New WHO/Europe report offers policy options to reduce out-of-pocket payments for medicines in Kyrgyzstan

Samvel Azatyan

A new WHO/Europe report examines the causes of high out-of-pocket payments for prescription drugs in Kyrgyzstan and presents ways to address the problem through policy reform.

WHO/Europe conducted a study of prescription drug costs in Kyrgyzstan between 2013 and 2015. During this time, co-payments for reimbursed medicines in outpatient care increased by 20% in the country. As the report observes, the absence of formal regulation of medicine prices has contributed to this increase. Despite the fact that Kyrgyzstan attempted to standardize prices in 2012, ex-factory, wholesale and retail prices remain unregulated, and there is limited information about or control over prices at the pharmacy level.

Additionally, the devaluation of the Kyrgyz currency has meant that the country has had to pay more for medicine imports, while the volume of imports has not changed. This situation was observed during the period of the study.

Based on these observations, the report proposes a number of recommendations to limit and bring down high out-of-pocket payments, including: regulating the price of medicines reimbursed by public health insurance; regulating retail sector margins; updating legislation on the criteria and processes for adding or removing medicines from the list of reimbursed medicines; and improving data collection on reimbursement prices. These policy options were discussed with national stakeholders in September 2016 during a policy forum on moving towards universal health coverage under the current national health care reform programme (called Den Sooluk).

The report also proposes assessing the efficiency of medicines procurement in the hospital sector as part of a comprehensive approach to pharmaceutical sector reform.

“In 2016, we reached an important milestone with the proposal of a package of regulations and complementary laws on medicines. Parliament will take steps to implement the package in 2017 and to help increase access to affordable and quality medicines,” said Minister of Health Dr Talantbek Batyraliev.

“Introducing price regulation is of the highest priority as it will help bring down out-of-pocket payments for medicines. Our ultimate goal is that publicly reimbursed medicines will be the same price throughout the country, in any retail pharmacy you enter,” said Ms Saltanat Moldoisaeva, Consultant at the WHO Country Office in Kyrgyzstan.

A key part of European and global health priorities

The report, entitled “Pharmaceutical pricing and reimbursement reform in Kyrgyzstan”, is part of WHO/Europe’s support to Member States, set out in its 2016–2017 biennial collaborative agreement with the Ministry of Health of Kyrgyzstan. WHO/Europe is assisting the country with developing and implementing strategies to contain the cost and optimize the use of medical products. For countries in transition, this means helping to establish and support regulation, pricing and reimbursement systems, and to address other relevant supply-related matters.

The topic of improving access to medicines in the WHO European Region is on the agenda for the 67th session of the WHO Regional Committee for Europe, to be held in September 2017 in Budapest, Hungary. It also links directly to the Sustainable Development Goals: target 3.8 is “access to safe, effective, quality and affordable essential medicines for all”.