Insights from Japan’s cost-effectiveness analysis policy on pricing for China’s NRDL access / 中国药房

The cost-effectiveness analysis policy for drugs was institutionalized in Japan since 2019， realizing quantitative adjustment of price across varieties. A hierarchical categorization approach was adopted to select medicines with high expected annual sales. For selected medicines， adjustments were made to the premium and profit components within the existing price structure based on a pre-defined incremental cost-effectiveness ratio （ICER） threshold， effectively resolving the issue of inconsistent criteria and magnitudes caused by subjective judgment. Meanwhile， incentive measures like evaluation exemption or threshold enhancement were granted for specific medicines. Besides， a price adjustment mechanism， which was allowed for upward and downward adjustments， involving tiered ICER threshold and quantified formulas， had been established for the premium and profit components of drug price. In China’s National Reimbursement Drug List （NRDL） access， certain issues remained to be addressed： insufficient clarity in the quantitative mechanism of price formation， incomplete price adjustment measures， and lagging in the communication channels. It is recommended that the following measures could be referred to when further improving the scientificity and fairness of drug pricing during China’s NRDL access， such as enhancing the ICER threshold for medicines catering to special populations， quantifying criteria and extents for price adjustment， granting preferential pricing policies to pharmaceutical companies that present high-quality evidence of effectiveness， preceding communication channels with pharmaceutical companies， as well as exploring a price floor mechanism for the drugs with excessive price reduction.

Medicines in Mexico, 1990-2004: systematic review of research on access and use: [review] / Medicamentos en México, 1990-2004: revisión de investigación sobre acceso y uso: [revisión]

OBJECTIVE: To review original research studies published between 1990 and 2004 on the access and use of medicines in Mexico to assess the knowledge base for reforming Mexico's pharmaceutical policy. MATERIAL AND METHODS: A literature review using electronic databases was conducted of original studies published in the last 15 years about access and use of medicines in Mexico. In addition, a manual search of six relevant journals was performed. Excluded were publications on herbal, complementary and alternative medicines. RESULTS: Were identified 108 original articles as being relevant, out of 2289 titles reviewed, highlighting four policy-related problems: irrational prescribing, harmful self-medication, inequitable access, and frequent drug stock shortage in public health centers. CONCLUSIONS: This review identified two priorities for Mexico's pharmaceutical policy and strategies: tackling the irrational use of medicines and the inadequate access of medicines. These are critical priorities for a new national pharmaceutical policy.

OBJETIVO: Revisar estudios de investigaciones originales publicados sobre el acceso y uso de los medicamentos en México de 1990 a 2004, con el fin de evaluar el conocimiento que existe para reformar la política farmacéutica nacional. MATERIAL Y MÉTODOS: Se condujo una revisión de la literatura sobre estudios originales publicados entre 1990 y 2004 sobre el acceso y uso de medicamentos en México. Además, se revisaron manualmente seis revistas relevantes. Se excluyeron publicaciones sobre herbolaria, medicamentos tradicionales y alternativos. RESULTADOS: Se revisaron 2 289 artículos e identificaron 108 como relevantes que destacan cuatro problemas importantes relacionados con las políticas farmacéuticas: prescripción inadecuada, automedicación dañina, acceso inequitativo y desabasto de medicamentos en servicios públicos de salud. CONCLUSIONES: Esta revisión identificó dos prioridades críticas para el desarrollo de una nueva política farmacéutica en México: actuar sobre el uso irracional de medicamentos y sobre el acceso inadecuado a medicamentos.

Perfil de utilização de fitoterápicos em farmácias comunitárias de Belo Horizonte sob a influência da legislação nacional / Profile of the utilization of phytotherapie medicines in communitary pharmacies of Belo Horizonte, under the influence of the national legislation

Um panorama do consumo de fitoterápicos em farmácias comunitárias de Belo Horizonte (MG) é utilizado neste artigo como instrumento para analisar a influência da legislação nacional sobre este mercado. Para tal, foram entrevistados indivíduos que adquiriram fitoterápicos nos estabelecimentos farmacêuticos visitados. Observa-se que, na mesma nação detentora da maior biodiversidade do planeta e privilegiada por uma cultura popular conhecedora das propriedades terapêuticas das plantas, existe uma tendência de mercado para a utilização de plantas exóticas, oriundas de países desenvolvidos. A influência da legislação brasileira de fitoterápicos, que prima pela qualidade, eficácia e segurança desses medicamentos, mas que, ao mesmo tempo, tende a proscrever as drogas nativas que fazem parte da medicina popular brasileira, é discutida nesse trabalho. Verifica-se, assim, a pertinência de se discutir o perfil de usuário de fitoterápicos à luz das normas de registro desses fármacos no país no campo da saúde pública, tendo em vista que essa legislação repercute nas estratégias e/ou empecilhos para aumentar o acesso a medicamentos pela população.

An overview of the herbal drugs consumption in communitarian pharmacies in Belo Horizonte (MG), Brazil is used in this article as a tool to analyze the influence of the national law over this market. In order to reach this goal, individuals that had bought herbal drugs were interviewed at the pharmacies. It was observed that, in the same nation that has the highest biodiversity in the planet and is privileged by a popular culture knowledgeable in the therapeutic properties of the plants, there is a tendency in the market for the use of exotic plants, coming from developed countries. The influence of the Brazilian law about the herbal drugs, which constantly worries about the quality, efficiency and safety of these medicines, but at the same time, tends to proscribe the native drugs that are part of the popular medicine, is discussed in this assignment. It is concluded that it is pertinent to discuss the profile of the herbal drugs users in the spot of the laws of the country related to these drugs, in the field of the public health, since this legislation is reflected in the strategies and/or barriers to increase the access to the drugs by the population.