Research Article |
Corresponding author: Satibi Satibi ( satibi@ugm.ac.id ) Academic editor: Valentina Petkova
© 2022 Satibi Satibi, Luthfi Kinanthi Kirana P, Mella Aziza P, Monica Hutasoit, Prasojo Pribadi.
This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Citation:
Satibi S, Kirana P LK, Aziza P M, Hutasoit M, Pribadi P (2022) Analysis of e-catalogue drug prices in the era of Universal Health Coverage in the Indonesian pharmaceutical industry. Pharmacia 69(2): 555-562. https://doi.org/10.3897/pharmacia.69.e83068
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Context: Since the implementation of the Universal Health Coverage (UHC) policy in Indonesia, the drug procurement system has changed to using the e-catalogue system. The impact of this policy change on the pharmaceutical industry in Indonesia is unclear and has not been widely studied.
Objectives: This study analyzes the impact of the UHC policy on drug pricing by the pharmaceutical industry in Indonesia.
Methods: This study collects data from 3 pharmaceutical industries that won the e-catalogue drug tender. Data on drug prices produced by these 3 industries in 2013 were taken from the Drug Price Ceiling List, while drug prices in 2015 and 2018 were obtained from the e-catalogue drug list. The drug price data is compared from year to year to see the trend of change and the magnitude of the change. Data were analyzed using a price index calculation adapted from the concept of Median Price Ratio (MRP) calculation to compare drug prices in 2013 with drug prices per each region in 2015 and 2018 in the Microsoft Excel Office application as a measuring tool.
Results: There was a change in drug prices from the era before UHC (in 2013) and after the UHC era (in 2015 and 2018). There are drugs that have increased in price and some have decreased in price. The price increase ranged from 0.01–6.15 in 2015 and 0.01–6.46 in 2018. The price decrease ranged between 0.04–0.75 in 2015 and 0.01–0.83 in 2018.
Conclusion: Drug prices from before the UHC era (2013 and 2015) to after UHC (in 2018) experienced a change in the form of an increase or decrease in price.
UHC, drug prices, e-catalogue, pharmaceutical industry
The Universal Health Coverage (UHC) is a government program contained in the National Social Protection System (SJSN) program. According to Law Number 40 of 2004 concerning the National Social Security System (SJSN), the health insurance benefits that patients get include drugs. The supply of drugs to fulfill this SJSN has been regulated in the National Formulary (Fornas) which is a guideline for health services in procuring the necessary medicines which are guaranteed quality, safe, and at affordable prices. According to Presidential Regulation (Perpres) No. 157 of 2014, the UHC program implements an e-catalogue system in drug procurement. Changes in the old drug procurement system into an e-catalogue to reduce the occurrence of mark ups or drug price inflation (
Drug prices in the UHC era decreased. These efforts were made to implement a system of quality control and cost control as a form of social protection in the health sector to ensure the fulfillment of basic health needs that are appropriate for the community (
The implementation of UHC with BPJS health insurance focuses on the use of generic drugs. This is in accordance with the Regulation of the Minister of Health of the Republic of Indonesia No. HK.02. 02/MENKES/068/2010 in which government-owned health facilities are required to provide generic drugs for the needs of outpatients and inpatients. This regulation also causes a shift in the use of drugs in the community from using branded drugs to generic drugs. As shown in the research conducted by
Facts related to the impact of UHC implementation are shown by research conducted by
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 UHC - drug price before UHC) / drug price before UHC. The calculation using this price index adapts the concept of calculating the Median Price Ratio (MRP) which is referenced by Management Sciences for Health (MSH) and recommended by WHO. MRP itself is an average price index that is used to see drug prices in developing countries and then compare them with international standard drug prices. The price index according to the MRP if the value is less than 1, it is considered that the price is efficient (
Ethical Clearance approval was obtained from the Ethics Commission Team of the Faculty of Medicine, Public Health, and Nursing (FK-KMK) Universitas Gadjah Mada with the approval number KE/FK/0216/EC/2020 for research at A Ltd, KE/FK/0299/EC/ 2020 for research at B Ltd, and KE/FK/0455/EC/2020 for research at C Ltd. Before an indicator is assessed, experts fill out an informed consent form containing information about the filling procedure, the importance of expert involvement, and the course of the study. Informed consent was further signed by each expert as evidence of consent and voluntary involvement in the study.
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 INN (International Nonproprietary Name) drugs and 12 branded generic drugs. At B Ltd, all 8 drug items are branded generic drugs. At C Ltd, all 5 drug items are generic drugs.
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
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
No. | Drug Names | Drug Price Index 2015 | ||||
---|---|---|---|---|---|---|
Region I | Region II | Region III | Region IV | Region V | ||
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 |
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.
No. | Drug Names | Drug Price Index 2018 | ||||
---|---|---|---|---|---|---|
Region I | Region II | Region III | Region IV | Region V | ||
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
No. | Drug Names | Drug Price Index 2015 | ||||
---|---|---|---|---|---|---|
Region I | Region II | Region III | Region IV | Region V | ||
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.
No. | Drug Names | Drug Price Index 2018 | ||||
---|---|---|---|---|---|---|
Region I | Region II | Region III | Region IV | Region V | ||
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
No. | Drug Names | Drug Price Index 2018 | ||||
---|---|---|---|---|---|---|
Region I | Region II | Region III | Region IV | Region V | ||
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 UHC era in Table
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 UHC in 2013 and after UHC in 2015 and 2018 were caused by the existence of a public drug production auction mechanism organized by the Ministry of Health with the assistance of LKPP. This is also in accordance with research conducted by Verghese, et al in 2019 which showed that the auction system was able to reduce drug prices on the market in several countries in Asia. The decline in drug prices also occurred in Belgium, which implemented an auction system for the drug simvastatin (
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 UHC era (2013 and 2015) to after UHC (in 2018) ten to decrease. The difference in the price of e-catalogue drugs is in the form of price increases and decreases from 2013 to 2015 and 2018.
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.