WHO South-East Asia Journal of Public Health
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 Table of Contents  
Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 115-117

Follow-up data on patent expiry and atorvastatin price: experiences in Brunei Darussalam, Malaysia, the Philippines and Thailand

1 Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
2 Pharmaceutical Division, Health Regulation Team, Department of Health, Manila, the Philippines
3 Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
4 Pharmacy Practice and Development Division, Ministry of Health, Putrajaya, Malaysia

Date of Web Publication30-Aug-2019

Correspondence Address:
Anna Kemp-Casey
Sansom Institute for Health Research, University of South Australia, Adelaide
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DOI: 10.4103/2224-3151.264857

PMID: 31441448

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How to cite this article:
Kemp-Casey A, Ceria-Pereña J, Guerrero AM, Suchonwanich N, Salleh SM, Roughead EE. Follow-up data on patent expiry and atorvastatin price: experiences in Brunei Darussalam, Malaysia, the Philippines and Thailand. WHO South-East Asia J Public Health 2019;8:115-7

How to cite this URL:
Kemp-Casey A, Ceria-Pereña J, Guerrero AM, Suchonwanich N, Salleh SM, Roughead EE. Follow-up data on patent expiry and atorvastatin price: experiences in Brunei Darussalam, Malaysia, the Philippines and Thailand. WHO South-East Asia J Public Health [serial online] 2019 [cited 2022 Jan 19];8:115-7. Available from: http://www.who-seajph.org/text.asp?2019/8/2/115/264857

We wish to follow up on our paper “Pricing policies for generic medicines in Australia, New Zealand, the Republic of Korea and Singapore: patent expiry and influence on atorvastatin price”, published in the September 2018 edition of this journal.[1] This paper examined the price per defined daily dose (DDD) of atorvastatin supplied in four countries of the World Health Organization (WHO) Western Pacific Region (Australia, New Zealand, Republic of Korea and Singapore) in the years before and after atorvastatin’s patent expired in each country. It reported that atorvastatin prices, converted to international dollars, fell in all of these countries in the years after patent expiry; however, there was a large variation in prices throughout the study period. At the end of the study (2014/2015), New Zealand’s tendering system and use of preferred medicines had resulted in the lowest price per DDD for atorvastatin ($0.03). By contrast, mandatory price cuts as the sole measure in the Republic of Korea resulted in a price of $1.15 per DDD.

Since publication of that paper, data have been received from an additional four countries: Brunei Darussalam, Malaysia, the Philippines and Thailand. Atorvastatin’s patent expired in the Philippines in 2008; however, no pricing data were available for the years before that. Generic atorvastatin became available in Thailand in 2010. No patent was ever in place for atorvastatin in Brunei Darussalam, and no patent data were available for Malaysia. However, it was possible to compare the price per DDD of atorvastatin, converted to international dollars,[1] for the period 2006–2015 (see [Figure 1]).
Figure 1: Annual price of atorvastatin (international dollars) per defined daily dose supplied or sold in Brunei Darussalam, Malaysia, the Philippines and Thailand

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Pricing policies differ across the countries. In Brunei Darussalam, free pricing is used, and manufacturers are able to set their own prices.[2] Competitive tender procurement is used in Malaysia.[3] A variety of price regulations are employed in the Philippines and Thailand. In 2008 and 2009, the Government of the Philippines subjected five medicines (including atorvastatin) to mandatory price control (i.e. a maximum drug retail price, or MDRP), which cut the retail prices of those medicines by half. A voluntary drug price-reduction scheme was also introduced for 24 drugs from several manufacturers (i.e. a government-mediated access price, or GMAP). Both the MDRP and the GMAP are implemented across the market to control the retail prices of medicines sold to patients. The wholesale procurement prices of all essential medicines procured through government tenders and public hospitals is controlled through the Drug Price Reference Index.[4],[5] For government tenders, drug prices are negotiated when products are from a single source and/or patented. The prices of other medicines are currently negotiated between suppliers and manufacturers, although new price reviews are currently under way.[4] In the Thai public sector, price ceilings are in place and hospitals negotiate prices with manufacturers.[2],[6],[7] Since 2012, changes to the essential medicines list have encouraged greater competition between pharmaceutical companies and increased manufacture and import of generic medicines. The prices of private sector medicines are not regulated in Malaysia or Thailand.[2],[3]

At the end of the study period, the price per DDD for atorvastatin was $0.24 in Brunei Darussalam, $0.66 in Malaysia, $1.07 in the Philippines and $0.84 in Thailand. All have decreased substantially in price since data first became available: 95% in Brunei Darussalam, 80% in Malaysia, 68% in the Philippines and 79% in Thailand. While prices fell substantially in the four countries over the study period, there remained a wide price variation at the end of the study, with the Philippines paying a little over four times more than Brunei Darussalam in 2015.

It is not clear why recent atorvastatin prices were lower in Brunei Darussalam than in the other countries. It might be expected that Brunei Darussalam’s small population and free pricing policy would lead to higher prices, although the historical absence of an atorvastatin patent might be expected to have the opposite effect. One possible explanation for the low prices is the combination of public sector dominance and free pricing. The public sector in Brunei Darussalam pays for 90% of pharmaceutical expenditure, compared with only 15% in the Philippines.[2] Although manufacturers are free to set their own prices, there is likely to be strong price competition to supply the public sector.

When compared with the prices in the higher-income countries reported in the previous paper, the prices in the four countries reported here were also high (see [Table 1]). Prices were compared for 2014, which was the last year of comparable data for all countries. The price in the Philippines was 30-fold higher than in New Zealand, 3-fold higher than in Australia and 2-fold higher than in Singapore. Malaysia’s price was 20-fold higher than New Zealand’s, double that of Australia and 1.4-fold higher than Singapore’s price. The lower-income countries in this study are paying a higher price per DDD of atorvastatin than the higher-income countries, suggesting that there is still room for improvement in pricing policy in these countries.
Table 1: Price of atorvastatin per defined daily dose supplied, by country

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Ethics approval was not deemed necessary for this study.

Acknowledgements: We are grateful to Ms Wong Wai See from the Ministry of Health, Brunei Darussalam, for providing data and health system information.

Source of support: No funding was received for this study. Elizabeth Roughead is supported by a National Health and Medical Research Council Senior Principal Research Fellowship, AP1110139.

Conflict of interest: None declared.

Authorship: EER conceived the study. AK-C and EER drafted the manuscript, performed the statistical analysis and acquired and interpreted data. JC-P, AMG, NS and SMS assisted with acquisition and interpretation of data and critically reviewed the manuscript. All authors read and approved the final manuscript.

  References Top

Roughead EE, Kim DS, Ong B, Kemp-Casey A. Pricing policies for generic medicines in Australia, New Zealand, the Republic of Korea and Singapore: patent expiry and influence on atorvastatin price. WHO South-East Asia J Public Health. 2018;7(2):99–106. doi:10.4103/2224-3151.239421.  Back to cited text no. 1
How pharmaceutical systems are organized in Asia and the Pacific. Manila: World Health Organization Regional Office for the Western Pacific; 2018. doi:10.1787/9789264291706-en.  Back to cited text no. 2
Pharmaceutical Services Programme, Ministry of Health, Malaysia. Medicines prices monitoring in Malaysia: survey report. Putrajaya: Ministry of Health; 2017.  Back to cited text no. 3
Sarol JN. Effect of government mediated access pricing on prices of targeted drugs in the Philippines. Journal of Asian Scientific Research. 2014;4(9):473–89.  Back to cited text no. 4
Prescribing the maximum drug retail prices for selected drugs and medicines that address diseases that account for the leading causes of morbidity and mortality (Executive Order 821). Manila: Malacañang Records Office; 2009 (https://www.officialgazette.gov.ph/2009/07/27/executive-order-no-821-s-2009/, accessed 6 February 2019).  Back to cited text no. 5
Holloway KA. Thailand: drug policy and use of pharmaceuticals in health care delivery. Mission report 17–31 July 2012. New Delhi: World Health Organization Regional Office for South-East Asia; 2012 (http://www.searo.who.int/entity/medicines/thailand_situational_analysis.pdf, accessed 27 June 2019).  Back to cited text no. 6
Nguyen TA, Knight R, Roughead EE, Brooks G, Mant A. Policy options for pharmaceutical pricing and purchasing: issues for low- and middle-income countries. Health Policy Plan. 2015;30(2):267–80. doi:10.1093/heapol/czt105.  Back to cited text no. 7


  [Figure 1]

  [Table 1]


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