Given the high burden of Sub-Saharan Africa's infectious diseases, improvements in healthcare systems are crucial to addressing these underlying issues. A lack of proper price regulations for essential medicine, however, remains a key challenge, threatening accessibility of medicine and continuing to place strain on out-of-pocket payments for pharmaceuticals.
Prices vary significantly within many Sub-Saharan Africa countries, as pharmaceutical products move down the value chain. Wholesalers and distributors in Zimbabwe for instance, add mark-ups of as much as 43% for branded and generic drugs, while innovator drugs are marked up as high as 45%. The same situation is evident in Malawi. Retail pharmacies add price mark-ups of approximately 35% for innovator and branded generic drugs, while generic drugs are marked up by an average of 25%.
"Given the high reliance on out-of-pocket expenditure for healthcare (approximately 72.4% for the Sub-Saharan Africa region) the ultimate burden of these high drug prices rests on private consumers who have to spend more for their medication", stated Frost & Sullivan's Healthcare Research Analyst Kudzai Moyo.
Health expenditure per capita in Malawi and Zimbabwe is $19.00 and $78.60, respectively, and any significant increase in the price of pharmaceuticals down the value chain has adverse effects on access to medication. Pharmaceuticals procurement by governments may, however, be insulated from these high price margins. Favourable prices are negotiated with manufacturers by leveraging on monopsonistic buying power to set prices below more liberalised prices, or alternatively if competitive bids are used.
"In contrast, the Mauritian government has imposed profit controls to manage spending on pharmaceuticals. A maximum allowable profit margin of 9% is set for pharmaceutical wholesalers and distributors, while retail pharmacies are allowed a maximum profit margin of 21.6%", noted Moyo. "Failure to adhere to these price caps result in significant fines. This is one manner in which the Mauritian government is keeping the prices of pharmaceuticals affordable".
Profit controls limit the amount of profit a pharmaceutical wholesaler or distributor may earn per product. Nevertheless, industry participants often see these price regulations as suppressive. Due to the low profit margins, sustainability for wholesalers only comes from large trading volumes, while other distributors are expanding into high profit margin food supplements.
Although, responsible authorities should look into ways of capping these exorbitant mark-ups, there should be a balance between access and liberal market policies.
The governments' actions should be focused on creating an environment that would best encourage a constant flow of new and innovative medicines to the market, providing substantial health benefits to consumers, Moyo concludes.
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