Pooled Procurement of Drugs in Low and Middle Income Countries Pierre Dubois, Yassine Lefouili, and Stéphane Straub Abstract We use data from seven low and middle income countries with diverse drug procurement systems to assess the effect of centralized procurement on drug prices and provide a theoretical mechanism that explains this effect. Our empirical analysis is based on exhaustive data on drug sales quantities and expenditures over several years for forty important molecules. We find that centralized procurement of drugs by the public sector allows much lower prices but that the induced price reduction is smaller when the supply side is more concentrated. Keywords: drugs, procurement, low and middle income countries Working Paper 508 April 2019 www.cgdev.org Pooled Procurement of Drugs in Low and Middle Income Countries Pierre Dubois Toulouse School of Economics
[email protected] Yassine Lefouili Toulouse School of Economics
[email protected] Stéphane Straub Toulouse School of Economics
[email protected] We gratefully acknowledge financial support from the Center for Global Development. We are particularly indebted to Mead Over for extensive and thoughtful comments. We also thank Michael Borowitz, Kalipso Chalkidou, Susan Nazzaro, and Rachel Silverman for their comments and Daniel Rosen for hisinitial help with the data. We also thank Christian Dale Abad, Celina Gacias, Beverly Lorraine Ho, Biljana Kozlovic, Martha de la Paz, and Tommy Wilkinson for helping us access information on centrallyprocured molecules in the Philippines, South Africa, and Serbia. The data were provided as part of anagreement with IMS Health (IQVIA). Note on figures: All figures copyright IMS AG and its affiliates.