Challenges

Governments of all countries face the growing economic impact caused by the increasing cost of medicines, especially those from a single source, and other technologies in the health area. It is known that, for proper health management, access to good quality information is essential to strengthen decision-making on the rational use and management of medicines and, where appropriate, the control or regulation of their prices, for the most efficient application of resources. Access to information on prices negotiated for drugs and other health products that health system stakeholders purchase with public funds is an important tool in this process.

These records – particularly information regarding drug prices – are useful in guaranteeing the transparency of public management processes and ensuring that public resources are allocated efficiently. They are also useful in terms of promoting an international information-sharing network that strengthens the negotiating position of procurement managers and public payers/financiers by providing data on the prices that pharmaceutical companies propose under different circumstances and at different points of the value chain.

Toward a Solution

To address this challenge, the Group on Universal Access to Medicines (GAUMU) of the Union of South American Nations (UNASUR), with the support of South American Institute of Governance in Health (ISAGS), developed an initiative that aims to strengthen negotiating capacity among decision-makers responsible for drug procurement using public funds. The initiative also serves as an information tool that provides procurement prices in the region as a point of reference. The idea is to share information on the prices each country pays for selected medicines so that countries can strengthen their negotiating position with industry. The Medicines Price Bank of UNASUR (BPMU) will thus strengthen States’ bargaining power and ability to negotiate more favourable drug prices.

As part of moving towards a comprehensive medicines policy, since 2012, UNASUR nations committed to creating a database with the prices of publicly procured drugs in all the countries of the region as a negotiating strategy. The objective of the BPMU is thus to strengthen the management capacity of health system stakeholders responsible for procuring drugs and managing public resources and the competent authorities’ ability to enforce price controls (where applicable). This is to be achieved via a computerized system with information on drug procurement prices and related data in the UNASUR Member States. The BPMU is a reservoir of information on prices obtained by UNASUR countries through government negotiation, procurement and/ or contracts with pharmaceutical companies. Governments provide the information periodically based on previously agreed common definitions.

Good governance, strong and concrete accountability mechanisms, and greater transparency are key drivers of the United Nations 2030 Agenda for Sustainable Development. Diverse accountability mechanisms and levels of transparency are important to ensure coherent policy in the areas of human rights, trade, intellectual property and public health. Indeed, to earn a fair return on public investment, government stakeholders and public funding providers require clear information on the costs of innovation and the introduction of specific health technologies to the market. Some public databases on drug, vaccine and medical device prices do exist; they are generally referenced to those of multilateral organizations or civil society organizations. However, they address very specific conditions and do not necessarily reflect real and accurate information. Public procurement is one mechanism that some regions have implemented to confront the economic power of the pharmaceutical industry.

The project’s main methodological steps involve:

• identifying similar national and regional initiatives, strengths and weaknesses;
• identifying opportunities to coordinate with other regional initiatives;
• developing presentations and analyses of national procurement legislation (by public health system stakeholders);
• holding discussions on how to organize the listings;
• conducting surveys of the relevant legislation of each country involved related to drug policies and purchases (by the systems’stakeholders);
• surveying the information needed for countries to register in the Drug Price Bank System of UNASUR;
• surveying the list of the countries’ drugs of interest and standardizing product descriptions;
• obtaining approval of the changes made in the system; and
• providing user training.

To date, 10 countries have registered purchases of 30 drugs and seven vaccines and a total of 313 procurements from 2011 to 2015 were uploaded. The GAUMU coordinator country now manages the platform.

The development of this project has fostered active interaction among the regional technological entities administered by the UNASUR General Secretariat, GAUMU member countries, as well as UNASUR States’ public-sector managers of drug purchasing and financing.