Essential medicines for children not available in China

by Michael Woodhead
Essential paediatric medicines such as amoxicillin and salbutamol are often not available in Chinese hospitals or private sector pharmacies, and those that are stocked come with hefty markups, a survey from Shaanxi has found.
When researchers from Xi'an Jiaotong University surveyed a sample of pharmacies and hospital dispensaries to check the availability of 28 common paediatric medicines they found that less than 30% of the drugs on their list were available. The list included basic medicines such as antibiotics, analgesics, antihistamines and vitamins. Drugs that were not available included amoxycillin-clavulanic acid, ibuprofen, morphine and vitamin B6.
Writing in PLOS One, the researchers said this was a concern because when paediatric drugs are not available, doctors   may try adapt adult versions of the drug by using lower doses, which is dangerous. Or if the recommended drug is not available, doctors may substitute a less appropriate drug, they added.
They also found that the paediatric drugs that were available often had huge markup over and above the manufacturers selling price. Amxoycillin, for example, had a manufacturer's price of 6.20 yuan but was sold to the patient for 11 yuan,  a markup of 77%. Salbutamol had a manufacturer's list rice of 13 yuan but sold for 37 yuan to the public. The recommended treatment for chronic asthma,  beclomethasone, cost about 1.6 days’ wages, which made it unaffordable in the public sector hospitals especially as it is needed for ongoing treatment of a chronic condition.
Most of the high markups was due to  public hospital pharmacy profit margins.
The researchers concluded: "We recommend that relevant measures should be taken to enable children to obtain sufficient medicines and effective treatment at affordable prices. The government should adjust the prices of originator brands and lowest-priced generics and improve the efficiency of centralised medicine purchasing systems.
"We recommend urgently that the government should substantially improve public drug procurement and price management, making the procurement system more efficient and the pricing system more scientific, rational and transparent."

Manufacturers stop production of essential medicines after price controls

China's pharmaceutical manufacturers have stopped production of important essential medicines after price controls limited how much they could charge and profit from them, the government has conceded.
The National Health and Family Planning Commission has announced that it is now "working on a new mechanism to balance the economic interests of pharmaceuticals and the public demand for affordable and effective drugs," according to spokesman Mao Qun'an.
The move follows growing shortages of important but unprofitable drugs such as those for hyperthyroidism. In the China Daily, a report details how locally-produced anti-thyroid treatments such as methimazole (Tapazole) are no longer available for the 10 million people in China who have an overactive thyroid. Many hospitals can no longer access Chinese-made products and have to buy imported products instead.
The pricing for listed essential drugs such as Tapazole has been strictly controlled under a system introduced in 2009, but this has resulted in small profit margins for drug producers, and many of the 13 pharmaceutical companies producing the drug in China have ceased production.
Shortages of Tapazole have been noted in regional areas, but until now supply has not been a problem for major hospitals in big cities, many of which use imported drug.
The spokesman for the National Health and Family Planning Commission said: "Under a market economy, all stakeholders need to cooperate and negotiate a balance to prevent similar problems from happening again in a bid to secure the drug supply."

Chinese obsession with IV drips and antibiotics persists

China's National Essential Medicines Policy (NEMP) campaign has reduced the average cost of prescriptions but patients are still being prescribed too many antibiotics and given drugs by injection unnecessarily.
The findings come from a study of the impact of the National Essential Medicines Policy (NEMP) on the use of medicines in government-owned primary care institutions in Hubei province of China.
The study analysed 55 800 prescriptions from 18 primary care organizations who progressively implemented the NEMP from January 2009 to July 2011. After the campaign there was an immediate increased uptake of essential medicines of all drugs prescribed which ultimately neared 95%.
However, 68% of prescriptions included antibiotics, and there was no reduction in this overuse after the NEMP campaign. A high propotion (59%–66%) of prescription drugs were administered through parenteral routes and no reduction was found after the NEMP interventions.
Although the average number of medicines per prescription remained unchanged (nearly four), the average cost per prescription declined significantly after the NEMP interventions from ¥ 45 vs ¥ 27.
"The goals of the NEMP are partially achieved; we therefore recommend a strategic approach involving all stakeholders to comprehensively achieve all aspirations," say the authors of the study.
Read more: Health Policy and Planning