Availability and Affordability of Essential Medicines for Children in Perlis
Creators: name: Ang, Wei Chern
name: Azni, Nurul Najihah
name: Fazwin Samsu Rahman
name: Mohd Shainol Azmar Kassim
Publisher: name: Zenodo
Year: 2020
Subjects: Availability
Affordability
Essential
Medicines
Children
Perlis

description: <strong>Introduction </strong>Access to essential children medications in developing countries is still low1-3 • Lack of price control may also lead to high medicine price in Malaysia. This study aimed to determine the availability and affordability of essential medicines for children in community pharmacies in Perlis, Malaysia. <strong>Methods </strong>A cross-sectional survey was conducted in September to November 2019 on all community pharmacies in Perlis. Availability was expressed as the percentage of paediatric essential medicines available over the 37 included in the data collection form. Median price ratio (MPR) was calculated using two methods: i. ratio of the median unit price to the Malaysian recommended retail price (RRP) 2019 as published in the Pharmaceutical Services Program website or ii. international pricing reference (IPR) as publish in the MSH International Medical Products Price Guide, 2015. MPR &gt; 2 indicates medicines sold at a high price. Affordability was calculated by the days’ wages of lowest-paid unskilled government worker required to purchase selected treatment courses. <strong>Results and Discussion </strong>Of 22 community pharmacies, 15 (68.2%) participated. The mean availability of innovator brand (IB) (31.4%) and generic (GB) (55.9%) paediatric essential medicines was low (&lt;70%) as shown in Table 1. Similar finding to a local study by Babar et al., 20072. Essential over-the-counter medicines (List C in the Poison’s Act) is widely available as compared to those in List A and B (prescription required). No dispensing separation in private practices in Malaysia. Innovator brands was less available compared to generic medicines. • Majority of physician from private sector tend to use innovator brands. Generics were sold at cheaper prices. Psychotropic drugs showed low availability such as Diazepam 5 mg and Phenobarbitone 30 mg due to stricter regulations. Loratadine tablet had the highest MPR per RRP of 15.8 for innovators; chlorpheniramine tablet had the highest MPR per IPR of 8.3 for generics. 30% essential medicines (8 out of 27) for both innovator (18.5%) and generic brands (13%) showed MPR &gt; 2 - sold at higher prices compared to RRP and IRP, no pricing regulation in Malaysia. MPRs per RRP were 0.8-15.8 and per IPR were 0.6-3.6 for innovators; MPRs per RRP:0.7-3.6 and per IPR:0.3- 8.3 for generics (Table 2). Syrup forms has lowest availability compared to other dosage forms. Asthma treatment was the most expensive (Table 3) at 0.31 day’s wage, followed by pain (0.28) and nappy rash (0.17). The three common diseases were considered affordable by most people in Perlis ( &lt; 1 daily wage). Most acute medicines for children were affordable according to a study done in a province in China. Affordability of essential medicines in private retail pharmacies are high and different from place to place (1.2 to 5.9 weekly salary). <strong>Conclusion </strong>Innovator medicines for paediatrics are less available than generics in community pharmacies in Perlis. Essential medicine costs higher than RRP and IPR, although still affordable for the three medical paediatric conditions. There is a need to develop paediatric medicine price control guidelines to reduce expenses for those with low and middle-income population.