A win-win solution?: A critical analysis of tiered pricing to improve access to medicines in developing countries

Globalization and Health

Tido von Schoen-Angerer¹  Michelle Childs¹  Elodie Jambert¹  Suerie Moon² 

[1] Médecins Sans Frontières, Campaign for Access to Essential Medicines, Geneva, Switzerland;Harvard Kennedy School and School of Public Health, Boston, USA

关键词: Market segmentation;    Pharmaceuticals;    Drugs;    Low- and Middle-income countries (LMIC);    Developing Countries;    Access to Medicines;    Differential Pricing;    Tiered Pricing;    Essential Medicines;   

Others  :  819590
DOI  :  10.1186/1744-8603-7-39

 received in 2011-06-24, accepted in 2011-10-12,  发布年份 2011

【 摘 要 】

Background

Tiered pricing - the concept of selling drugs and vaccines in developing countries at prices systematically lower than in industrialized countries - has received widespread support from industry, policymakers, civil society, and academics as a way to improve access to medicines for the poor. We carried out case studies based on a review of international drug price developments for antiretrovirals, artemisinin combination therapies, drug-resistant tuberculosis medicines, liposomal amphotericin B (for visceral leishmaniasis), and pneumococcal vaccines.

Discussion

We found several critical shortcomings to tiered pricing: it is inferior to competition for achieving the lowest sustainable prices; it often involves arbitrary divisions between markets and/or countries, which can lead to very high prices for middle-income markets; and it leaves a disproportionate amount of decision-making power in the hands of sellers vis-à-vis consumers. In many developing countries, resources are often stretched so tight that affordability can only be approached by selling medicines at or near the cost of production. Policies that "de-link" the financing of R&D from the price of medicines merit further attention, since they can reward innovation while exploiting robust competition in production to generate the lowest sustainable prices. However, in special cases - such as when market volumes are very small or multi-source production capacity is lacking - tiered pricing may offer the only practical option to meet short-term needs for access to a product. In such cases, steps should be taken to ensure affordability and availability in the longer-term.

Summary

To ensure access to medicines for populations in need, alternate strategies should be explored that harness the power of competition, avoid arbitrary market segmentation, and/or recognize government responsibilities. Competition should generally be the default option for achieving affordability, as it has proven superior to tiered pricing for reliably achieving the lowest sustainable prices.

【 授权许可】

   
2011 Moon et al; licensee BioMed Central Ltd.

【 图 表 】

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