How to determine medicines benefits policy and program needs?

What are the objectives of medicines benefit policies and programs on the path toward UHC?

• Affordability and cost effectiveness• Equitable Access: means different things to different people: acceptability - patients/ consumer education & provider engagement, reliability availability = physical, geographic, equity, economic/ affordability, staff capacity and competence, access to appropriate/ high value services, meeting community needs and values, new approaches to address gaps and needs• Quality service provision and good systems to deliver services (Appropriate and

rational use of medicines)• Achieving clinical outcomes (should have minimum package of care)

What are the objectives of medicines benefit policies and programs on the path toward UHC?

• Systems (capable to implement now & strength over time)• Safety• Non traditional supply mechanisms• Idea of social solidarity• Needs good governance• Should have acceptable minimum package of care• Engage political support• Confidence in system and trust/ satisfaction with care – “meeting community needs”• Political objectives and timing• Managing public/ private interface• Private aligning with public• Know disease profile in country (country specific context)• Matching with national health strategy• Sustainability• Monitoring as a way of continuous improvement• Good systems to deliver healthcare services• Availability - procurement

How to set priorities for selection of medicines

• Traditional medicines/ complimentary & fund for ‘unusual’ needs - need to be aware of needs • Cost effective (pharmaco- economic approaches, including use in practice)• STGs, protocols• Organisational capacity to use and deliver• “Essential” medicines - high value and special needs• Budget impact• Risk sharing• OP/ IP balancing acts (IP considered catastrophic, private: greater IP benefit, hidden cost of

recurrent OP costs, prevention of NCDs)• Epidemiological profile – disease patterns• Medicines that reduce other healthcare costs• “Health balance sheet” of investment – longer term prevention• Allowing innivators• Appropriate incentives – goals• Manage stakeholder expectations• Local industry capabilities

Unintended Impacts

• “Abuse” – managing clinical and financial, outsourcing to private sector, investigations• Market forces change• Loss of clinical goals – treat to payments• Waste of resources• Focus on activities with incentives• Providers/ manufacturers lose interest (not subsidised)• Collusion to take advantage - monitoring essential• Political interference - “promises”/ media pressure• Risk sub-standard products (low price)• Poor buy- in by providers and patients• Limited choice• Increased access - risk AMR/ poor RUM• Loss of overall goals - poor alignment