ACKNOWLEDGEMENTS The Second Edition of the Drug Price Reference Index (DPRI) was made possible with the hard work, dedication and team effort of the National Center for Pharmaceutical Access and Management’s DPRI Team headed by Mr. Manuel Alexander Haasis, Project Manager/Consultant and Ms. Marinette J. Ladioray, Senior Health Program Officer, together with the team members namely: Mr. Achilles Aragona, Information System Researcher II, Mr. Julius Jocson, Health Program Officer I, Mr. John Irving Telingban, Supply Officer I and Mr. Jeffrey Castro, Health Program Researcher and all NCPAM staff for their support. We also acknowledge the guidance of the System Support Division Head, Ms. Vanessa Saulog-Obera and lastly to the unwavering support and supervision of Dr. Anna Melissa S. Guerrero, OIC- Program Manager, NCPAM, Dir. Lilibeth C. David, OIC- Health Policy Finance and Research Development Cluster, and Dr. Madeleine De Rosas-Valera, former Undersecretary of Health. 13 October 2014 Manila, Philippines 1 | P a g e Overview The high and extremely variable prices of medicines in the Philippines impact on access to effective, efficient and equitable health care. In 2009, a study conducted by Health Action International revealed that there was extreme variability in the procurement prices of essential medicines in the national and local public health facilities in the country. On average, originator brands and generic equivalents were procured almost 16 times and 3 times higher, respectively, compared to prices available on the international market. 1 DOH-Central Office Bids and Awards Committee (DOH-COBAC) and DOH hospitals were shown to have more efficient procurement prices compared to provincial and municipal health facilities, thus leading to variability in access to essential medicines across the Philippines. Republic Act (RA) 9502 or the Universally Accessible Cheaper and Quality Medicines Act of 2008 gave the DOH instruments to monitor and regulate the prices of drugs and medicines to protect consumers and the public procuring entities from excessive mark-ups applied to prices of medicines resulting from information asymmetry and the lack of effective market competition. To address these issues, the National Center for Pharmaceutical Access and Management (NCPAM) has established a Drug Price Reference Index (DPRI) for all essential medicines to guide all national and local government health facilities in the efficient sourcing of pharmaceutical products in the public sector. What is the Drug Price Reference Index (DPRI)? The DPRI lists the ceiling prices of essential medicines for government bidding and procurement set by the DOH for all DOH Retained Hospitals and Regional Health Offices (RHOs). Winning bid prices of essential medicines within the DPRI ceiling reflect efficient and effective procurement that facilitates consumer access to medicines and protection from excessive mark-ups of prices. The DPRI only reflects the acquisition costs including landed cost, packaging, drug content, quality assurance, manufacturing overheads and Food and Drug Administration (FDA) fees. The DPRI excludes other costs such as pharmacy services, preparation and storage fees and applicable taxes to medicines (i.e. VAT), and other reasonable pharmacy mark-ups, which are now being evaluated by the DOH. The DPRI aims to improve the efficiency and good governance in the pricing and procurement of medicines in the public sector through establishing a transparent and publicly available reference price for affordable and quality medicines. It also aims to guide the Philippine Health Insurance Corporation (PHIC) in setting reimbursement caps for medicines both for inpatient and outpatient services. Who should use the DPRI? All government entities should be guided by the DPRI when procuring medicines. It shall be applied to all forms of procurement such as public bidding, direct contracting, shopping, negotiated procurement, emergency procurement and consignment to ensure that the government achieves the best value for money in sourcing essential medicines. 1 Douglas B, Tisocki K (2009) Public Procurement Prices of Medicines in the Philippines. Health Action International. 2 | P a g e What are the sources of the Price Data? The DPRI is computed based on the prevailing public tender prices of the previous year reflected in the actual Purchase Orders (POs) submitted by the DOH Retained Hospitals, RHOs, Central Office Bids and Awards Committee (COBAC) and Philippine International Trading Corporation (PITC) Pharma Inc. (PPI) to the DOH. Only data coming from reputable suppliers are considered in the database which means that they should be licensed by the Philippine Food and Drug Administration (FDA) and have a certificate of Good Manufacturing Practice issued by the FDA. How is the Drug Price Reference (DPR) determined? The DPR is set at the Median or the 50th percentile across the range of prevailing tender prices of essential medicines. For medicines with less than three (3) suppliers, the DPR may be set at the lowest winning bid price from a reputable supplier. Projected inflationary costs have already been considered in the calculation of the DPR. For innovator drugs approved for inclusion in the Philippine National Formulary, the price may be set by referencing with relevant international markets particularly those with similar income status (i.e. Thailand, India). It may also be informed by economic evaluations conducted in the Philippines used by the DOH to value their claimed clinical benefits and negotiate tender prices where an innovative pharmaceutical p ro- duct has only one sole supplier. How often shall the DPRI be updated? The DPRI shall be updated annually. All DOH hospitals and RHOs are directed to submit a copy of their POs of the previous year to the NCPAM at or before the end of the first quarter of the succeeding year. The updated DPRI shall be based on the procurement price data of medicines from the previous year. 3 | P a g e Generic Name Dosage Strength/Form Lowest-Highest DPR Tender Price (Php) (Php) A 1 Acarbose 100 mg Tablet 13.11 - 17.54 13.11 2 Acarbose 50 mg Tablet 8.23 - 11.01 8.23 3 Acetazolamide 250 mg Tablet 19.00 - 33.00 19.00 4 Acetylcysteine 100 mg Sachet 7.90 - 16.80 11.75 5 Acetylcysteine 200 mg Sachet 6.49 - 15.56 11.05 6 Acetylcysteine 200mg/mL, 25mL Bottle 1,610.84 – 1,610.84 1,650.00 7 Acetylcysteine 100mg/5mL. 150mL Suspension 290.00 - 313.00 290.00 8 Acetylcysteine 600 mg Effervescent Tablet 19.80 - 53.00 32.94 9 Aciclovir 200 mg Tablet 2.45 - 22.83 4.74 10 Aciclovir 400 mg Tablet 5.25 - 139.24 22.85 11 Aciclovir 800mg Tablet 55.00 - 206.87 70.00 12 Aciclovir 25 mg/mL, 10 mL Vial 729.94 - 938.49 729.94 13 Albendazole 400 mg Chewable Tablet 0.84 0.84 14 Albumin, Human 20% 50mL Bottle 1650.00 - 2500.00 1,650.00 15 Albumin, Human 25% 50mL Bottle 1,938.00 – 2,450.00 2,800.00 16 Alfuzosin 10mg Tablet 27.50 - 59.49 28.75 17 Allopurinol 100 mg Tablet 0.45 - 4.95 0.70 18 Allopurinol 300 mg Tablet 0.61 - 7.90 1.70 19 Alprazolam 250 mcg Tablet 4.00 - 12.72 4.00 20 Alprazolam 500 mcg Tablet 5.00 - 18.33 5.00 21 Aluminum Hydroxide + 225 mg + 200 mg/5 mL, 120 mL 17.65 - 150.00 25.00 Magnesium Hydroxide Suspension 22 Aluminum Hydroxide + 225 mg + 200 mg/5 mL, 60 mL 11.95 - 35.00 18.90 Magnesium Hydroxide Suspension 23 Amikacin (as Sulfate) 100 mg Vial 28.12 - 49.81 28.12 24 Amikacin (as Sulfate) 100 mg/mL, 2mL vial 22.08 - 22.10 22.08 25 Amikacin (as Sulfate) 125mg/mL, 2mL Vial 18.10 - 94.50 25.90 26 Amikacin (as Sulfate) 250 mg Vial 19.05 - 42.10 19.05 27 Amikacin (as Sulfate) 250 mg/mL, 2 mL Vial 16.78 - 339.00 22.40 28 Amikacin (as Sulfate) 50mg/ml, 2ml Vial 17.45 - 194.00 23.74 29 Amino Acid Solutions for Hepatic 8%, 500mL Bottle 444.44 - 480.00 444.44 Failure 30 Amino Acids, Crystalline 10%, 500mL Bottle 450.00 - 770.00 450.00 Standard 31 Amino Acids, Crystalline 5%, 500mL Bottle 400.00 - 425.00 400.00 Standard 32 Amino Acids, Crystalline 6%, 100mL Bottle 362.00 - 480.00 362.00 Standard 33 Amino Acids, Crystalline 7%, 500mL Bottle 450.00 - 500.00 450.00 Standard 34 Amino Acids, Crystalline 8%, 500mL Bottle 412.00 - 1018.00 442.22 Standard 35 Aminophylline 25 mg/mL, 10 mL Ampule 14.35 - 55.00 24.13 4 | P a g e Generic Name Dosage Strength/Form Lowest-Highest DPR Tender Price (Php) (Php) 36 Amiodarone 50 mg/mL, 3 mL Ampule 137.77 - 450.00 210.14 37 Amiodarone 200 mg Tablet 6.50 - 80.45 21.45 38 Amlodipine 10mg Tablet 0.27 - 23.26 1.05 39 Amlodipine 5 mg Tablet 0.31 - 13.24 0.94 40 Amoxicillin 100mg/mL, 10mL Drops 11.98 - 48.50 16.20 41 Amoxicillin 100mg/mL, 15mL Drops 11.44 - 33.48 18.95 42 Amoxicillin 125mg/5mL, 60mL Suspension 11.90 - 43.00 14.75 43 Amoxicillin 250 mg/5 mL, 60 mL Suspension 13.65 - 70.00 18.50 44 Amoxicillin 250 mg Capsule 0.69 - 3.81 0.95 45 Amoxicillin 500 mg Capsule 1.08 - 6.90 1.22 46 Amphotericin B (Non-Lipid 50 mg Vial 3,150.00 – 3,150.00 Complex) 5,800.00 47 Ampicillin 1g Vial 6.87 - 169.00 9.00 48 Ampicillin 250 mg Vial 4.10 - 54.25 5.98 49 Ampicillin 500 mg Vial 2.94 - 106.00 5.75 50 Ampicillin + Sulbactam 1.5g Vial 45.00 - 583.56 285.00 51 Ampicillin + Sulbactam 250mg + 125mg Vial 78.00 - 153.09 94.25 52 Ampicillin + Sulbactam 500mg + 250 mg Vial 18.42 - 702.00 87.00 53 Anti-rabies Serum (equine) 200 IU/mL,5mL Vial 940.00 - 1300.00 1,050.00 54 Anti-tetanus Serum (ATS) 1500IU/mL, 1mL Ampule 15.80 - 160.00 27.41 (equine) 55 Ascorbic Acid (Vitamin C) 100 mg/ml, 15 mL Oral Drops 9.35 - 60.90 14.98 56 Ascorbic Acid (Vitamin C) 100 mg/ml, 60 mL Oral Drops 10.07 - 13.00 11.00 57 Ascorbic