A general overview of the issue focusing in the antineoplastic and immunomodulatory therapies.

1. High cost of
medications in
Colombia
A general overview of the issue
focusing in the antineoplastic and
immunomodulatory therapies.
Pharm Dr. B. Sc. Alexander
Bermudez Rubashkyn
MBA Health Care Administration
student at TMU.

2. Introduction
 Lack of resources to provide delivery
services in health.
 Too many causes have been
determined, but without any doubt
the most relevant is the high cost of
the medications.
 The part of the drugs which contributes
more in the issue in terms of total
percentage in the expenditure are the
High Cost Drugs (HCD).

3. Introduction
Catastrophic Illness and High Cost
Medications
A Catastrophic Illness is a severe illness requiring
prolonged hospitalization with a high risk of
recovery and high probability of death, (coma,
cancer, leukemia, heart attack or stroke).
A High Cost Drug is the medication used to treat
the catastrophic illness, which represents a high
expenditure as well, (chemotherapy,
immunomodulation therapy).

4. Introduction
Antineoplastic and Immunomodulatory
Therapies
Antineoplastic drugs Immunosuppressant Immunostimulants
•Anti TNF (Tumoral
•Monoclonal antibodies Necrosis Factor)
•Pyrimidine Analogues •Interferons
•Selective
•Taxanes (IFNs)
Immunosuppressants
•Protein-Kinase inhibitors •Interleukin inhibitors
•Others

5. The Issue
What it’s happening in
Colombia?
 The high price in medications is limiting the
access to health.
 The spending per capita in medications is
getting higher.
 Price regulation is deficient.
 The expenditure in medications have had an
increase about 45% between 2006 and 20101.

6. The Issue
Why the overpricing in the
medications in Colombia?
Why the lack of resources in
this health system?

7. The Colombian Health
System 2010
SGSSS
4,5% 51,4% 4,4%
39,7%

8. Pharmaceutical Market
66% National laboratories
23% Int Innovative laboratories3
95% of HCD are produced
by Multinational Industry.4
Ph. IPS - EPS
Distributor 50% of the HCD are
Price regulated.5
Logistic
Agencies
Trade Margins.
Pharmaceutical
Industry
Overprice the real cost: 45%
Importations

9. Understanding the Issue
Evidences
Key elements:
 Incidence IC kept
stable.
 Guardianships kept
stable.
 The CTC have
increased in 2000%.

10. Understanding the Issue
Evidences
 While drug use increases, also the price increases, which is
not consistent with the behavior "supply and demand”.

11. Understanding the Issue
Evidences
Colombia consumes drugs more expensive than Australia, Canada,
Spain, United States, France, Italy and England.
In Colombia drugs are paid up to 240% more expensive than in
other countries. Econometrics SA6

12. Understanding the Issue
Understanding the Issue
“Cause – Effect Analysis”

13. Understanding the Issue
In Summary
2000 2010
Malpractices.
Expenditure Δpopulation *QL
Our behavior • Overpricing of
medicines.
problem
• Irrational use of
medication
• Irrational use of the
Behavior health resources
expected
Goal behaviour
• No deficit in the
National Health
system.
• Rational expenditure
in medicines.
• Equity in the Health
Pharmaceutical Inflation ΔP*Q System

14. The government’s solution
Pharmaceutical Policy8
10 strategies were established in this new
policy.
First three were focused on ensuring access to
reliable information about pricing, and quality
and use of drugs.
The last seven including the development of
tools and systems to regulate prices, including
several other items that link their action on
other aspects of the drug chain.

15. My solution
Cost Effectiveness Analysis
and Operations Research9.
Why?
 Health priorities.
 Budget constrains (OR).
 Get great health gains.
 Feasible solution,
sometimes is not obvious.
 Equitable solutions

16. My solution
Operation Research Quality Unit Gain per $Unit.
(per treatment of Breast Cancer)11.
Docetaxel
Optimal Solution
Government
Solution
Paclitaxel
Objetive function

17. Conclusions
 The causes which contribute more in the high
expenditure in medications in Colombia according
with this survey are:
1. The overpricing of medicines.
2. The irrational use of medication / prescribing
3. and the irrational use of the health resources.
 The Pharm Policy 12’ need to focuses its action in the
definition of the tools and strategies to ensure the
rationalization of the health budgets, not only focusing
in price regulation.
 The CEA and OR, are tools which can give
quantitative solutions to help guide optimal and
equitable decisions.

18. References
 1 Colombian National Administrative Deparment of Statistics
http://www.dane.gov.co
 2 World Health Organization http://apps.who.int/ghodata/?vid=710
 3 Colombian Health Indicators June 2007
www.minproteccionsocial.gov.co
 4 Some indicators of health expenditure ratios, 1999-2003.
http://www.who.int/whr/2006/es/index.html
 5 Base Agruphar, IMS, Money Magazine.
 6 Ombudsman "Evaluating Health services offered by health
promotion entities". Bogotá, 2003, p. 52-53
 7 Econometrics, Consultants, Study of drug pricing policy in
Colombia Final report. Bogota 2005
 8 Colombian National Pharmaceutical Policy 2012
http://www.minsalud.gov.co/
 9 Document Ministry of Agriculture and Rural Development - Aloe
Production Chain
 10 Market Intelligence. Pharmaceutical Sector. IFARMA. September
2008
 11 Study of the pricing of drugs in Colombia. Final Report, August
2005, econometrics consultants.

19. THANK YOU
謝謝!