Funding and Service Organization to Achieve Universal Health Coverage for Medicines: An Economic Evaluation of the Best Investment and Service Organization for the Brazilian Scenario.

BACKGROUND: There are many health benefits since 31 years after the foundation of the National Health Service (NHS) in Brazil, especially the increase in life expectancy. However, family-income inequalities, insufficient funding, and suboptimal private sector-public sector collaboration are still areas for improvement. The efforts of Brazil to achieve universal health coverage (UHC) for medicines have resulted in increased public financing of medicines and their availability, reducing avoidable hospitalization and mortality. However, lack of access to medicines still remains. Due to historical reasons, pharmaceutical service organization in developing countries may have important differences from high-income countries. In some cases, developing countries finance and promote medicine access by using the public infrastructure of health care/medical units as dispensing sites and cover all costs of medicines dispensed. In contrast, many high-income countries use private community pharmacies and cover the costs of medicines dispensed plus a fee, which includes all logistic costs. In this study, we will undertake an economic evaluation to understand the funding needs of the Brazilian NHS to reduce inequalities in access to medicines through adopting a pharmaceutical service organization similar to that seen in many high-income countries with hiring/accrediting private pharmacies. METHODS: We performed an economic evaluation of a model to provide access to medicines within public funds based on a decision tree model with two alternative scenarios public pharmacies (NHS, state-owned facilities) versus private pharmacies (NHS, agreements). The analysis assumed the perspective of the NHS. We identified the types of resources consumed, the amount, and costs in both scenarios. We also performed a budget impact forecast to estimate the incremental funding required to reduce inequalities in access to essential medicines in Brazil. FINDINGS: The model without rebates for medicines estimated an incremental cost of US$3.1 billion in purchasing power parity (PPP) but with an increase in the average availability of medicines from 65% to 90% for citizens across the country irrespective of family income. This amount places the NHS in a very good position to negotiate extensive rebates without the need for external reference pricing for government purchases. Forecast scenarios above 35% rebates place the alternative of hiring private pharmacies as dominant. Higher rebate rates are feasible and may lead to savings of more than US$1.3 billion per year (30%). The impact of incremental funding is related to medicine access improvement of 25% in the second year when paying by dispensing fee. The estimate of the incremental budget in five years would be US$4.8 billion PPP. We have yet to explore the potential reduction in hospital and outpatient costs, as well as in lawsuits, with increased availability with the yearly expenses for these at US$9 billion and US$1.4 billion PPP respectively in 2017. INTERPRETATION: The results of the economic evaluation demonstrate potential savings for the NHS and society. Achieving UHC for medicines reduces household expenses with health costs, health litigation, outpatient care, hospitalization, and mortality. An optimal private sector-public sector collaboration model with private community pharmacy accreditation is economically dominant with a feasible medicine price negotiation. The results show the potential to improve access to medicines by 25% for all income classes. This is most beneficial to the poorest families, whose medicines account for 76% of their total health expenses, with potential savings of lives and public resources.

Tendências da balança de comércio exterior da indústria farmacêutica brasileira: evolução das importações e exportações de farmoquímicos e medicamentos na década de 1990

O objetivo deste trabalho é analisar a evolução e as tendências da balança de comércio exterior da indústria farmacêutica na década de 1990. O estudo foi elaborado tanto para produtos farmoquímicos quanto para medicamentos prontos. No primeiro caso, a análise também foi apresentada por classe e subclasse terapêutica, o que possibilitou identificar algumas variações significativas no comportamento da balança comercial desse setor. Pode-se perceber que operou na indústria farmacêutica um círculo vicioso que manteve uma pauta de importação de fármacos e medicamentos, que não são majoritariamente de última geração, com preços desproporcionalmente altos. Essa tendência de "reprimarização" da pauta de comércio exterior, em razão do baixo conteúdo tecnológico da grande maioria de fármacos e medicamentos importados, provocou um aumento ainda maior no crescente déficit percebido nesse setor na última década. Dessa forma, uma política industrial e de regulação na indústria farmacêutica se faz necessária para romper esse cenário negativo.

Estratégias empresariais de crescimento na indústria farmacêutica brasileira: investimentos, fusões e aquisições, 1988-2002 / Texto para Discussão (TD) 995: Estratégias empresariais de crescimento na indústria farmacêutica brasileira: investimentos, fusões e aquisições - 1988-2002

"Analisa as estratégias e o comportamento dos investimentos na indústria farmacêutica brasileira nos anos 1990, considerando separadamente a fabricação de farmoquímicos e de medicamentos. Analisa as estratégias e a dinâmica das reestruturações societárias - fusões e aquisições - na indústria farmacêutica doméstica, enfatizando a reorganização patrimonial das grandes empresas framacêuticas mundiais e suas implicações na estrutura industrial e na oferta doméstica de medicamentos no mesmo período."