Strategic purchasing in the medicines to Hepatitis C in Colombia: equity and health financing innovations
Creators: name: Rivillas, Juan Carlos
name: Moreno-Mattar, Ornella
name: Castro, Hector Eduardo
name: Perez, Angela Viviana
name: Merchan, Lizbeth Acuña
name: Ramirez, Carlos Mario
name: Uribe, Alejandro Gaviria
Publisher: name: F1000 Research Limited
Year: 2018

description: The high cost is one of the main limitations of new drugs for the treatment of hepatitis C virus (HCV). As key immediate response, World Health Organization has already included direct-acting antivirals in domestic essential medicines lists for globally, and fast-tracking domestic drug approvals to facilitate government-level price negotiations with originator and generic pharmaceutical companies (1-2). Urgent action by a broad range of stakeholders is needed to facilitate access to HCV treatment in order to ensure that the millions of people living with this disease may effectively access to life-saving treatments.<br> <br>The strategic purchasing function has so far received relatively little attention in terms of reflection and action in many low- and middle-income countries. Too often, purchasing of medicines is done in passive and non-strategic way. This can constitute a major obstacle in progressing towards Universal Health Coverage (UHC).<br><br>In Colombia, estimates of prevalence of HCV in overall population are limited. However, the Center for Disease Analysis estimated a prevalence of active infections between 0.66%, which would correspond around 325.000 people.<br><br>The response is still at an early phase in most countries. At the same time, some countries have taken groundbreaking actions to combat the epidemic, with results that bring encouragement everywhere. In particular, Colombia that recently expressed its alarm about major public health challenge and the economic burden of HCV, which requires an urgent response. In May 2017, under the leadership of the PAHO and the Colombian Ministry of Health and Social Protection (MoHSP), the country put in place the first strategic purchasing in medicines to treatment of HCV.<br><br>The acquisition of 1220 medicines (750 Harvoni, 250 Daklinza and 250  Sovaldi) certainly will contribute on the road to elimination of viral hepatitis by 2030, improve diagnosis and number of persons completely. At the same time, with the significant reductions in prices of the medicines (until 80% in some cases), it will be possible to improve access to the treatment to more diagnosed HCV people with the same resources.<br><br>Based on this preliminary strategic purchasing, Colombia is looking to impact health system performance at three levels: i) to improve health equity, ii) to promote technical efficiency and distribution of resources, and iii) to ensure sustainable financing, which ones are required to enable universal health coverage, the overarching framework for health in the 2030 Agenda for Sustainable Development. This certainly, will allow a better understanding barriers and opportunities to strategic purchasing in support UHC at country-level.<br><br>Yet, the success of these strategic purchasing on the road to elimination by 2030 will require a comprehensive public health approach over time. First, MoHSP, health care providers, health insurers and patients as well, will play a pivotal role eliminating barriers in the access to treatments and ensuring highly adherence to treatment.<br><br>Second, we need innovative thinking more than ever to integrated people-centered health care. This means, ensuring treatments are tailored to people’s needs. Third, essential new diagnostics to essential treatments are necessary. In few words, to increase access to treatment with quality and efficiency. And finally, new cure and vaccines need to be developed, tested and delivered urgently to transform the hepatitis response and attain the elimination targets.