Drug Price Control 43, Mar Roxas and the Cheaper medicines law of 2008

During the 3rd and final Presidential debate last Sunday, Sec. Mar Roxas said, "Alam mo, Karen, sa kasaysayan ko, binangga ko mga malalaking interes. Pharmaceutical industry, cheaper medicine law, banking industry..."

Then a friend reposted a comment from someone attacking the Secretary saying, "You (Mar) lied by proclaiming you are instrumental in cutting the prices of medicines. On July 2009, there was a Senate press release....

"...Authors of the Cheaper Medicines Act in the House or Representatives urged Roxas to support the move to reinstate provisions on automatic price regulation.

"Authors of the Act in the House noted that Roxas vehemently opposed the automatic price regulation, which is the 'heart and soul' of the House version because it could have reduced the prices of more or less 1,600 medicines by at least 50 percent," Sen. Loren Legarda said in response to a question by members of the audience after her speech.

"Mar's amendments on the Cheaper Medicines Act killed the spirit of that law, and instead set a limit to its mandate in regulating pharmaceutical companies' pricing practices," Loren stressed.

The drug price control policy of 2009 affected about 20 or so molecules, usually the most saleable products by multinational pharma. What Cong. Biron, even Sen. Manny Villar, also Sen. Loren? wanted was the creation of a new bureaucracy, the drug price regulation board (DPRB) with a new set of bureau directors, asst directors, staff, office, travel, etc. to be incorporated in the cheaper medicines law of 2008 (RA 9502).

That law was mainly about amending the intellectual property (IP) code so that some newly-invented, patented medicines by multinational pharma, the patent can be confiscated by the government so that local pharma like Unilab will benefit, they can also manufacture and make good profit of those newly-invented medicines. The chapter on price control was a rider in the law, not part of the original draft bill.

So did Mar lie on his role in the cheaper medicines law?

No. He delivered on that amendment to the IP Code, something that I personally did not support, but the law was created nonetheless. Mar was correct in opposing the creation of that permanent bureaucracy DPRB (likely would have been headed by ex-Cong. Biron) and endless drug price control policy.

The threat of patent confiscation by the state from innovator pharma to local generic pharma (silent cronyism actually) created some downward pressure on patented drugs. The off-patent drugs that constitute about 95% of all essential medicines list (EML) of the DOH, again off-patent, are not affected by that law.

The advocates of the creation of DPRB are mostly socialists, explicit or implicit, or plain bureaucrat extortionists. They argue that private pricing of their products is wrong, it should be the state that should price those products. Then the state and the price bureaucrats may allow some pharma products not to be included in the mandatory price control, in exchange for bribes and extortion.

The world health org (WHO) has its global essential medicines list (EML) and from what I read once, 99% of them were off-patent, meaning only 1% of those EMLs in the WHO list are newly-invented and still patented ones. In the DOH's EML, I read that it's between 90-95% are off-patent. Meaning RA 9502 has zero effect on these non-patented, non-IP protected medicines. Like the famous anti-fever paracetamol molecule, it's been off patent since 30 or more years ago.

Generics medicine was given a huge boost since 1988, the Generics law under DOH Sec. Flavier. So the cheaper medicines law of 2008 (20 years after) has contributed very little to generics promotion. The compulsory licensing (CL) and special CL provisions of RA 9502 were also meant to align PH's IP law with WHO's TRIPS flexibilities. 

Funny thing about drug price control/regulation, the head of PCPI, the local pharma lobby, said during one DOH meeting that perhaps it's the first time that the local pharma + multinational pharma (represented by PHAP) were united in opposing a govt policy. Before, it was easy for them to take a stand. If PHAP takes position A, PCPI almost always takes position B that's opposed to A.

Death from infectious or communicable diseases is falling worldwide. So since all of us, 100% of us will die anyway, that means that more and more of us will die of non-infectious diseases, like cancer, stroke, hypertension, etc. That is where many of medicines innovation are directed, like there are perhaps 200 different types of cancer, then varieties like a patient with prostate cancer + diabetes vs a patient with prostate cancer + hypertension vs a patient with prostate cancer only.

Also during the 3rd and final Presidential debate, Sen. Miriam Santiago said that her physician sister or friend said that there are new anti-cancer drugs that come out in the US almost every week. These are never-heard before, not part of "orig" nature, science-invented molecules and medicines. They are very expensive, to compensate for very high cost of R&D and long processes of clinical trials, and usually very effective. Miriam added that she feels like new, so alive, because of the new medicines she is taking but are very expensive.

Actually the most expensive medicines are those that don't work. Even a P1 tablet is "expensive" if it does not heal a patient, if it allows the disease to evolve into something more sinister and fatal inside a person's body. A drug that costs P1 M or P5M treatment but can heal a cancer patient, can be considered "cheap" if a patient survives to live more years or decades of productive life.

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See also: 

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

Drug Price Control 40: CWF Wants Price Dictatorship for Lipitor, September 12, 2014

Drug Price Control 41: Exchanges with Joey Ochave at MeTA PH, September 17, 2014 

Drug Price Control 42: New Round of India Price Caps, September 25, 2014

IPR and Medicines 36, On patent protection, data exclusivity and TPP

There was a DOH Advisory Council on the Implementation of RA 9502 (Cheaper Medicines Act of 2008) last April 20, 2015 that I was not able to attend. The Secretariat failed to invite me, but at least they sent me the minutes of the meeting, Among the speakers that day was Atty. Allan Gepte of the Intellectual Property Office (IPO), DTI and he was asked to give updates about the US (and PH?) Free Trade Agreement (FTA) and the European FTA (EFTA). He said that he was not aware of any current (PH-) USFTA negotiations and there are talks among EFTA countries. 

He gave some updates about IP concerns in the country instead, like the DTI-IPO-DOH public consultation on IP issues, with some NGOs last March 31, 2015. The topics covered data protection patent term extensions. I was not there in that meeting. 

But I  have attended the same DTI-IPO-DOH meeting last June 04, 2015 at the DTI International building. It was chaired by DTI Assistant Sec Rodolfo, IPO Dep. Allan Gepte, and DOH-NCPAM Doc Meme Guerrero. I learned about the meeting because three days ahead, June 01, there was another anti-TPP, anti-IPR forum at PRRM, QC, sponsored by IDEALS, MAG, AGAP and CHAT, and the speaker was Dr. Burku Kilik of Public Citizens, an NGO in the US. Then there was a belated invite to attend the March 31 meeting at the DTI.

I think it was a limited consultation because only very few NGOs were there, led perhaps by the Focus on the Global South (FGS) leader, Joseph Purugganan, plus the Fair Trade Alliance, they are campaigning against strong IPR protection in the non-existent EU-PH FTA or non-existent PH membership in the TPP. 

At the DTI consultation (a few CHAT members were also there, also Dave Escalona of Unilab), I commented that the PH is not even among the invited members of the TPP (only 4 of 10 ASEAN countries were invited to the TPP) and yet there are a number of noise against those proposed FTAs the issue of IPR.

Assuming for the sake of arguments that (1) there is a TPP Agreement already today or tomorrow, (2) the PH is a member of TPPA, and (3) all those "dreaded data exclusivity", etc. provisions are implemented -- then they will affect only a few, newly-invented medicines and not the 90-99% of off-patent, useful generic medicines in the WHO and DOH essential medicines list (EML). I think anti-IPR campaigners are not aware of this, perhaps they think that any extended regulatory data protection (RDP) and patent protection on innovator drugs also apply to off-patent, generic drugs. Far out, man.

I posted the above comments at the AC email loop. Atty. Joey Ochave, SVP of Unilab and a friend since the 80s in UP Diliman, replied to my comments. He said that

"data exclusivity can apply to off-patent, or even non-patented, drugs. Patent protection is different from data exclusivity but both seek to prevent the entry of generic competition and preserve the monopoly status of the originator. The only difference is patent protection is protected by TRIPs while data exclusivity is TRIPS Plus. Data exclusivity is NOT required by WTO. This is why the US tries to insert it in bilateral or multilateral trade agreements."

I thanked Joey for his comments. These are legal matters, outside my usual cup of coffee so I yield to his explanation.

For now, the PH government through DTI Sec. Domingo has officially signified its intention to join the TPP in the next round of membership expansion. I support this move, I believe that it is not possible for the PH to have a bilateral FTA with the US or even Canada, and the US will remain to be the biggest, most innovative economy in  the planet for the next decade or two. The only way to have an FTA with them is through the TPP.

If what Joey mentioned that data exclusivity is to "prevent the entry of generic competition", then it will have a rough sailing in the PH as access to generics is both a health and emotional issue here and in many other countries.

Things like this, the AC can discuss as RA 9502 is first and foremost, about IPC amendment and price regulation is just an add-on or after-thought chapter in the law. I have attended 2 fora already about TPP and IPR involving 2 foreign speakers who are generally anti-IPR and  both facilitated by IDEALS and CHAT. The first was a lady speaker from France, the 2nd was another lady speaker from the US, from Global Citizen. The 2 fora did not have legal minds as discussants after the presentation.

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See also:

IPR and Medicines 32: The Policy Workshop's Hong Kong Dialogue, November 28, 2015 

IPR and Medicines 33, Geneva Network's Forum in Singapore, May 22, 2015

IPR and Medicines 34, Another Forum on TPP and IP, Manila, May 27, 2015 

IPR and Medicines 35, New paper from Geneva Network, July 17, 2015

IPR and Innovation 22, The USTR 301 Report 2015 and the Philippines, July 10, 2015 

IPR and Innovation 23, Letter to WIPO by 85 think tank leaders from 51 countries, July 21, 2015

Drug Price Control 41: Exchanges with Joey Ochave at MeTA PH

After my  discussion on CWF Wants Price Dictatorship for Lipitor, Joey Ochave, SVP of Unilab and Vice-Chairman of MeTA Philippines, reacted to it. We have a nice, friendly and civil discourse and mini-debate the past two days. The other members of MeTA PH (80+ people in the email loop) expressed satisfaction reading our exchanges. Copy-pasting them below raw, zero alteration even comma. Later, another friend, Karen Villanueva joined. Karen is from Merck and also MeTA PH member. Both Joey and Karen gave me permission to use their comments for this blog post.

The two tables below are not part of the original exchanges. I made them and inserted them here as additional background info about the price control or mandatory, forcible 50 percent price cut policy in August 2009. This is about 3,200 words,  six pages long including the two tables. Enjoy.

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I never thought I would say this – I agree with Nonoy. (Biro lang, Nonoy.) Price control is not the answer. It is not a sustainable policy instrument to address issues relating to access.

If I remember correctly, there was a preliminary study done before on the impact of the 2009 MDRP (or MRP, if one is to follow the text of the Cheaper Medicines Law). It showed that the ones who benefited most from the 50% price reduction were those who were buying the “originator” medicines and not the poor who were its intended beneficiaries. The poor, after all, were getting free medicines from the government or already using generic equivalents. (I do not, however, discount the possibility that there were some poor people who having been prescribed the originator brands never used generics and thus were able to benefit from the MDRP. I would assume though that their numbers were not significant.) Hence, if the policy objective is to provide access to the poor, then price control is not the answer. (I just learned from former UP College of Pharmacy Dean Yollie Robles that  she just completed a similar study. It would be good if she could share it with META.)

Further, the situation now is much different from that in 2009. Competition in the pharma sector has flourished since then. Filipino patients have more choices now than before, with several brands at different price points for every non-patent protected molecule. Since 2009, generic drugstores have thrived due to the successful marketing programs of TGP and Generika. Even Watsons has seen it fit to introduce now its Watsons Generics brand, with all the marketing gloss that one would previously associate only with “branded” medicines. More importantly, the government put in more money for medicines, with the latest figures showing a 40% increase in budget. Many expect this to grow further as Universal Healthcare becomes a reality. After oncology and kidney transplant medicines, I understand that PhilHealth is interested in covering also out-patient medicines for diabetes and hypertension. They have an existing pilot program with a generic drugstore that they might scale up soon. Hence, while access to essential medicines is still an issue, there are already several successful initiatives to address it since 2009.

On Pfizer’s differential pricing scheme, this is nothing new. This is standard practice after patent expiry. Companies will have different prices for different geographical markets. This is why, for example, the price in Thailand for the same product by the same company may be lower than in the US. What is new now is that differential pricing is being done within a single country. In the Philippines, this has been made possible because of the Certificate of Listing of Identical Drug Product (CLIDP) scheme of FDA, which allows a manufacturer to provide several marketing companies a “daughter CPR” from its Principal (“mother”) CPR. This means that two or more marketing companies can source a drug from a single manufacturer, and each one is free to price it depending on its cost structure and intended market.  As anyone in the pharmaceutical sector knows, medicines are priced depending on what the company thinks the “market” will accept. The definition of “market” depends on the population segment the company wants to serve. If SEC (socio-economic class) AB, then one would expect a company to price it higher than another company which wants to serve the SEC D market. Theoretically, a company may choose to cater to both the SEC AB and SEC D using identical products, except for the packaging and the go-to-market strategy. There are many reasons why a company may want to do this – for CSR purposes, to have a flanking brand, to protect its market share, or as a product life cycle management strategy, among others. Each company will have its own reasons.

On the GMAP, it is actually a voluntary price reduction by selected companies in response to the government’s request. There is nothing illegal in it, Nonoy. In truth, almost all molecules (except for one) covered by the Executive Order imposing MDRP are Pfizer products, for reasons all of us know. Atorvastatin (LIPITOR) is one of them. This means that the current LIPITOR price is already 50% lower than its pre-MDRP price. If indeed, Pfizer is supplying Rhea an atorvastatin product that is identical (same manufacturer, same shape and color of tablet) to LIPITOR and it is 40-60% cheaper than the current post-MDRP LIPITOR price, then we should welcome this. Doctors and patients (who continue to prescribe or buy LIPITOR despite the presence of its generic equivalents) may be advised to shift to Rhea Atorvastatin so they can save.  (I bought samples over the weekend, and what James says is true. LIPITOR and Rhea atorvastatin are identical.) Kung ayaw ng RiteMed o Pharex (okay ba, Beau?), then LIPITOR users can shift to Rhea Atorvastatin. Switch and save, sabi nga ng Watsons Generics. Rhea, by the way, is only available in MDC.

I was told that Pfizer is also supplying Rhea Mefenamic Acid. I checked this over the weekend, and it’s true. Totoo nga, parehong-pareho. Same manufacturer, same color and shape of tablet as PONSTAN. The only difference is the price – PhP 3.90 for Rhea Mefenamic Acid and PhP 31.25 for PONSTAN, or almost 10x the Rhea price. This is even bigger than the Rhea atorvastatin savings. Remember Sec. Pagdanganan during the Cheaper Medicines Law campaign? Remember when he was comparing the PONSTAN prices in the Philippines and India and wondered aloud why the big difference? J

While I disagree with James on the price control proposal, we should nevertheless thank him for his continuing advocacy of patients’ right and welfare. C’mon, none of us in this email loop has done more individually for patients than James has. He was an influential voice during the Cheaper Meds campaign and he was instrumental in persuading PhilHealth to cover out-patient oncology medicines, especially for childhood leukemia. At the last META Board meeting, we noted the continuing absence of patient organizations (except the Psoriasis group now) in META. Until now, the access campaign in the Philippines has largely excluded patient groups. Maybe it’s because patients’ hands are already full coping with their condition and they find tiring the endless discussions/arguments that we have. However, if we are to have meaningful changes in the healthcare system, the voices of the patients have to be given primacy. It is a real issue for them, life and death, not a theoretical one as it is to some of us. Kaya James, saludo kami sa iyo. Yes, kindly give the same passion you gave to Cancer Warriors to your advocacy for Lolo and Lola. Sadly, many of us are either compromised or do not have the courage to do that.

Hala, masyado nang mahaba itong email ko. Bottomline, I agree with Nonoy that price control is not the answer. Competition is. The fact that Pfizer is now in the generics arena through Rhea should be a cause for celebration. Now, the LIPITOR and PONSTAN prescribers or users who are not comfortable switching to existing generic brands will have the option of switching to Rhea. Trust me, parehong-pareho sila. This is what competition is all about.

-- Joey Ochave

Thanks Joey. I believe that majority of players and stakeholders in the PH health sector never support or advocate price control or price dictatorship. When the issue became sensationally hot in early to mid-2009, there was never a "health crisis" or emergency, only a political crisis for then Sen. Mar Roxas who was too desperate to raise his low ratings as a Presidential candidate.

Re studies about the impact of price control, it is in the law that the DOH should submit a report to Congress Oversight Committee on RA 9502 at least once a year, and submit a report to the President two times a year. I think this was never done by the DOH, or if ever it did so, those reports were never made publicly available, freely downloadable.

Leonie Ocampo of PPhA, Reiner Gloor of PHAP then, Beau Agana of PCPI, have made several presentations showing that (a) drug prices have been declining even before the 2009 price control because of growing competition among drug manufacturers and distributors, and (b) only the overall revenues of affected innovator companies were affected but volume wise, their sales have not significantly increased. Someone taking Norvasc 1 tablet a day against hypertension does not take 2 tablets a day simply because the price is cut by half. Ma-'undertension" na sya noon :-)

Price differentiation, market segmentation, is a natural thing to do for private enterprises. The prices of a can of Coke in a sari sari store, 7-11, Mini Stop, SM grocery, Rustan,s, Itallianis, Shangrila, Intercon, etc., can vary widely. Same product, same volume, same packaging, same manufacturer, and yet have different prices. Because they cater to different buyers and consumers. The same practice applies to a bottle of C2 or a piece of Toblerone.

A tablet of Norvasc or Biogesic can have different prices in Mercury, Watsons, TGP, Aling  Merced drugstore, etc because they have different cost structures. Aling Merced and other small drugstores rent a small space and pay little on space rental, have no air-con and pay little on electricity, have no full time pharmacist and pay smaller on manpower, etc.

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.

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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.

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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!

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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

IPR and Medicines 29: Parallel Importation and Patent Linkage

This news report last August 8, 2014, was posted with discussion by Atty. Joey Ochave at the Medicines Transparency Alliance (MeTA) Philippines email loop. Joey is the Vice-Chairman of MeTA Philippines, SVP of Unilab, and a friend way back in UP Diliman undergrad in the 80s.

Here is Joey's discussion. Posting this with his permission. It is a well-written, well-argued piece as always, which many people outside of MeTA would be interested to learn. My short comments and Joey's reply further below. A bit long, about four pages, enjoy.
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Parallel Importation and Patent Linkage

I came across the attached article entitled “Pharmaceutical firms seek full implementation of generics law” in Philippine Star last August 8th. It mentions a forum in Manila where three companies called “for the government to strengthen the [Cheaper Medicines Act’s] implementation to allow drug outlets to carry a variety of medicine brands, including those sourced through parallel importation, and give choices to consumers.” (emphasis supplied) The three companies were raided by the National Bureau of Investigation agents for alleged “violation of infringement on patent rights” (sic) and selling “illegal drugs”. They argue that since their drugs have been registered with the FDA, they are “not illegal”.

As an IP & Health Law practitioner and an advocate of the Cheaper Medicines Act, I feel compelled to comment on this news article. (Disclosure: I have no involvement in this case. My only interest is to make sure that the Cheaper Medicines Law is properly understood.)

1.     I asked around and learned that the drug molecule in this case is etoricoxib. This medicine is indicated for “acute and chronic treatment of signs and symptoms of osteoarthritis and rheumatoid arthritis; treatment of ankylosing spondylitis; acute gouty arthritis and primary dysmenorrhea; relief of acute pain; moderate to severe acute pots-op pain associated with dental surgery and abdominal gynaecological surgery.” It comes in two strengths – 30 mg. and 60 mg. (MIMS, 135th Ed., 2013). It is marketed in the Philippines as Arcoxia® by Merck Sharp & Dohme (MSD), who I believe is also the patent owner or at least authorized by the latter.

2.     The etoricoxib molecule has a valid and subsisting patent in the Philippines. The patent is on the molecule itself. It is therefore not a frivolous patent, which the Cheaper Medicines Law (CML) prohibits.

3.     Sec. 72 of the CML amended the Intellectual Property Code of the Philippines to allow parallel importation. The patent owner does not have the right to prevent third parties from importing a drug or medicine that has been “introduced in the Philippines or anywhere else in the world by the patent owner.” (emphasis supplied) By inserting the phrase “anywhere else in the world”, the Philippines adopted the “international exhaustion” principle, which means that if the patent owner sells the patented product anywhere in the world (not just in the Philippines), his patent rights over the patented product is exhausted. He cannot subsequently prevent the buyer of the patented product from selling or importing it into the Philippines. To illustrate, if patent owner X sells his patented medicine to Company Y in Thailand and the latter sells the product to Company Z in the Philippines, Company X cannot prevent Company Z from importing and selling the patented medicine in the Philippines. Why? Because Company X has exhausted its patent rights over the patented product when it first sold it to Company Y in Thailand. Stated differently, a patent owner loses his patent rights over a specific patented product the first time he sells the latter. It is also called the “doctrine of first sale”. The policy rationale behind this rule is that the patent owner has already recovered whatever economic benefits he is entitled to as a patent owner when he first sells the product. In short, kumita na siya when he made the first sale.

4.     The article mentions “parallel importation”. I do not know whether this is because the three companies believe they are engaged in parallel importation. In parallel importation, however, what may be imported is only the product of the patent owner. This means one can only import Arcoxia® or any etoricoxib brand manufactured or authorized by MSD. It is not parallel importation  if one imports a generic etoricoxib because it did not come from MSD. Again, under Sec. 72 of the CML only the product placed in the market by the patent owner anywhere in the world can be parallel imported into the Philippines. If one imports the generic equivalent of Arcoxia®, this means it was not MSD who placed it in the market and MSD has not derived economic benefit from it. It therefore patent infringement if you import the generic etoricoxib into the Philippines. Hindi siya parallel importation kapag generic equivalent ang inangkat.

5.     The three companies also argue that since they were able to secure Certificates of Product Registration (CPR) from the FDA for their etoricoxib product, they are free to sell the same in the Philippines. No, that is not true. They should still have to make sure that they are not infringing upon the IP rights (trademarks and patents) of others. The FDA has nothing to do with patents.  Patents are with the IPO. The role of the FDA is simply to make sure that the medicines you will market in the Philippines are safe, effective and of good quality. (This task is no joke given the proliferation of substandard medicines in the world.) This is why the CPRs issued by the FDA state that the CPR holder holds the FDA free and harmless from any damage resulting from any trademark or patent infringement suit against the CPR holder. This means that there is no linkage between drug registration and patents. This is what public health advocates fought for several years ago, which the then BFAD accepted. (Malaysia and Indonesia Drug Regulatory Authorities followed suit.) Unfortunately, with their argument the three companies are unwittingly arguing for patent linkage. (Offhand, I don’t think they realize the implications of their argument.) In any case, for the nth time, patent linkage is NOT required by the TRIPS Agreement. It is in fact a TRIPS Plus provision, or one that it not required by the World Trade Organization. The WTO Doha Declaration on TRIPS and Public Health itself (aside from WHO)  encourages developing countries to exercise the public health flexibilities afforded by the TRIPS Agreement. Removing any linkage between patents and drug registration is one of those flexibilities. Kapag naman ibinalik pa natin ‘yan, tayo na ang may problema. Sinabi na nga ng WTO that developing countries like us should make use of TRIPS flexibilities to protect public health, eh.

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

Two weekends ago, I gave a talk at the University of San Carlos (USC) in Cebu City, some 100 Pharmacy Economics students of a friend, Prof. Frank Largo. Frank is a fellow UP School of Economics (UPSE) alumni, also a fellow International Academy for Leadership (IAF) alumni at Gummersbach, Germany.

Four years ago, I also gave a talk at his Economics graduate class also at USC. I was one of four speakers then. See  Drug Price Control 38: Presentation at USC, Cebu, March 2010.

The other speaker that day was Prof. Eric Salenga, Chairman of the Pharmacy Department, UP Manila, also President of the Young Pharmacists Association of the Philippines (YPAP). He's a very articulate speaker.

My outline was simple. I.  Dreaming a single national price, II. Drug price control of RA 9502,

III. Senior citizens discount of RA 9994, IV. Conclusions.

I. Dreaming a single national price

Many of those who advocate government price control and/or mandatory discounts of certain commodities in society make this faulty assumption. That same product with same dosage or quality made by the same manufacturer in the same country should have only one price nationwide. Thus, medicine price by the same manufacturer should be the same regardless of outlets.

Any difference in pricing is explained by corporate greed; the wider the price difference, the bigger the greed, so government should control or limit that greed in the name of public health and welfare. This can be an emotionally powerful argument.

When this logic is applied internationally, it would imply that same product with same dosage or quality by same manufacturer made in different but similarly developing countries should have little price differentials. But why this did not happen?

This line of thinking is illogical because there can never be a single national price.

To make meaningful price comparison of a commodity country by country, one must show:

a.       same or comparable retail outlet, say only from Watsons (not a hospital pharmacy in country A vs. small drugstore in country B)

b.       same reference period for price, say December 30, 2012 (not end-January in A vs end-December in B of same year)

c.       Same reference period for exchange rate in converting different currencies into a common currency, PhP or US$, say as of end-June 2013

d.       taxes and fees, national and local, applied on each commodity

e.       subsidies or mandatory discount or price control, if any, applied on each commodity;

f.         other factors.

I asked some individuals who were involved in the lobbying and crafting of the Cheaper Medicines bill into a law, RA 9502, the raw data for such price comparison in the above table, they could not present one. Those numbers in the Senate Committee Report therefore, were suspicious, but they have become strong basis for enactment into a law of the bill.

RA 9502's main concerns were as follows:

* Amending the Intellectual Property Code (IPC) to allow TRIPS flexibilities in the intellectual property rights (IPR) like patents of innovator drugs and allow compulsory licensing (CL), special CL, “early working” and parallel importation.

*  Drugs and medicines price regulation through the issuance of maximum retail price (MRP, not MDRP or GMAP).

* Non-discriminatory clause, amending the pharmacy law and generics law and strengthening BFAD, now FDA.

* Only one goal: cheaper and safe medicines be more accessible to the poor.

But even before RA 9502, average medicine prices were already declining. Not because of political coercion and harassment, but because of competition among drug manufacturers themselves.

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

* Note: This is an expanded version compared to the one I originally posted last Thursday. The discussion on game theory below is explained as many readers may not be familiar with this applied math theory used in Economics and other social sciences.

Upon the invitation of a friend, Prof. Frank Largo, who was the Chairman of Economics Department then, University of San Carlos (USC), Cebu City, I spoke at his university in March 2010. I forgot to blog about it here, posting now.

My title was a play of words on right and left. Private property rights can be subverted by leftist pricing policy.

I was one of four speakers then. The three other speakers were (from left) Dr. Sophia Mancao of DOH Region 7, Mr. Juanito Luna of Prosel Pharmaceuticals Inc. in Cebu, and Prof. Yolanda Deliman, Dean of College of Pharmacy, USC.

My presentation, below.

Senior Citizens Discount 5: Supreme Court Flip-Flopping on the Law

A fried from Mercury Drugstore, Atty. Edsel Manuel, gave a long reply to the complaint of Mr. James Auste, head of the Cancer Warriors Foundation, why his demand to get a 3-months supply of his medicines from Mercury was denied. The email exchange was posted in our DOH Advisory Council for RA 9502 (Cheaper Medicines Law of 2008) email loop. Atty. Manuel's long reply covered several topics, from the law on mandatory discounts to persons with disabilities (PWDs) or RA 9442, to the expanded mandatory discounts to senior citizens or RA 9527 (enacted February 2004) and RA 9994 (enacted January 2010), to pricing by big drugstore chains.

Below, I am posting portions of his reply related only to RA 9994. I will reserve my further comments about this law in my next blog post on the subject. I thank Atty. Manuel for giving me permission to blog his long reply. Photos here, I got from the web.

(S)ince the enactment of senior citizen and PWD discounts, drugstores have been crying afoul and have been literally crying a river in Congress and Senate.  If this 20% discount is viable and reasonable to drugstores why on earth will drugstores complain? And with the burden shared to manufacturers and suppliers, why are they complaining also? This means that there is something wrong with the law.

The first giver of 20% discount is RA 7432 or the original senior citizen law. This law is the most fair that even without the implementing rules being issued, Mercury Drug has initiated the giving of 20% discount believing in the just and fairness of the law as the cost of the discount was treated as tax credit. 

However, the anticipated fairness of the law was saddened by the issuance by the Bureau of Internal Revenue of Revenue Regulation No. 2 series of 1994, by treating the grant of the 20% discount as tax deduction instead of tax credit; and the expected propriety of the elderly was frustrated by the abuses made by unscrupulous persons. We were able to convict in Valenzuela court a person who used fake senior IDs and the discounted medicines he illegally acquired were sold to other establishments.

Appeal to the Executive branch of the government turned to be futile thus, the company sought the intervention of the Judiciary.  

From 1994 until the company won the case with the Supreme Court in 2005, the company had suffered substantial reduction in sales,  profit, and drain in the company’s cash flow, not to mention the litigation costs  incurred . 

It has been decided in numerous decisions of the Supreme Court that tax deduction is not fair- is not a just compensation for the loss revenues brought about by the discount. (Commissioner of Internal Revenue v. Central Luzon Drug Corporation G.R. No. 159647, April 15, 2005, 456 SCRA 414; Bicolandia Drug Corporation  v. Commissioner of Internal Revenue, G.R. No. 142299, June 22, 2006, 492 SCRA 159; Commissioner of Internal Revenue v. Bicolandia Drug Corporation, G.R. No. 148083, July 21, 2006, 496 SCRA 176; Commissioner of Internal Revenue v. Central Luzon Drug Corporation , G.R. No. 159610,(June 12, 2008] 

To quote the Supreme Court, thru Justice Panganiban, 

“Be it stressed that the privilege enjoyed by senior citizens does not come directly from the State, but rather from the private establishments concerned.  Accordingly, the tax credit benefit granted to these establishments can be deemed as their just compensation for private property taken by the State for public use.” (Commissioner of Internal Revenue v. Central Luzon Drug Corporation G.R. No. 159647, April 15, 2005, 456 SCRA 414)

That light we saw from the Supreme Court in redeeming the company from injustice did not continue to flame-up because the Legislature enacted RA 9527 or the Expanded Senior Citizen Act of 2004, which changed the original tax treatment of the discount from tax credit to tax deduction.

With the enactment of the Expanded Senior Citizen Act of 2004, the small drugstores filed a Petition with the Supreme Court questioning the constitutionality of the tax deduction provision of the law.

Surprisingly, the Petition by the small drugstores was dismissed by the Supreme Court, in deviation from their previous ruling by upholding the  tax deduction scheme, but questioning the business decision of drugstores in pegging a small mark-up. 

The Supreme Court enunciated thru Justice Azcuna

“it is unfair for petitioners to criticize the law because they cannot raise the prices of their medicines given the cutthroat nature of the players in the industry. It is a business decision on the part of petitioners to peg the mark-up at 5%. Selling the medicines below acquisition cost, as alleged by petitioners, is merely a result of this decision. In as much as pricing is a property right, petitioners cannot reproach the law for being oppressive, simply because they cannot afford to raise their prices for fear of losing their customers to competition.” (Carlos Super Drug vs. DSWD, G.R. No. 166494, June 29, 2007)

As evident from the above ruling, the Supreme Court teaches drugstores to increase their prices to counter the effect of tax deduction, but this has been rendered inutile by the enactment of RA 9502 or the Cheaper Medicine Law in June 6, 2008, where prices of medicines have been limited to the dictated price of the government. 

Where now will the drugstores put themselves? Again, woe to drugstores! Additional salt to wound is that the drugstores are being punished if they will not give discounts and the aggressive complaints of seniors and pwds as if drugstores are the dictator of prices….

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See also:
Senior Citizens Discount, Part 2, November 03, 2010 
Drug price control 5: Mandatory discounts and acronym politics, March 21, 2011 
Senior Citizens Discount 3: Sharing of Mandatory Discounts on Medicines of Senior Citizens, December 14, 2012 
Senior Citizens Discount 4: Distortion in Consumers' Perception of Drug Prices, February 04, 2013 

Drug price control 5: Mandatory discounts and acronym politics, March 21, 2011 
Welfarism 25: Centenarians and Populist Legislators, May 30, 2013

Drug Price Control 34: No Single National Price, And a Wailing Cat

Among the reasons often cited why some groups propose government price control of certain commodities is that the local price of the same product by the same manufacturer is higher compared to other countries in the developing world. The assumption is that since it is (a) same product (b) made by the same manufacturer, then the price should be generally the same.

This assumption is intrinsically wrong because it assumes that there is only one price in one country or city for each product that satisfies (a) and (b) conditions above.  For instance, the price of a can of coca cola 350 ml should be the same for the entire country.

This is terribly wrong. The price of that (a) same Coke 350 ml in can (b) made by the same manufacturer is different when bought in different retail outlets: a sari-sari store, carinderia, average resto, 7-11, Mini-Stop, SM, Rustans, Robinsons, Shangrila, Manila Hotel, Mandarin Hotel, and so on. There is no single price to represent the “national price” of that can of soda, or any other commodity. This can be said in another country with generally higher or lower price levels as the Philippines. This point can be represented by these graphs.

Each equilibrium price or intersection between supply and demand represents the prevailing price in each outlet. There are sellers and buyers in each equilibrium point. There is no single price, but different prices by different sellers for different consumers, for each country.

When the Senate in the 14^th Congress (2007-2010) reported out Committee Report No. 6 made by three Committees -- Trade and Commerce, Health and Demography, Finance – dated October 01, 2007, before the Cheaper Medicines bill became a law (RA 9502 in June 2008), among the reasons cited is this table showing how expensive the prices of (a) same medicines (b) made by the same manufacturers in the Philippines were compared to those in India and Pakistan.

As in the example of coke above, there can never be one price of particular medicine in one country. If one will buy say, Ponstan 500 mg by Pfizer in different drugstores and pharmacies – Mercury, Watsons, Rose, The Generics, Generika, Manson, Dr.  Pharmacy, Botika ng Bayan, Makati Med, St. Lukes, Asian Hospital, Capitol Medical, etc. – one will get different prices. So  what is the “national price” that can represent the price of that drug in the Philippines? None. And yet the Committee Report has assumed there is such a thing for each country. 

If one will highlight the idea that Philippine drug prices are “among the highest, if not the highest” in SouthEast and East Asia, one will pick up the highest price, say from Makati Medical Center’s pharmacy or St. Lukes Hospital pharmacy as the “national price.” If one will highlight the idea that local drug prices are “comparable if not lower than those in SE and East Asia”, one will pick up the price of The Generics or smaller, non-chain drugstores.

Besides, if one will make a meaningful price comparison of a particular commodity by country, then one must show:

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

(b) same reference period, say December 30, 2012;

(c) exchange rate used for converting different currencies into a common currency, say PhP or US$, on a particular day, say as of end-December 30, 2012

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

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

(f) other factors.

These data and numbers should be shown for verification by third-party players or the public in general.  It is possible that the list of drugs mentioned in the Committee Report were those that are price-controlled (hence, priced very low) in India. Otherwise, anyone can produce a table of comparative prices, make agitating title and spread it around to achieve a particular political and business agenda.Take this second table for instance. 

What are the difference/s and similarity/ies of the two tables above?

The difference is that the price gap between those in the Philippines and those in India and Pakistan are not that big.

The similarities are  that both tables  (a) assume there is one “national price” for each drug molecule by the same manufacturer, and (b) they do not show how the figures were arrived at. 

The second table of course is hypothetical -- readers should not use it. I posted it simply to illustrate the point that unless the supporting data are shown and verified to be true as basis for comparison, people, policy makers and legislators especially, should be wary of accepting those numbers as basis for making public policies.

Meanwhile, the cat in my previous posting, Drug Price Control 33: Debate with a Cat has gone ballistic and really emotional, fuming with personal attacks. Well, low minds can stoop low and do ad hominems as replacement for producing hard data. Among the cat’s words are

It would seem that the THINK TANKER has crossed the LINE... You're into "name-calling", now just so you can DIVERT the discussions from REAL ISSUES and go into the realm of PERSONALITY ATTACKS...? Alright, I'll play this game...

My profile picture is a CAT, yes.. A beautiful cat from Siam whilst your FACE looks like that of a WORN OUT "INTELLECTUAL WANNABE..." After all these years trying to make your own mark in the Policy Circles, you have not ACHIEVED anything SUBSTANTIAL you can call your OWN... 

Awww! Well, for someone who supports drug price control or other statist proposals, the simple path would have been to show numbers and data – Prices of drugs (or other commodities) have not gone down, say from the time the law was enacted in 2008, to 2012. Show the charts, show the tables. Like this,

Then the debate is on the issue and not on ad hominem stupidity.

Pointless to debate with low level minds who cannot focus on substance, who cannot produce verifiable numbers, only  kilometric brickbats.

She made this warning,

“Mind you, I'm an expert when it comes to NAME-CALLING and PERSONALITY ATTACKS, you might cry if you ENGAGE ME...”

Ouch. Mark Twain's advice is worth noting.

Visit this blog from time to time, Kinse. I might revisit some of your other comments.

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See also:
Drug Price Control 30: Reversing the Policy on AC Resolution in 2009, September 14, 2012 
Drug Price Control 31: Cancer Drugs and CWF, December 01, 2012 
Drug Price Control 32: Policeman of Pharma Companies, June 04, 2013
Drug Price Control 33: Debate with a Cat, June 15, 2013

Drug Price Control 33: Debate with a Cat

When some people’s ego  is bruised, they tend to take revenge. And if that requires abandoning a previous advocacy, say from anti-statist interventionism and move to the opposite, statist and socialist, they will do it.

My blog post,  Drug Price Control 32: Policeman of Pharma Companies, about my reply to a demand for another round of price control by the head of the Cancer Warriors Foundation (CWF) here in Manila, was posted yesterday in the facebook group,  Imperium et Populi (Philippines), to be countered and debated by the fb group owner, Kensi Blye-Two.

Until last week, this person – don’t know if a he or she, I think a she – took an anti-statist interventionism (trying hard free marketer?) position. In my previous long debate with her (or him),  Business Bureaucracy 8: Exchanges at Imperium et Populi (Philippines), she wrote,

This would BOIL DOWN again to "EASE of DOING BUSINESS..." The SMALL PEOPLE are HEAVILY TAXED but the BIG COMPANIES can get away with almost anything...
Imagine this:

( 1 ) Corporate Tax 30%
( 2 ) VAT 12%
( 3 ) Withholding Tax
( 4 ) Business Permit from the LGU
( 5 ) BOC - Duties and Taxes for Imported Goods
( 6 ) Other Taxes from other Agencies...
What's left of the MICRO and SMALL Enterprises...?

That’s an anti-statist, anti-bureaucratism position, right? Cool.

Then in attacking my paper on drug price control, she wrote,

If you have read RA 9502 which I'm sure you have... There's a certain provision that says:  

SEC. 17. Drugs and Medicines Price Regulation Authority of the President of the Philippines…. 

These said PROVISIONS have already given the LEGAL FRAMEWORK to NO LESS than the President the POWER to IMPOST MRP to ANY and ALL "DRUGS" and "MEDICINES..." This itself would mean one thing- DRUG PRICE CONTROL...

Now she is pro-state intervention, justifying government price control and politicized price-setting.

That’s a 180 degrees turn around. Mental inconsistency, intellectual dishonesty, plain brickbats to have a revenge, any of these can possibly explain the behavior.

I checked the fb profile of this person…  

A cat! I was debating with a half human, half feline entity J Kidding aside, this person has no real name, no photo, no affiliation, no school, nothing. This is a perfect formula for people who appear “brave” and utter almost anything, but are cowards that their words and ideas will be associated with their faces and names.

Anyway, below are Kensi’s rapid-fire-revenge attempts, my brief rejoinder to her comments and questions, then another round of insecure brickbats.   Copy-pasting everything so readers can see the kind of mentality this cat or person has. Seven pages long, almost 3,000 words including this intro, get your fave drinks and enjoy the ride.

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Kensi Blye-Two   "That "MDRP" by the way is an illegal term coined by former DOH Secretary Francisco Duque and Malacanang under former President Gloria Arroyo. The original provision in RA 9502 is MRP but Malacanang did not like it to mean "Mar Roxas for President" then so they invented MDRP." (Noynoy Oplas) 

http://funwithgovernment.blogspot.com/2013/06/drug-price-control-32-policeman-of.html

( 1 ) Has the term "MDRP" been DECLARED "ILLEGAL" by any competent Court...? Has EO 821 (Executive 821) been REVOKED...? Has AO 2011-0012 (Administrative Order 2011-0012) been AMENDED or REVOKED...?

( 2 ) And where did you get this RUMOR or GOSSIP that the ONLY REASON the MRP was changed into MDRP by the former Administration was mainly due to the fact that it could be used by Mar Roxas (which eventually RAN for Vice President)...? Can you show some PROOF or EVIDENCE to support your claim...?

"Besides, it is preposterous for someone to claim that he or she can speak "in behalf of the millions of Filipinos who are sick and dying". Have the sick and dying organized themselves into a national organization and they elected a leader to speak in behalf of them? There is no such thing or organization or leader."

( 1 ) Did you CLARIFY whether he wanted all the DETAILS and INFO for ALL MEDICINES or perhaps for certain Medicines that their GROUP are eyeing...?

( 2 ) I think that you KNOW or UNDERSTAND the REALITIES that beset a lot of Filipinos when it comes to ACCESSIBILITY to MEDICINES... Are you "DENYING" that FACT that a lot of Filipinos who are SICK and DYING just because they can't buy MEDICINE...? Do clarify...

( 3 ) Whether the INTENTIONS or Mr. Auste is GOOD or BAD, he has introduced REALITIES that needs to be ADDRESSED immediately and these are LEGITIMATE ISSUES... Now, would you HELP the Filipino SICK and DYING or you would stick to your "brand of bureaucratic maneuverings...?"