Enhancing access to affordable medicine in small countries

One of the topics discussed during the Fourth High-level Meeting of Small Countries in Malta at the end of June 2017 was access to affordable medicine in small countries and how this could be enhanced.

The United Nations 2030 Agenda added impetus to addressing this issue, offering the opportunity of a sustained global and regional effort to ensure that everyone has access to the affordable, quality medical products they need to remain healthy and productive over the life-course. Target 8 of the Agenda’s Sustainable Development Goal 3 (ensure healthy lives and promote well-being for all at all ages) focuses on the pursuit of universal health coverage in all countries and stresses the importance of “access to safe, effective, quality and affordable essential medicines and vaccines for all”.

Discussion at the Malta meeting revealed that small countries face a number of problems in relation to increasing access to affordable medicines. For example, because companies decide single-handedly when and where to offer their products, costs are relatively high for the national medicines agencies, resulting in low profits. In addition, there is often a lack of transparency regarding pricing and reimbursement, and the generics’ monopoly of the market means that only one product per category attracts interest. Moreover, their limited markets leave small countries little power to negotiate, which can create problems in obtaining new (innovative) medicines and drugs required for rare diseases and in patients resorting to purchasing these over the Internet or in neighbouring countries. Finally, small countries are faced with a parallel market development, involving both high import prices and export problems.

In dealing with these issues, cooperation and trasparency seem to be the key. During the meeting, participants highlighted the importance of using platforms, such as the WHO Small Countries Initiative, to strengthen collaboration on procurement. This would increase pricing transparency, enhance the power of negotiation, contribute to the containment of costs, and lead to greater fairness in access to and the affordability of medicine. Strategic public procurement could contribute by ensuring a sustainable supply of new medicines.

At the Malta meeting, Iceland, Monaco and Montenegro shared their experiences related to the issue of access to affordable medicines.

Iceland has a new medicines policy and is in the midst of streamlining procedures for the purchase of new medicines. Although access to affordable medicines is the cornerstone of this policy, the country still faces the challenge of shortages.

A 50-year-old agreement between Monaco and France in the field of access to medicines has made the link between the two countries in this area very close. Collaboration with a country with a broader pharmaceutical market has enabled Monaco to deal with all the challenges a small country may encounter in relation to the supply and supervision of medicines. The agreement also provides for the sale, in Monaco, of medicines available in France. On the other hand, Monaco is obliged to accept the prices of medicines agreed to between France and the pharmaceutical company in question. Among other advantages of this collaboration is, for example, the possibility of the delivery by the French authorities of an innovative drug for the treatment of very serious or rare diseases, even though it is not yet available on the French market. In the case of medicine shortages, France has committed to supplying Monaco with the quantity required to meet the most urgent needs.

Montenegro shared information about measures the country has put in place to address the challenges of access to medicines, including new and potentially highly priced medicines. A centralized tender process was organized to procure medicines for hospitals and prescriptions covered by the compulsory health insurance. This measure was coupled with promoting the use of generics as a part of the solution to managing pharmacological expenditure and improving the continuity of access to and supply of medicines. As a result of these measures, the prices of pharmaceuticals were halved in the period 2005–2012.