Corresponding author: Satibi Satibi (
The Universal Health Coverage (
Drug prices in the
The implementation of
Facts related to the impact of
This research was conducted using a quantitative method which was presented descriptively. Retrospective data collection of drug prices from the 2013 DPHO obtained from Askes Ltd was then compared with 2015 and 2018 e-catalogue drug price data accessed from LKPP documentation. The price data of the drugs selected as samples are e-catalogue drugs which were won by the auction tender by each pharmaceutical industry that was the subject of the research. The drugs compared are drugs that have names, indications, strengths and dosage forms that were won in 2013, 2015 and 2018 by each industry. Data on e-catalogue drug prices in 2015 and 2018 consists of five different price data representing each region based on the Ministry of Health’s policy which stipulates the difference in e-catalogue drug prices into five regions in Indonesia. The research subjects are two state-owned pharmaceutical industries (A Ltd and C Ltd) and one private pharmaceutical industry (B Ltd).
Data analysis uses mathematical calculations by comparing drug prices in 2013 with drug prices per each region in 2015 and 2018 using Microsoft Excel Office as a measuring tool. The calculation uses the formula: Price index = (drug price after
Ethical Clearance approval was obtained from the Ethics Commission Team of the Faculty of Medicine, Public Health, and Nursing (
The results of the selection of drug price data from the 2013 DPHO from Askes Ltd and the 2015 and 2018 e-catalogues obtained from LKPP show that there are 28 drug items from the three pharmaceutical industries as research samples to which the price differences will be compared. The data for the 28 drug items have different types of drugs. In A Ltd there are 15 drug items consisting of 8 drug items from B Ltd, and 5 drug items from C Ltd. In A Ltd 15 drug items consist of 3 generic
Analysis of drug price trends in this study is needed before performing mathematical calculations using the drug price index. Price trend analysis is intended to help see market trends, in order to participate in analyzing drug prices after the implementation of the e-catalogue program. (
Fig.
Drug Price Trend e-Catalogue A Ltd. Note: 1) azithromycin; 2) metronidazole; 3) betamethasone valerate; 4) theophylline; 5) verapamil; 6) ketoconazole; 7) fluconazole; 8) hydrochlorothiazide; 9) glyceryl trinitrate; 10) miconazole nitrate; 11) codeine tablets 10 mg; 12) codeine tablets 15 mg; 13) codeine tablets 20 mg; 14) ascorbic acid; 15) morphine (HCl)
The drug price index in 2013 against 2015 and 2018 can be seen in Tables
Drug Price Trend e-Catalogue B Ltd. Note: 1) aminofuscin L600; 2) liver aminofuscin; 3) clinimix combination; 4) rexta oxaliplatin; 5) triofuscin 500; 6) tutofuscin ops; 7) vincristine kalbe vial 1 mL; 8) vincristine kalbe vial 2 mL
There are differences in the range of the price index in 2015 and 2018. The range of the index of decline and increase in the price of e-catalogue drugs for each region is different, as can be seen in Tables
Drug Price Index A Ltd 2015.
No. | Drug Names | Drug Price Index 2015 | ||||
---|---|---|---|---|---|---|
1. | Azithromycin tablet 500 mg | -0,75 | -0,75 | -0,75 | -0,75 | -0,75 |
2. | Metronidazole (vagizol) ovule 500 mg | -0,23 | -0,19 | -0,11 | -0,08 | -0,04 |
3. | Betamethasone valerate cream 0,1% | -0,24 | -0,24 | -0,24 | -0,24 | -0,24 |
4. | Theophyllin tablet SR 300 mg | -0,29 | -0,25 | -0,22 | -0,18 | -0,22 |
5. | Verapamil HCl tablet/caps 80 mg | -0,18 | -0,18 | -0,12 | -0,16 | -0,05 |
6. | Ketoconazole cream 2% tube @ 10 g | -0,06 | -0,06 | 0,01 | -0,04 | 0,09 |
7. | Fluconazole tablet/caps 150 mg (G) | -0,04 | 0,01 | 0,11 | 0,16 | 0,20 |
8. | Hydrochlorothiazide tablet 25 mg | 4,73 | 5,00 | 5,58 | 5,88 | 6,15 |
9. | Glyceryl trinitrate 2,5 mg | 0,09 | 0,15 | 0,26 | 0,31 | 0,37 |
10 | Miconazole nitrate cream 2% tube @10 g | 0,08 | 0,14 | 0,25 | 0,30 | 0,35 |
11. | Codeine tablet/caps 10 mg | 0,29 | 0,35 | 0,47 | 0,54 | 0,61 |
12. | Codeine tablet/caps 15 mg | 0,28 | 0,35 | 0,48 | 0,54 | 0,60 |
13. | Codeine tablet/caps 20 mg | 0,27 | 0,34 | 0,46 | 0,52 | 0,59 |
14. | Ascorbic acid (vitamin C) tablet 50 mg | 3,00 | 3,19 | 3,62 | 3,81 | 4,00 |
15. | Morphine (HCl) tablet 10 mg (G) | 0,16 | 0,22 | 0,34 | 0,39 | 0,45 |
Price increase index range | 0,08–4,73 | 0,01–5,00 | 0,01–3,62 | 0,16–5,88 | 0,09–6,15 | |
Price decrease index range | 0,04–0,75 | 0,06–0,75 | 0,11–0,75 | 0,04–0,75 | 0,04–0,75 |
Drug Price Trend e-Catalogue C Ltd.
The average drug that has increased in the data sample is a drug item that has an efficient increase. This is because the index number is less than 1. Drug items that experienced an efficient price increase in 2015 were 7 and in 2018 there were 8 drug items. For example, a drug that has increased quite efficiently is glyceryl trinitrate 2.5 mg. This drug in region I in 2015 was 0.09 more expensive and continued to increase in each region until region V was 0.37 more expensive than in 2013.
Drug Price Index A Ltd 2018.
No. | Drug Names | Drug Price Index 2018 | ||||
---|---|---|---|---|---|---|
1. | Azithromycin tablet 500 mg | -0,75 | -0,75 | -0,75 | -0,75 | -0,75 |
2. | Metronidazole (vagizol) ovule 500 mg | -0,33 | -0,33 | -0,33 | -0,33 | -0,33 |
3. | Betamethasone valerate cream 0,1% | -0,25 | -0,25 | -0,20 | -0,23 | -0,15 |
4. | Theophyllin tablet SR 300 mg | -0,24 | -0,20 | -0,12 | -0,09 | -0,05 |
5. | Verapamil HCl tablet/caps 80 mg | -0,05 | 0,00 | 0,09 | 0,14 | 0,19 |
6. | Ketoconazole cream 2% tube @ 10 g | -0,04 | -0,04 | 0,03 | 0,03 | 0,11 |
7. | Fluconazole tablet/caps 150 mg (G) | 0,00 | 0,05 | 0,15 | 0,20 | 0,25 |
8. | Hydrochlorothiazide tablet 25 mg | 4,96 | 5,27 | 5,85 | 6,15 | 6,46 |
9. | Glyceryl trinitrate 2,5 mg | 0,14 | 0,20 | 0,31 | 0,37 | 0,42 |
10 | Miconazole nitrate cream 2% tube @10 g | 0,14 | 0,20 | 0,31 | 0,37 | 0,42 |
11. | Codeine tablet/caps 10 mg | 0,34 | 0,31 | 0,54 | 0,60 | 0,60 |
12. | Codeine tablet/caps 15 mg | 0,36 | 0,42 | 0,56 | 0.63 | 0.70 |
13. | Codeine tablet/caps 20 mg | 0,37 | 0,43 | 0,57 | 0,64 | 0.71 |
14. | Ascorbic acid (vitamin C) tablet 50 mg | 3,04 | 3,23 | 3,62 | 3,85 | 4,04 |
15. | Morphine (HCl) tablet 10 mg (G) | 0,21 | 0,27 | 0,39 | 0,45 | 0,51 |
Price increase index range | 0,14–4,96 | 0,05–5,27 | 0,03–5,85 | 0,20–6,15 | 0,11–6,46 | |
Price decrease index range | 0,04–0,75 | 0,04–0,75 | 0,12–0,75 | 0,03–0,75 | 0,05–0,75 |
The drug price index of B Ltd e-catalogue can be seen in Tables
Drug Price Index B Ltd 2015.
No. | Drug Names | Drug Price Index 2015 | ||||
---|---|---|---|---|---|---|
1. | Aminofuscin L 600 | 0,22 | 0,22 | 0,22 | 0,22 | 0,22 |
2. | Aminofuscin Liver | 0,05 | 0,05 | 0,05 | 0,05 | 0,05 |
3. | Clinimix Combination | 0,09 | 0,09 | 0,09 | 0,09 | 0,09 |
4. | Rexta Oxaliplatin | -0,73 | -0,73 | -0,73 | -0,73 | -0,73 |
5. | Triofuscin 500 | -0,05 | -0,05 | -0,05 | -0,05 | -0,05 |
6. | Tutofuscin OPS | 0,01 | 0,01 | 0,01 | 0,01 | 0,01 |
7. | Vincristine Kalbe vial 1 mL | -0,37 | -0,37 | -0,37 | -0,37 | -0,37 |
8. | Vincristine Kalbe vial 2 mL | -0,23 | -0,23 | -0,23 | -0,23 | -0,23 |
Price increase index range | 0,01–0,22 | 0,01–0,22 | 0,01–0,22 | 0,01–0,22 | 0,01–0,22 | |
Price decrease index range | 0,05–0,73 | 0,05–0,73 | 0,05–0,73 | 0,05–0,73 | 0,05–0,73 |
The index range of B Ltd drug price increase in 2015 and 2018 is greater than the index range of decreasing drug price index. The range of the drug price index that experienced an increase was 0.05–0.73 in 2015 and 0.06–0.83 in 2018. This shows that at B Ltd there was an increase in drug prices but still efficient.
Drug Price Index B Ltd 2018.
No. | Drug Names | Drug Price Index 2018 | ||||
---|---|---|---|---|---|---|
1. | Aminofuscin L 600 | 0,12 | 0,20 | 0,38 | 0,37 | 0,43 |
2. | Aminofuscin Liver | -0,11 | -0,07 | 0,06 | 0,06 | 0,11 |
3. | Clinimix Combination | 0,11 | 0,16 | 0,25 | 0,25 | 0,25 |
4. | Rexta Oxaliplatin | -0,83 | -0,83 | -0,83 | -0,83 | -0,83 |
5. | Triofuscin 500 | 0,04 | 0,09 | 0,23 | 0,23 | 0,30 |
6. | Tutofuscin OPS | -0,06 | -0,01 | 0,06 | 0,06 | 0,06 |
7. | Vincristine Kalbe vial 1 mL | -0,40 | -0,40 | -0,40 | -0,40 | -0,40 |
8. | Vincristine Kalbe vial 2 mL | -0,30 | -0,30 | -0,30 | -0,30 | -0,30 |
Price increase index range | 0,04–012 | 0,09–0,20 | 0,06–0,38 | 0,06–0,37 | 0,06–0,43 | |
Price decrease index range | 0,06–0,83 | 0,01–0,83 | 0,30–0,83 | 0,30–0,83 | 0,30–0,83 |
The index of changes in the price of C Ltd e-catalogue drugs can be seen in Table
Drug Price Index C Ltd 2013 and 2018.
No. | Drug Names | Drug Price Index 2018 | ||||
---|---|---|---|---|---|---|
|
|
|
|
|
||
1. | Salbutamol sulfate syr 2 mg/5 mL | -0,11 | -0,11 | -0,11 | -0,11 | -0,11 |
2. | Paracetamol drop 100 mg/mL fls @15mL (60mg/0,6mL) | 0,40 | 0,33 | 0,53 | 0,53 | 0,66 |
3. | Glibenclamide tablet/caps/caplet 5 mg | 1,40 | 1,29 | 1,63 | 1,63 | 1,87 |
4. | Ondansentron hydrochloride/ Ondansentron HCl dihydrate / Ondansetron tablet/caps/caplet 8 mg | -0,75 | -0,77 | -0,73 | -0,73 | -0,71 |
5. | Ofloxacin tablet/film coated caplet 400 mg | -0,08 | -0,12 | 0,01 | 0,01 | 0,10 |
Price increase index range | 0,40–1,40 | 0,33–1,29 | 0,01–1,63 | 0,01–1,63 | 0,10–1,87 | |
Price decrease index range | 0,08–0,75 | 0,11–0,77 | 0,11–0,73 | 0,11–0,73 | 0,11–0,71 |
The price reduction range for this drug is between 0.08 to 0.77. This shows that there has been a decrease in the price of medicines, but they are still considered efficient. The price increase occurred in the index range of 0.01–1.87. This figure shows that there was an increase in inefficient drug prices from 2013 to 2018. This inefficient drug price increase occurred in Glibenclamide 5 mg tablets/caplets/capsules because the price index value was greater than 1.
The e-catalog drugs are the responsibility of the pharmaceutical industry that won the tender, meaning that the industry produces the national e-catalog drug needs to be produced. The fulfillment of these needs is produced nationally, but the price of e-catalogue drugs in each region has a different price. This is due to the distribution costs to each district and city of destination which are not the same, depending on the distance traveled (
The range of the different e-catalog drug price indexes for each region in 2015 and 2018 can be seen in Tables
Data on the results of the comparison of drug price samples before and after the
The prices for the 2015 and 2018 drug samples are different for each region, but to see the price trend, an average drug price from all regions is carried out. This average price is to represent price differences in different regions and can describe the trend of changing drug prices. The bar chart in Figs
Changes in drug prices from the era before
Contrast occurs in the data obtained in Tables
The increase in drug prices is also due to changes in the exchange rate (exchange rate) that affect inflation each year. Changes in the exchange rate can affect supply inflation through the price of goods directly (direct pass-through effect). As a result, the high rate of inflation is mainly related to the price of goods that have a high import content as a result of the exchange rate crisis (
Depreciation of the domestic currency causes foreign currencies to become more expensive, this means that the relative value of the domestic currency declines (
The drastic price drop remains must be wary of because it has an impact on the availability of drugs and drug quality. The decrease in drug prices will impact on profit reduction for the pharmaceutical industry, which can resulting in reduced interest in producing drugs (
This study provides practical implications, including: 1) The government needs to control prices through price control regulations because companies are mainly on drugs with higher prices. The proposal to control drug prices must have strong political and public support. Thus, this regulation has a high chance of success. 2) Government should engage strategically with pharmaceutical industries to move them to a more positive attitude. 3) The government should avoid backtracking on the policy as this would represent a critical weakness for other stakeholders. It is important to strengthen continuous monitoring of changes in the price and structure of drug consumption related to policies, ensuring the accessibility and rationality of drugs for patients.
This study has several limitations, including: the research was conducted with using the observation period relatively short, namely in 2013, 2015, 2016, therefore that the number of samples use is still very limited. The study used 3 companies that were used as research subject.
Drug prices from before the
The authors declare there is not conflict of interest with the data contained in the manuscript.
Thank you to the Faculty of Pharmacy, Universitas Gadjah Mada for the funds that have been given to finance this research. I would like to thank my student Luthfi Kinanthi Kirana P and Mella Aziza Putri, for their support throughout this project.