs:

(a)     to inquire on behalf of his/her private sector associates, or determine the status of a rival company

(b)     to request earlier facilitationof application (expediting or jumping the queue

(c)     to demand aprovals even if the license or product registration is to be denied, or to demand a denial against a rival company, and

(d)     to reverse a regulatory decision.

My comments to some of these points in my next article about ETHIKOS..

Drug Price Control 35: DOH Procurement Price and Lobbying for Another Price Coercion

Government price control is price dictatorship. It is wrong, messy and ugly.

Explore new data below, 2,500+ words, nine pages long including seven tables and one graph, get your favorite drinks and enjoy the ride.

Price comparison across countries of certain goods and services is useful both for public and private decision making, provided that people are using the appropriate and verifiable conversion factors. Otherwise, the comparison can only lead to confusion, not education, and can lead to wrong public policy formulation.

After my reply to the email of James Auste, head of the Cancer Warriors Foundation (CWF), to all members of the DOH Advisory Council on the Implementation of RA 9502 (Cheaper Medicines Law of 2008), see Drug Price Control 32: Policeman of Pharma Companies, Dr. Melissa Guerrero of NCPAM-DOH iinformed me that prices of anti-cancer drugs in the Philippines remain expensive and out of reach of many Filipinos and offered to show the data. I was happy for her offer, and after several emails, she sent me the data. Posting these with her permission, as they plan to post this also in the DOH website, for transparency purposes. Thanks a lot for the data, Doc Melissa.

Tables 1 to 4. DOH Purchase Price Index (PPI), Selected Medicines, 2009-2013, in Pesos

Of the 10 drugs shown above, there is a notable increase in the PPI from 2009-2010 for all except #s 2, 3 and 10. No price change from 2010 to 2012 for all except #7 (increase) and #10 (decrease). Then a declin in prices from 2012 to 2013 for all except #8. The change in prices were mainly due to the change in the name of supplier or trader.

Here are the other 11 drugs.

Price movement from 2009-2010, increase except #s 13, 14,16,  18, 20, 21, which retained their prices or declined (#16). From 2010-2012, prices have generally remained the same except #s 11 and 12 which declined. And from 2012-2013, price declines except # 16 (same price) and 18 (increased).

Before I show the price comparison of the above medicines among the Philippines, Thailand and India, I warned readers in my previous article that there is No Single National Price for most if not all commodities like medicines in a particular country. There are many sellers catering to particular customers and buyers and thus, have different prices for the same product made by the same manufacturer.

Consider these two graphs below for a particular medicine. Equilibrium points (where supply meets or intersects demand) A and B are prices in the pharmacies of the high end hospitals in Metro Manila like Makati Med and St. Lukes; C and D are prices for cheaper hospitals; E and F are prices for the big drugstores like Mercury and Rose or Watsons, G and H are for The Generics, Generika, and points I, J, K and so on are prices of the smaller drugstores.

Thus, one can make a table of price differences not only between the Philippines and Country B or Country C, but also among different drug outlets and retailers within the Philippines. There is NO national price for a particular commodity in one country. Only the price of the biggest retailer or second or third biggest retailer, as proxy or estimate of the prevailing price in a country at a given point in time.

So for inter-country price comparison to become meaningful and verifiable, I suggested that  one 

must show, or at least consider and mention the following:

(a) same or comparable retail outlet, say only from Watsons;

(b) same reference period, say June 15, 2013;

(c) exchange rate used for converting different currencies into a common currency on a particular day, say as of June 15, 2013;

(d) taxes and fees, national and local, applied on medicines;

(e) subsidies or mandatory discount, if any, applied on medicines;

(f) other factors.

When those verifiable factors are not shown or even considered, then the price comparison becomes less effective as the readers would only blame the country with the higher price, especially the drug manufacturers and/or drugstores.

It is possible that drug manufacturers and pharmacies in country A would have higher profit margin than those in countries B and C, even if they have lower retail prices than their counterparts in B and C.

How? When the government in country A (a) does not impose taxes on medicines, (b) has lower corporate income tax and other business taxes than in countries B and C, (c) directly subsidizes a particular medicine so that it can be sold at a lower price, (d) other factors.

With that caution, here now are the price comparison for the Philippines, Thailand and India, for the 21 medicines purchased by the DOH. The current market price for the Philippines referred here is the price of Mercury Drugstore (it corners about 60 percent of the total retail pharma market in the Philippines) and an undisclosed "big private hospital". 

Health Transparency 14: IMS-CHAT Meeting

The Coalition for Health Advocacy and Transparency (CHAT) is the umbrella organization of health and research NGOs and think tanks that gathered during the Medicines Transparency Alliance (MeTA)-sponsored CSOs Mapping in January 2009. Many of the health NGOs there are coalition themselves of other community and sectoral organizations. CHAT is affiliated with MeTA Philippines and is considered the civil society arm or partner of the latter.

Last week, April 12, 2013, the International MeTA Secretariat (IMS) had a half day meeting with NGO leaders that composed CHAT. About one-half of the organizations within CHAT were represented, good attendance. The IMS were composed of Tim Reed, Executive Director of Health Action International (HAI), Ms. Renee Vasbiner, Administrative Coordinator of MeTA Secretariat, also of HAI, and Ms. Deirdre Dimancesco. Technical Officer of Medicines, Access and Rational Use, Department of Essential Medicines and Health Products, WHO Geneva HQ. 

CHAT was led by former Bulacan Gov. Roberto "Obet" Pagdanganan and Cecile Sison of HealthWatch. Gov. Obet and Cecile are also the Chairman and Secretary General of MeTA Philippines, respectively. The big coalitions within CHAT are the Ayos na Gamot sa Abot-kayang Presyo (AGAP, or good medicines at affordable price), Cut the Cost Cut the Pain Network (3CPNet) and Medical Action Group (MAG), Woman Health, Health Action Information Network (HAIN) and COPAP, the organization of senior citizens. Everyone was given the floor to introduce themselves and the NGOs that they represent, what they do and who are their main constituency.

I introduced Minimal Government Thinkers, Inc. as an independent think tank advocating free market, less government, personal responsibility and rule of law. Our constituency are individuals and groups here and abroad, who read about any free market reforms in the country and in this case, in healthcare policies.

So we have some big NGOs and coalition of NGOs themselves that played very active roles in the enactment of the Cheaper Medicines Law of 2008 or RA 9502, groups and individuals that supported major amendments to the Intellectual Property Code (IPC) of the Philippines like institutionalizing compulsory licensing (CL) of certain patented medicines. And MG Thinkers that advocate respecting IPR as much as possible. So CHAT is a loose coalition and members recognize that.

One advantage, members say, is that there is wide range of discourse and policy options to choose when we discuss certain issues, so they benefit from such diversity of opinions and observations. But one disadvantage is that it is difficult to come up with a consensus stand or statement on some issues, like I advocate less government while many want more government involvement in healthcare. Or possible disagreement in the possible TRIPS Plus provision in the soon to be negotiated EU-Philippines Free Trade Agreement (FTA).

At this point, I spoke. I said that MG Thinkers' involvement in CHAT was a bit interesting. Many if not all of the groups that attended the CSO Mapping workshop were known groups in the IPR debate before RA 9502 was enacted into law. And I was not with them as I was writing many articles defending IPR and my articles were published in many countries like the US, UK, India, Malaysia, Singapore, Philippines, and even in some Arab countries, published in Arabic, courtesy of MG's international free market network.

That when Ms. Klara Tisocki, then of the EU and now with WHO Western Pacific Regional Office (WPRO) invited me to attend the CSO Mapping workshop in January 2009, she has read my name and my articles, and she must have wanted diversity, not monotony, of ideas among CSOs. Klara played a key role in the MeTA formation in the Philippines. And so CHAT was designed to have diversity, to allow some looseness in the umbrella organization. 

On the issue of IPR and medicines, Tim Reed of HAI showed a youtube video produced by HAI Global, about the "EU zoombies" as a result of EU insistence that stronger IPR protection on patented medicines be adopted in various EU negotiations for FTA with different countries.

Then some organization matters were discussed, like key activities for CHAT.

Last April 08, Monday or four days before the meeting with IMS, CHAT also held an internal meeting about issues to discuss. We devise a Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis of CHAT. The matrix was shown and discussed by Atty. Paula "Pau" Tanguieng of AGAP. Good presentation, Pau.

It was a good meeting with the IMS, food was nice too.

I keep writing about these meetings and events as many CHAT and MeTA members tell me that although they may not agree with many of my ideas, they still look forward to my analysis, stories and photos. Just one proof that diversity is preferable to monotony. :-)

Cheers guys.
------------

See also:
Health Transparency 10: Depoliticizing Health, Corporatizing Government Hospitals, September 18, 2012
Health Transparency 11: MeTA Philippines and Multistakeholder Process, September 19, 2012 
Health Transparency 12: MeTA Philippines Dynamism, October 02, 2012 
Health Transparency 13: MeTA International Visit to Manila, April 16, 2013

Free Trade 27: Proposed EU-PH FTA and TRIPS Plus

Free trade and intellectual property rights (IPR), these are among my favorite topics to discuss and debate. Here are my latest papers on these subjects,

Free Trade 26: "Buy Local" and Protectionism, June 24, 2012
On IPR Abolition 17: Copyright by a Government Corporation, September 02, 2012
IPR and Medicines 24: Balancing Costly Innovation and Cheaper Drugs, March 20, 2012

The Department of Trade and Industry (DTI) called for a public consultation on “One Country One Voice” (OVOC) regarding the proposed EU-Philippines Free Trade Agreement (FTA) on September 20, 2012. I read about the invitation last September 13 and quickly confirmed my attendance.

Fearing that such proposed FTA might contradict certain provisions of the Cheaper Medicines Law of 2008 or RA 9502, a joint statement was released by MeTA Philippines, Coalition for Health Advocacy and Transparency (CHAT), Ayos na Gamot sa Abot-kayang Presyo (AGAP) and the Fair Trade Alliance (FTA). Below are screen shots of portions of the eight-pages position paper. I checked the websites/blog of AGAP, FTA and MeTA, it’s not posted there.

Below are the exchanges we have the past few days. Copy-pasting them with no alteration, so pardon our French and whatever typo errors, just showing the raw exchanges. I am adding some photos of the event that day.

A bit long, about 17 pages including images/photos, so grab your favorite snacky and enjoy the ride.

----------

September 20-21, 2012:

Hi Pau,

I am sorry that I did not read the attached paper on the joint position of Meta-CHAT-FTA on this issue. I saw this during the MeTA meeting yesterday as Gov Obet presented this. I spoke and commented that the conclusions seem to be an over-reaction to the IPR issue on medicines. Why?

I am not a lawyer but my understanding is that a national legislation like RA 9502 which deals with amending the IP Code on medicines has supremacy over whatever treaty that the Senate and the Executive branch may enter into any country or block of countries. In this case, should it be true that the proposed EU-PH FTA will have provisions extending  patents of drugs, I don't think it will have supremacy over RA 9502 and hence, can not be implemented.

My feeling is that whatever TRIPS Plus provisions will apply to other sectors -- patents on softwares and cell phone applications, see the fight between Samsung and Apple for instance; copyrights on music and movies, see the rampant counterfeiting of DVDs, albums, etc.; or trademark infringement on the brand and logo of huge companies. I read in some newspapers how some individuals caught stealing and using the trademark of other companies so they can sell their copycats at high price. Even Kumon, the tutorial school, its logo and trademark is being stolen by some entities and they too teach "kumon education" and charge the same rate but pay zero royalties to the original brand, and their style may just be a bogus and inferior.

I still have to see the actual document, even in its draft form, of the proposed PH-EU FTA pertaining to medicines. As Daisy Cembrano of GSK said yesterday, after RA 9502, the innovator companies have practically ceded many of their IPRs in the country.

Health Transparency 11: MeTA Philippines and Multistakeholder Process

The Medicines Transparency Alliance (MeTA) Philippines and its multi-stakeholder process and dialogues, along with the DOH Advisory Council on Healthcare (ACH), are the best venues that allowed me to get involved in many policy discussions and even debates on various health issues with various players and stakeholders in this country.

I began writing on health topics in late 2007 after the Symposium on Intellectual Property, Innovations and Health in early September 2007 at Manila Hotel, jointly sponsored by the International Policy Network (IPN) and Minimal Government. I produced lots of blog posts and oped articles in various newspapers, here and other papers in Asia, thanks to IPN media network, on health, especially on intellectual property rights (IPR), drug patents and compulsory licensing, in 2008.

In January 2009, I was invited by the DOH to a first meeting by the Advisory Council. I also invited by Ms. Klara Tisocki, previously with the EU and now with WHO, WPRO, to participate in the MeTA Civil Society Organizations (CSO) mapping two-days workshop. I missed the DOH Advisory Council meeting and the first day of the CSO mapping because I was in Singapore then, in a meeting with fellow free market leaders in Asia.

I was able to attend the 2nd day of the CSO mapping, I was glad to meet the various NGO leaders who were often in the news then because of their involvement in the discussions of the Cheaper Medicines Law or RA 9502, that was enacted in June 2008. I was in the US for the Atlas Liberty Forum when the law was signed that day.

Anyway, I was able to attend the 2nd MeTA National Forum, a 3-days event after the 2-days CSO mapping. I was amazed at the big audience and the wide range of topics that covered not only medicines policy but also other health issues. The officers of MeTA Philippines at that time were former DOH Secretary Alberto "Quasi" Romualdez as Chairman, former Bulacan Governor and former PITC President Roberto "Obet" Pagdangan as Chairman, and Dr. Kenneth Hartigan-Go as Secretary General.

Since then, I got involved in the formation of the Coalition for Health Advocacy and Transparency (CHAT), the civil society partner of MeTA Philippines, as well as other MeTA fora and discussions.

Below, during the MeTA National Forum in January 2010. This is the press conference made while there were on-going panel discussions. Second photo, from left: Nancy Tacandong, acting FDA Director at that time; Gov. Obet, Doc Quasi, Wilbert Bannenberg, the Technical Consultant of MeTA in London, and Reiner Gloor of PHAP.

Group photo also during the 3rd MeTA National Forum. It was a 2-days forum, also held at Diamond Hotel. I attended this forum but I don't think I joined that group photo. I got this from the MeTA website, http://metaphilippines.org.ph/.

Lower photo is another two-days MeTA forum on universal health care (UHC). I was able to attend this too, held at the Ramon Magsaysay Center.

More multi-stakeholder discussion workshops by MeTA sometime in March 2010. I was not there. Lower photo, I like that shot of a friend, respected academic and immediate past Director of FDA, Doc Suzette Lazo, speaking, nice.

We also have several discussions on our own in CHAT, photos below. MeTA Philippines alloted a separate budget for CHAT to conduct various health education and discussion activities.

I am thankful for the nth time, to MeTA Philippines and its multi-stakeholder process in policy discussions. Many members of the MeTA Council are also members of the DOH ACH. They have different agenda topics though as the latter is focused more on policy advice on certain issues to the DOH Secretary while those of MeTA are topics that each member and organization representatives should do in collaboration with each other.

The current officers of MeTA Philippines since about two years ago are Gov. Obet as Chairman, former DOH UnderSec and now PhilHealth VP Alex Padilla Unilab VP Joey Ochave as Vice Chairman, Cecille Sison of HealthWatch as Secretary General, and former PPhA President Normita Leyesa as Treasurer.

Recently, MeTa decided to expand membership of the Council. They will also be charging annual membership fees to members, both as organizational representatives and as individuals. For me this is a good move. A civil society organization like MeTA Philippines, should be able to raise funds internally through annual dues and other activities, and be less dependent on assistance from UK's Department for International Development (DFID) and WHO.

There is an expanded meeting this afternoon, I shall be attending it.
-----------

See also:
Health Transparency 6: Physician Protectionism, May 19, 2012
Health Transparency 7: DOH Advisory Council, CHAT, June 04, 2012
Health Transparency 8: Advisory Council on RA 9502, June 11, 2012
Health Transparency 9: Physician Misdiagnosis, Dispensing Medicines, July 20, 2012
Health Transparency 10: Depoliticizing Health, Corporatizing Government Hospitals, September 18, 2012

Health Spending 5: Raising DOH Budget for Childhood Cancer

A fellow member of our Coalition for Health Advocacy and Transparency (CHAT), James Auste, the head of the Cancer Warriors Foundation (CWF) has lobbied other CHAT members and CWF supporters, to lobby and write the Senators to demand:

1. Increase DOH budget for Acute Lymphocotic Leukemia (ALL) patient assistance program from P30 million to P100 million, to cover some 3,500 kids with cancer will be given proper care and treatment.

2. Increase DOH budget for non-communicable diseases (NCDs) from P70 million to P280 million for four
diseases: cardiovascular, lung cancer, diabetes,...

I replied that I support more government funding for (a) pediatric diseases, including NCDs for children like childhood cancer, (b) infectious or communicable diseases like leptospirosis, dengue and malaria, (c) people with physical and mental problems, both children and adults.

But I do not support more government funding for NCDs for adults. Why should the rest of society pay for diseases of people who over-eat, over-smoke, over-drink, over-sit? Lifestyle is a choice, not inherited.

Legislators, Congressmen/women and Senators, receive all types of higher budget request from:

(a) Departments and other Agencies themselves which suffer budgetary cut at the Department of Budget and Management (DBM).

(b) NGOs, media, other civil society groups lobbying for additional budget for their respective sectors (ie, health NGOs asking for higher DOH budget, education NGOs asking for higher DepEd and SUCs budget, etc.).

(c) Rent-seekers and contractors lobbying for bigger budget of agencies that will get their services (ie, suppliers of jet fighters and battle ships seeking higher DND budget, road contractors seeking higher DPWH budget, etc.),

(d) Foreign aid or multilateral bodies like the WB and ADB pushing for new loans that will require local counterpart funding.

(e) Other sectors and interest groups.

One will hear all types of justifications and even alibi from these sectors, interest groups and lobbyists. They know that they are indirectly competing with each other as taxpayers' money is not a bottomless pit, so some tend to shout or lobby louder than the others.

But legislators are also under pressure where to get the additional funding other than the usual, never say die "more borrowings, more borrowings, more borrowings". The annual budget deficit (expenditures larger than revenues) is around P300 billion a year, and that is also the similar amount of new borrowings each year. Our public debt has become so huge that we pay about P350 billion a year on average on interest payment alone. Utang lang ng utang, let the future administrations and taxpayers worry about those debts later.

So legislators would tend to ask, "kindly help us identify where to get the additional money and we will give your request." Good. And here are possible sources of additional money for one's favored sector or department.

1. Higher rates for existing taxes and fees, like the proposed increase in excise tax for tobacco and alcohol products, higher excise tax for mining revenues, etc. Or a proposal to hike VAT from 12 to 15 percent. Or DFA hike in passport fee, NBI hike in NBI clearance fee, DOTC hike in motor vehicle registration tax, etc.

2. New taxes and fees, say an excise tax on junk food and bottled water (now more expensive than oil).

Please note that those taxes and fees refer only to national government agencies. The local government units (LGUs) can also increase their respective taxes and fees, like the community residence tax, real property tax, business permit tax, etc. They can also create new taxes like the proposed dog ownership tax in Pasay or Paranaque, or increase penalties like penalty for dog shit on the streets, penalties for men who walk topless on the streets, etc.

3. Privatization, like privatizing PAGCOR, some military facilities or camps, some state universities, etc.

4. Shrink the budget of other agencies and rechannel the savings to one's favorite sector or department.

If one will go for option #1 like the proposed sin tax hike, malabo na, not practical. So many sectors are already salivating at the huge money that will come from it -- the universal healthcare (UHC) of PhilHealth and DOH, the condoms and pills of the RH bill, the pork barrel of legislators themselves, etc.

If option #2, it is a highly sensitive issue and next year being an election year, politicians would rather borrow like crazy than create new taxes that can spell defeat for them at the precincts.

If option #3, I myself will go for it. Prioritize PAGCOR privatization, I think up to P200 billion can be realized from it. There is a bill by Sen. Ralph Rector on this, but I think it's not moving fast enough.

If option #4, I will also support it myself. My favorite is to drastically cut the budget of the Department of National Defense (DND)-AFP. I am actually in favor of abolishing the AFP itself as I believe we have no threat of external aggression in the sense that foreign armies will invade Metro Manila and the rest of the country. The bigger threat here is internal -- those thieves and carnappers, killers and murderers, kidnappers and rapists, extortionists and terrorists, corrupt officials and plunderers, many other criminals. The noise over the WPS/SCS is hyped mainly by the rent seekers and suppliers of jet fighters and battle ships, some legislators and the DND guys themselves. I read that one battle ship from Italy will cost about P6 billion each, and the DND plans to buy two ships soon. Not included there are bombs, missiles, ammunitions, training of personnel, oil consumption, replacement of parts, that will cost several billions more.

The Philippine Military Academy (PMA) should be privatized. Our subsidy for those guys is P500,000 per student per year, or P2 million per student over four years. The same with the National Defense College of the Philippines (NDCP), which has a subsidy of about P1 million per student, and those masteral "students" are not exactly poor.  They are mid-level or senior level government officials, congressmen, governors, mayors, etc.

So if people have to write to those Senators and Congressmen, their request will have a better chance of being granted if they can pinpoint where to get new money or savings.

My suggestion, go for option #4. Target the DND, or the state universities and colleges (SUCs), or DPWH.

Then over the next few years, target option #3.
---------

See also:
Health Spending 1: Wastes in US health spending, June 23, 2011
Health Spendng 2: DOH, Public Health Budget, June 18, 2012
Health Spending 3: Obamacare and Huge Tax Hikes, June 30, 2012
Health Spending 4: Global Aid on Health, 1990-2011, August 28, 2012

Drug Price Control 28: On Cong. Biron and Sen. Villar Bills

Last June 29, 2012, the Coalition for Health Advocacy and Transparency (CHAT) held a meeting-discussion at the PRRM building, Quezon City, on three issues:

1. legislative bills amending the Cheaper Medicines Law (RA 9502) by creating a drug price regulations board,

2. update on the bill raising the excise tax on tobacco and alcohol products ("sin tax bill"),

3. discussions on the proposed Milk Code, other matters.

The meeting was moderated by Atty. Pau Tanquieng of the Ayos na Gamot sa Abot Kayang Presyo (AGAP), the biggest coalition within CHAT. She also presented the three bills creating the drug price regulations board, as well as Sen. Legarda's peculiar bill amending the amendments to the Intellectual Property Code (IPC) contained in RA 9502.

After the discussions, Pau as convenor/moderator, asked, "Anyone here supports drug price control?" Anyone supports the creation of a drug price control regulation board?"

None said Yes, meaning everyone who attended the meeting, including CHAT President, Gov. Obet Pagdanganan has NO as answer to the above questions by Pau. Since she has already written the AGAP position on the same subject, she begged off to write the draft position paper of CHAT. No one else volunteered to do it, so I did. Here's the draft that I wrote, posted in our googlegroups last July 03, 2012.
------------

Draft Statement by CHAT

On the Proposed Amendments to the Cheaper Medicines Law

The Cheaper Medicines Law of 2008 or RA 9502 is still a new law and there are several indicators that so far, it has succeeded not only in bringing down medicine prices but also in making more essential drugs become more available in more drug outlets nationwide. There are other provisions of the law that are not activated yet and which, when seriously implemented, will further bring down drug prices, The main challenge therefore, for the implementing agencies and various stakeholders in the Philippine healthcare sector, is how to carefully implement those provisions.

There are several bills in both the House of Representatives and the Senate though, that aim to amend certain sections of RA 9502, foremost of which is the creation of a new agency, the Drug Price Regulations (or Regulatory) Board (DPRB). These are HB 1386 by Cong. Ferjenel Biron, and SB 5 by Sen. Loren Legarda and SB 2960 by Sen. Manny Villar.

We believe that the proposed amendments of (a) expanding the drug price control policy made in August 2009, and (b) creating a new office or bureaucracy that will implement such expanded policy, are not necessary at the moment for the following reasons.

One, even before the drug price control policy was made in August 2009, average prices of essential medicines have been declining due to more competition among various drug manufacturers and among more drugstores and pharmacies.

Two, the policy benefited the rich and upper middle class patients who would be buying those branded innovator drugs whether their original price was retained or was slashed by half. Many of the 21 drug molecules that were covered by the policy have cheaper, off-patent competing drugs already available. The poor were patronizing the off-patent drugs which are still cheaper than branded innovator drugs even if their prices were slashed by half.

Three, the policy has contradicted the goals the Generics Act of 1988 or RA 6675. That law was successful in promoting cheaper generics, off-patent drugs to the public. The drug price control policy however, encouraged the people to shift back to the branded innovator drugs made by multinational pharmaceutical companies as their prices were made 50 percent cheaper.

Four, the policy has adversely affected many local generic manufacturers, some of which were forced to close, or pull out some of their drugs since their prices were already low enough. After the mandatory 50 percent price cut by the innovator drugs, they were forced to either make further price cuts which affected their profitability, or simply close shop even temporarily.

As a result, the policy has introduced business uncertainty especially among local generic drug manufacturers. The threat of being forced out of the market by the unfair price competition by the foreign pharmaceutical companies due to drug price control will remain.

Five, creating the DPRB will only add another layer of bureaucracy in the government, which will require another set of budgetary allocation each year. Right now, the DOH Advisory Council on RA 9502 is doing fine monitoring the implementation of the law including the drug price regulation or control policy.

Six, there is a danger that corrupt government officials who will head that board might use their powers to extort money from existing players, otherwise their profitable drug products will be put under price regulation list.

In lieu of those twin moves, we propose the following.

Health Spendng 2: DOH, Public Health Budget

After posting Fat-Free Econ 13: P2 Trillion of Election Spending and Taxes in our CHAT googlegroups, there were a few discussions among us.

James Auste of the Cancer Warriors Foundation (CWF) suggested that it is okey to engage in spending splurge, so long as "we are investing in life" by prioritizing public health.

If we go back to Table 2 of the article above, this is the priority spending for 2012 (this year), out of the P1.82 trillion total budget:

1. Interest payment of public debt, P333.1 billion.
2. Local government units (LGUs) IRA, P291.6 B
3. DepEd, P228.9 billion
3. DPWH, P125.5 billion
4. DND, P106.9 billion
5. Personnel benefit (bonuses of gobyerno personnel) P101.5 billion
6. DILG, P96.2 billion
7. DA, P54.1 billion
8. DSWD P49.4 billion
9. DOH, P43.3 billion
10. Government corporations, P43.2 billion

I do not know how much of the P43.3 billion DOH budget is alloted to procurement of medicines. But I notice that many LGUs are spending high for local public health.  The Manila City government alone maintains  6 city-owned hospitals, some are more modern than the UP-PGH, like the Santa Ana Hospital, 10 storeys high, fully air-conditioned.

From http://www.manila.gov.ph/manilahospitals.htm, these are:
Photos below, 1st row: Gat Andres Bonifacio Memorial Medical Center, Justice Abad Santos Mother and Child (General) Hospital.
2nd row: Ospital ng Maynila Medical Center, Ospital ng Tondo II,
3rd row: Ospital ng Sampaloc, Santa Ana Hospital.

Other rich municipalities and cities and almost all provinces, have their respective municipal/city hospitals, provincial hospitals.

Health Transparency 7: DOH Advisory Council, CHAT

There is a section in RA 9502 or the Cheaper Medicines Law (2008) that allows for the creation of the DOH Advisory Council for Price Regulation. I have written about the Council and the discussions there about the imposition of drug price control (or regulation) since June 2009, see Health Choices and Responsibilities, pages 2-13, then pages 63-76, of the book.

Some photos of the Council meeting sometime in 2009, below.

After about a year, then presiding officer of the Council, former DOH UnderSecretary Alex Padilla, now PhilHealth CEO or COO, moved that the Council be transformed from Price Regulation into "Advisory Council for Healthcare". There was consensus among members of the Council -- representatives from different industry associations (local and multinational pharma, drugstores, hospitals), professional associations (medical, pharmacists, other government agencies, and NGOs -- to support it.  That is because there was general consensus among the members that price control and regulation only distorted an already downward trend in medicine prices due to more competition among more players with more products introduced into the market. And price control did not really achieve its goal of making some essential medicines be more affordable to the poor, for some really poor people, they want the price to be zero, not just 50 percent cheaper of its original price. But the policy was carried out due to politics leading to the May 2010 Presidential elections.

There are four NGOs that are regularly invited in the Advisory Council: (1) Cancer Warriors Foundation (CWF), (2) Cut the Cost, Cut the Pain Network (3CPNet), (3) Ayos na Gamot sa Abot Kayang Presyo (AGAP), and (4) Minimal Government Thinkers.

The first three were active in the deliberations and enactment of RA 9502 while MGT is invited despite its being an "outlier" to help provide wider and broader range of perspectives in many public health discourses. For instance, MGT is perhaps the only NGO and think tank in the Council that explicitly argues for "less government" in Philippine society. MeTA Philippines leadership is also invited from time to time to the Council.

Below, upper photos, another Advisory Council meeting, chaired by former DOH USec Alex Padilla and DTI Assistant Sec. Baua, and one of those slides presented during the meetings. Lower photos, during the public hearing of the Congressional Oversight Committee on RA 9502 at the Senate, May 10, 2012. USec Padilla and ASec Baua were among those who spoke there.

During the Congressional Oversight Committee meeting last month, chaired by Sen. Manny Villar and co-chaired by Cong. Albert Garcia, Cong. Ferjenel Biron looked down on the role of the Advisory Council. Compare the nature of the Council vs. Cong. Biron's perspective.

The Council meets only on occasions where in the judgment of the DOH, there are important health matters to discuss that requires broad discussion and information from multi-sectoral participants. Hence, the Council has  no regular meeting, is not a permanent bureaucracy with its own set of regular bureaucrats. I think all members of the Council are comfortable with it.

Cong. Biron on the other hand wants a more permanent bureaucracy, the Drug Price Regulation Board (DPRB) with its own set of permanent bureaucrats. Based on his actuations and hard-sell eagerness to push it, I think he positions himself to to head that bureaucracy someday should it become a law.
--------

In my discussions with some health NGO leaders, like those belonging to the Coalition for Health Advocacy and Transparency (CHAT), the civil society partner of the Medicines Transparency Alliance (MeTA) Philippines, I always emphasize the importance of coupling right and responsibilities. Former DOH Secretary Alran Bengzon also emphasized this when he gave a talk several months ago, sponsored by AGAP. Rights and responsibilities are twins in the healthcare (or any other social/public policy) issue/s.

Consider this. Even if government will provide free medicines, free hospitalization, free diagnostic tests, free physician consultations ("health is a right" kasi) but if people do not take care of their body and that of their households, do not observe even very basic sanitation, health outcome will remain poor. We do not need the DOH or WHO or PhilHealth or the provincial/city hospitals, to tell people that over-drinking, over-smoking, over-eating, over-sitting, living in dirty places, etc. is bad to one's health. Healthy lifestyle, or preventive healthcare, is a lot more cost efficient, more useful, in attaining good health outcome for the population.

Below, during some of CHAT fora and meetings, sometime in 2009-2010.

Below, upper photos, the Pharmaceutical and Healthcare Association of the Philippines (PHAP), in partnership with CHAT, also organized a social dialogue with civil society organizations (CSOs) on universal health care (UHC). Lower photos, with Dr. Krisana Kraisintu, an NGO leader in Thailand who was among the recipients of the Ramon Magsaysay Award in 2009.

Rights without responsibilities will result in laziness and irresponsibility among the people. I have noticed that  the bulk of public health debates in the past until now, have been focused on curative healthcare -- people are sick, they need cheap medicines, subsidized or free medicines, free hospitalization, etc. -- very seldom on preventive healthcare.

Sometimes CSO leaders appear like politicians. They promise their supporters of this and that social "rights" from the government, and seldom or never tell them they have responsibilities to each right.

There is obligation to each entitlement. If we remove obligations, then we might be building a society of  welfare-dependents and rent-seekers.

I am happy to note that many fellow NGO leaders, at least within CHAT, implictly agree with my above thesis. Why did I say this, well at least they did not debate my above points :-)

In my next paper on "Health Transparency", I want to write about the role of MeTA Philippines. Generally they are doing a good job in making medicines pricing, access and availability, become more transparent. Although I think public awareness of the body and its activities remain low.
-------

See also:
Health Transparency 4: Drug Promotions and Government, September 03, 2010
Health Transparency 5: Forum on Good Governance in Health, March 08, 2012
Health Transparency 6: Physician Protectionism, May 19, 2012


FDA Watch 1: BFAD Strengthening Bill, May 06, 2009
FDA Watch 2: Inspection of cGMP Compliance, January 31, 2011
FDA Watch 3: Resignation of Dr. Suzette Lazo from FDA, May 16, 2012