HOW MUCH DOES MEDICINE COST PEOPLE?

The devaluation of the manat has had a considerable effect on Azerbaijan's pharmaceutical market which relies almost completely on imports.

The Tariff Council was also forced to take into account the transition to a floating manat exchange rate in its decision of 25 December 2015. Abbas Aliyev, the head of the press service of the Ministry of Economy and Industry, has told Regionplus that the Tariff Council has reacted effectively to the situation taking shape and has approved a new list of medicines whose prices are regulated by the state.

"The Tariff Council has revised the prices of 3,540 designations of medicinal preparations, taking into account the new manat exchange rate. At the same time, the prices have been established on another 1,510 designations of medicines which are subject to state regulation for the first time.

The new prices of 3,661 designations of medical preparations came into force from 25 December 2015, but the prices of 1,389 designations are to come into force from 25 February 2016," the Ministry spokesman said.

Thus, according to A. Aliyev, in spite of the changes in the manat exchange rate since the beginning of the year, the prices of 21 per cent of the state-regulated designations of medicines, have more than halved compared with their previous cost, and the prices of nine per cent of the designations of medicines have gone down more than threefold. On the whole, the prices of 60 per cent of the designations of medicines have dropped, while the prices of 40 per cent of medicines have risen by 30 per cent, taking into account the change in the exchange rate.

"Since the prices of medicines had been considerably cut two- to three-fold and in some cases five- to ten-fold before the change in the manat exchange rate, even taking into account the revision relating to the new exchange rate, the prices of medicines are, even so, several times lower than they were before the state-regulated procedure regarding medicines started," A. Aliyev notes. So, the spokesman for the Ministry of the Economy and Industry asserts that the state has done everything it can to ensure that consumers of pharmaceutical products do not experience any significant difficulties in obtaining them.

The answer is to produce them locally

But medicines with state-regulated prices only account for half of the entire pharmaceutical market. The Tariff Council is pledging to complete the process of approving unified prices on medicines in the first half of 2016. For the moment, chemists' customers may have to cope with difficulties, not only making up for the cost of individual medicines owing to the recent 50-per-cent devaluation of the manat, but may even face a doubling in the price. Their indignation is understandable. For many of them are suffering from chronic diseases and buy medical preparations regularly. In a conversation with Regionplus, a member of staff from one of the local chemists recounted that the prices depend on the suppliers who have ramped them up owing to the dollar becoming more expensive. At the same time, the suppliers cannot be reproached since too many factors are having an impact on their price policy.

Experts see the answer to the situation taking shape in getting local production of pharmaceutical preparations going. Incidentally, Azerbaijan's Deputy Prime Minister Ali Ahmadov recently said that the state does have similar plans. Abbas Aliyev commented to Regionplus in this connection that talks are to be held with leading world pharmaceutical companies, in cooperation with which pharmaceutical enterprises are to be built here. "It is planned to construct a factory on the basis of the Sumqayit industrial chemical park," he said.

In his turn, deputy of Chairman of the Milli Maclis Healthcare Committee Musa Quliyev noted that the setting up of a factory like that would be extremely good for Azerbaijan: "Instead of paying money for imports of medicines, we could export them to other countries and earn an income from them. Besides that, we have numerous medicinal plants. In producing medicines from plants, we would also boost employment in the countryside and provide jobs gathering these plants, moreover."

Since it is planned to involve world famous companies in setting up pharmaceutical enterprises, it is quite likely that in the near future the citizens of Azerbaijan will have access to top-quality medical preparations at acceptable prices.

Medicines will come back

For the moment, the country's pharmaceutical market continues to be in turmoil. It is not only the issue of high prices, but also the disappearance of individual types of medical preparations from the chemists. According to Parviz Azizbayov, the head of the inspectorate for medical quality control from the Ministry of Health's analytical expertise centre, there is no need to be concerned for the observed shortage of imports of medicines into the country will soon be eliminated.

According to a pharmacist at one of the local chemists, the reason why the products have disappeared is because the new price is being determined and they will very soon return to the shelves.

Up until that time, customers are being offered analogous products. On the other hand, the system of doctors providing patients with prescription medicines had to be regulated. In October 2015, the Ministry of Health approved this, and from November new "rules for the provision of medicinal preparations by chemists" were introduced. This was done to avoid doctors prescribing expensive medicines, since the latter were working hand in hand with the pharmaceutical company and receiving commission for prescribing the company's medicines. Thus, according to the new rules the issuing of prescriptions is strictly controlled.

Now three prescription forms - a white one, a red one and a green one - are envisaged for medicinal preparations. Outpatients will not be given a prescription; they will have to get the preparations that are issued by the state-run medical establishment. When a patient is discharged from hospital, the doctor does not have the right to provide him with a prescription. The patient should receive recommendations regarding his or her recuperation at the polyclinic.

Medicines for outpatients and those at private medical centres should be prescribed on the white form. The green forms are used for prescribing preparations that can be obtained free. Only state medical institutions can prescribe them on the basis of the medical programmes currently in force. And on the red form, narcotic preparations usually used by oncologists and surgeons are to be prescribed. 

The main thing indicated in these rules is that from now on doctors will not be able to prescribe preparations on a brand basis, but must indicate the molecular composition right there in the prescription. This will give a person the opportunity to go the chemists, and, on the recommendation of the pharmacist, to choose a preparation himself that he can afford. As envisaged in the rules, the doctor does not even have the right to recommend one preparation of another to the patient.

Specialist in skin and venereal diseases Orxan Abdullayev comments: "This is undoubtedly a positive factor. People will be able to choose a preparation themselves, without being afraid that the doctor is prescribing an expensive medicine for them. I myself always write down the medicine's molecular composition for my patients. The only exception is with internationally patented names, for example, aspirin or No-spa, and also combination medical and cosmetological preparations, and compositions for which it is impossible to indicate the molecular composition."

As far as the disappearance of frequently used preparations from the counter is concerned, the doctor comments on this, drawing on his own experience: "A number of major well-known pharmaceutical companies have withdrawn from the market since it is of no advantage to them to supply preparations in keeping with newly adopted Tariff Council prices." Frequently used branded preparations, for which there is sometimes no relatively cheap analogue, have simply disappeared from the market.

About prices once again

As far as the prices established by the Tariff Council are concerned, as the specialist in pharmacology reported, the fact is that everything is regulated in keeping with the standard prices of substances in five countries. This means that the prices established by the Tariff Council may be called appropriately realistic. Taking into account the fact that a number of serious pharmaceutical companies have withdrawn from the market, it turns out that the over-the-top prices of preparations are not only linked to the striving to get rich quick, as it may appear, but to the large number of overhead expenses. On the other hand, the prices of medicines from major pharmaceutical companies are initially high because they are made up of the expenditure on many-year-long periods of developing and testing the preparation. In adopting the prices, the Tariff Council is guided first and foremost by the prices of the cheaper analogues in order to make the preparation more accessible.

As far as the price rise on a number of medicines is concerned, according to the pharmacist, it is impossible to cut the prices of all preparations since they will cease to be supplied and the chemists will be operating at a loss. Therefore the chemists retain the right to establish their own prices on different preparations. These are largely supplements, vitamins, syrups and enzymes. Moreover, besides the chemists themselves, the prices of medicines not indicated in the list, may be raised by the chemists' depot itself. 

Naturally there is always the possibility of not buying branded preparations and, inspired by the new rules, of choosing a more economical variant. But many doctors note that, if you do this, the effect of European preparations and their cheaper analogues (generic medicines) differs. At best, this may lead to a lessening of the medicine's impact, and at worse to the appearance of various side effects and allergic reactions. Alt-hough, according to Parviz Azizbayov, if the preparation has undergone state registration, this automatically indicates its quality, so it should not be thought that more expensive preparations have a better effect. 

 The difference in medicines

Moreover, the quality control relating to preparations imported into Azerbaijan is not of a sufficiently high level, which is pointed out by the country's minister of health, Oqtay Siraliyev. He says that there are certain shortcomings in the way the chemists operate and in the quality control regarding imported and marketed preparations, and this control needs to be stepped up. Evidence of this is the change that some pharmaceutical firms have made in the brand names of their preparations to protect themselves from fakes and a flood of complaints. So we are faced with another problem which is inevitable when prices are strictly regulated: the market is quite likely to bring in poor-quality products, fake medicines, and some companies may sell their products on the black market at excessive prices.

A number of "proprietary" chemists which import their products from abroad are not inclined to lower their prices. In spite of this, customers do not refuse to buy their products since they feel confident that the preparations are of good quality compared with other cheaper analogues. According to one of the customers, he is forced to acquire a preparation from a good chemist since the cheaper analogue caused him to have a serious allergic reaction.

The activity of the chemists themselves and the pharmacists working in them is worthy of separate mention. Parviz Azizbayov assures us that for three or four years now there has been a practice of certification and courses are being run to boost the qualifications of not only pharmaceutical chemists with higher education but also those of pharmacists with secondary special education. He says that serious work is being done in this direction, and every five years staff have to undergo a certification process.

At the same time, many customers are dissatisfied with the standard of pharmacists' knowledge in chemists. "They frequently do not know anything about a preparation, and can sometimes provide something which sounds similar but has a completely opposite effect," our respondent Sara Rzayeva complains indignantly, who was once the victim of the incompetence of a pharmacist who gave her the wrong medicine. And in the same way, how can one know whether the cheap medicine recommended by the pharmacist will cause side effects in the patient? Besides this, you should not forget the fact that State All-Union Standards are still not observed with regard to a number of cheap medicines produced in the countries of the former Soviet Union and substances banned by the World Health Organisation are used in their production.

"For example let's take acetylsalicylic acid produced in Russia for 60 kopecks and aspirin from the firm Bayer for 15 manats. What is the difference? First and foremost in the ingredients - not only the active substance, but also the extent of purification of the talc, starch, silicon dioxide and so forth which are in any tablets. Furthermore, the price of the German producer is higher owing to higher labour costs. But what is most important is its effect. Whereas the Russian preparation hardly lowers the temperature at all, the German one tackles the fever in literally a few minutes and gets rid of the headache. When was the last time you took an aspirin to combat a headache? But in the USA and Germany they do take them. Possibly it is a question of the outdated equipment or the difference in the state standards in the two countries. Therefore it is better to tell a patient that the molecular composition (the chemical formula) is indicated in the prescription, but the preparation which costs more is often of better quality," Orxan Abdullayev notes.

At any rate, the state is not only trying to regulate the prices of pharmaceutical products, but also to step up the control over imports of them, their quality and production. There is a hope that the system, "as in the chemist" will be organised once the local pharmaceutical factory has started production. Only when that is the case, will medicines appear on the Azerbaijani market at acceptable prices. Undoubtedly, when that is the case, the issue of quality should become more important than any other.